How does vitiligo develop?
Vitiligo occurs at all ages, but you are never born with it. The disease usually manifests itself between the ages of ten and thirty. But there are also children aged three and people over eighty who get vitiligo. Vitiligo is familial. Approximately 30% of vitiligo patients have someone in the family with vitiligo. There are also relatively many other autoimmune diseases in the family, such as thyroid disease, diabetes, psoriasis, vitamin B12 deficiency, rheumatism, alopecia areata, lichen planus and asthma.
Vitiligo is an autoimmune disease
The exact cause of vitiligo is unknown. The most plausible theory is that vitiligo is an autoimmune disease. Scientific research shows this theory to be the most likely. The immune system of patients with an autoimmune disease targets certain body cells. While our immune system normally only destroys foreign cells. You could say that the body is attacking itself. There are different types of autoimmune diseases, such as: rheumatism, thyroid disease, diabetes and psoriasis.
Triggering factors
You are born with a predisposition to vitiligo. However, it is believed that some factors can trigger vitiligo. Consider, for example, serious emotional tensions, stress, sunburn, serious illnesses, operations, pregnancy and skin damage (wounds).
Vitiligo can be divided into two main types:
Segmental vitiligo
Segmental vitiligo is based on a defect in the construction of the skin during the embryonic phase, which attacks pigment cells in one specific skin area.
About 20 % of people with vitiligo have the segmental variant, which manifests itself in one area, on one side of the body.
The white spots spread rapidly in a relatively short time. After a few years the situation stabilizes and depigmentation no longer occurs. The rest of the body will not be affected.
Non-segmental vitiligo (vulgaris)
About 80% of people with vitiligo are affected by the non-segmental variant, also known as vitiligo vulgaris: an overactive immune system attacks their own pigment cells. This is therefore an autoimmune disease. The white spots spread over the entire body. Often more or less mirrored.
Different manifestations of non-segmental vitiligo
Vitiligo universalis
Patients with this form of vitiligo have hardly any (less than 10%) pigmented skin.

Acral vitiligo
This form of vitiligo occurs on the extremities of the body and on the arms and legs. Particularly on the fingers and toes.

Acrofacial vitiligo
Patients with this form of vitiligo have spots on the extremities of the body, on the arms and legs and on the face (around the eyes and mouth).

Mixed type vitiligo
Mixed form of vitiligo, which occurs rarely. In this case you have both segmental and non-segmental vitiligo. Both forms will behave differently. And because the cause is different, they may also be treated differently.
Explanation Prof. Dr. Marcel Bekkenk, head of dermatology department, Amsterdam UMC
The characteristic white spots of vitiligo were known long before our era. We know more about the causes, although not all questions have been answered yet.