Vitiligo: Causes, Treatment and Common Myths in India

Vitiligo is an autoimmune condition in which the body’s immune system destroys melanocytes, the cells that give skin its colour, leaving smooth, milky white patches. It is not contagious, it is not leprosy, and it is not caused by eating fish with milk, and with treatment many people regain colour, particularly on the face and neck.

In India, vitiligo (often called safed daag or leucoderma) carries a heavy social burden. People face questions about marriage, worry that they caused it with food, and are sometimes kept away from shared meals. Indian studies have documented how deeply this stigma affects mood and quality of life. Understanding the facts is the first step to fighting it.

What causes vitiligo?

Vitiligo is mainly autoimmune. Immune cells attack the pigment cells in certain areas of skin, and the skin there loses colour. Several factors contribute:

• Genes. Many people, roughly one in five to one in three in published series, have a family member with vitiligo or another autoimmune condition.
• Autoimmune links. Vitiligo is more common in people with autoimmune thyroid disease, type 1 diabetes, alopecia areata and some other conditions.
• Oxidative stress in pigment cells, which may make them more vulnerable to immune attack.
• Triggers that some people notice, such as a sunburn, a cut or friction (called the Koebner phenomenon), severe stress, or contact with certain chemicals.

Which vitiligo myths should I stop believing?

Myths cause more suffering than the patches themselves. Here are the most common ones we hear in clinic:

Myth	The facts
Eating fish with milk causes vitiligo	No food or food combination has been shown to cause vitiligo
Sour foods, curd, citrus or vitamin C make it spread	There is no good evidence for this. A balanced diet is fine
Vitiligo is contagious	It cannot spread through touch, food or sharing utensils
It is a form of leprosy	Leprosy is a bacterial infection. Vitiligo is autoimmune
It is a punishment or caused by impurity	It is a medical condition linked to genes and immunity
It always spreads to the whole body	Many people have stable, limited patches for years
Nothing can be done	Many people regain colour with treatment, though results vary

Strict diets that cut out milk, fruit, curd, tomatoes or fish often leave people, especially children, missing protein, calcium and vitamins, without any benefit to the skin.

What are the types of vitiligo?

• Non-segmental vitiligo: the most common type. Patches appear on both sides of the body, often on the hands, fingertips, face around the eyes and mouth, feet, knees, elbows and genitals. It can spread over time.
• Segmental vitiligo: patches on one side or one area of the body. It usually starts earlier in life, spreads for a year or two, then stabilises.
• Mucosal vitiligo: affecting the lips or genital lining.
• Leukotrichia: white hair within a patch, including eyebrows or eyelashes, which can make repigmentation harder.

What else can cause white or light patches?

Not every light patch is vitiligo, which is why an examination matters.

• Pityriasis versicolor, a common yeast infection in humid weather, giving fine scaly light or dark patches on the chest and back.
• Pityriasis alba, pale dry patches on children’s cheeks, linked to eczema and dryness.
• Post-inflammatory hypopigmentation after eczema, burns or other rashes.
• Idiopathic guttate hypomelanosis, small white spots on sun exposed shins and arms in adults.
• Leprosy, with patches that may have reduced sensation, needing urgent medical attention.
• Light patches from overuse of steroid creams. See our article on topical steroid misuse.

Your dermatologist may use a Wood’s lamp, a special ultraviolet light under which vitiligo patches glow bright white, to confirm the diagnosis and check how widespread it is.

How is vitiligo treated?

The goals are to stop spread, restore colour where possible, and protect the skin. Treatment works slowly, over months, and the face and neck usually respond better than the hands and feet. Your dermatologist may consider:

Prescription creams

• Topical corticosteroids, used in a carefully planned way for limited periods to reduce immune activity in the patches.
• Topical calcineurin inhibitors (such as tacrolimus), useful on the face, eyelids and folds where steroids are best avoided.
• Topical JAK inhibitor creams, a newer option approved for vitiligo in some countries.

These are prescription medicines. Please do not buy steroid creams over the counter to self treat white patches, as wrong strength or long use can thin and damage the skin.

Phototherapy

Narrowband UVB phototherapy is one of the most widely used treatments for widespread vitiligo. It is given two or three times a week in a clinic, or sometimes with a supervised home unit. Targeted phototherapy or excimer light can treat small patches. Visible improvement usually takes several months.

Oral medicines

For actively spreading vitiligo, your dermatologist may consider short courses of oral medicines that calm the immune system, chosen carefully and monitored for side effects.

Surgical options

For stable vitiligo (no new or enlarging patches for a period, often at least a year), procedures such as punch grafting, suction blister grafting, or melanocyte transfer can bring colour back to patches that have not responded to medical treatment. These are particularly useful in segmental vitiligo and on lips or fingertips.

Cosmetic camouflage

Waterproof camouflage creams and self tanning products can cover patches when you want them to. They are safe, temporary, and help many people feel more confident during treatment.

Will my children get vitiligo?

Having a parent with vitiligo increases the chance somewhat, but most children of parents with vitiligo never develop it. It is not passed on in a simple, predictable way, and it does not affect fertility or pregnancy. This matters in India, where fear of inheritance often comes up during marriage discussions. A dermatologist can explain your family’s individual situation calmly and factually.

Do I need sunscreen with vitiligo?

Yes. Patches without pigment burn easily, and sunburn can trigger new patches. Use a broad spectrum sunscreen on exposed patches, wear protective clothing, and avoid peak midday sun. Our sunscreen guide for India explains how to choose one.

How can I cope with stigma and stress?

• Get the facts and share them. Many family members change their attitude once they learn vitiligo is not contagious or caused by food.
• Support children early. Speak to teachers if a child is teased. Encourage normal meals and activities.
• Talk about marriage concerns openly. Vitiligo does not affect fertility or the health of a partner.
• Seek counselling if you feel anxious, withdrawn or low. Emotional health is part of vitiligo care.
• Connect with others through vitiligo support groups, online or in your city.

When to see a dermatologist

See a dermatologist if:

• You notice a new white or light patch, to confirm the diagnosis.
• Patches are spreading quickly or new ones keep appearing.
• White patches appear on the lips, eyelids, genitals or around a cut.
• A light patch has reduced sensation, which needs to be checked for other conditions.
• A child develops white patches.
• Vitiligo is affecting your confidence, relationships or mental health.

Starting treatment while vitiligo is active gives the best chance of controlling spread. Dr. Maria offers online consultations where she can review your patches, explain your options clearly, and plan follow up.