Why Is My Vitiligo Getting Worse?
What may seem like a progression of vitiligo may be your skin’s reaction to certain triggers. Learning what they are can help you prevent flares.
If a new vitiligo patch seems to pop up out of nowhere or an existing one suddenly appears bigger, it may seem like your vitiligo is getting worse. But, it could mean something in your environment is causing the changes you’re seeing, rather than a natural progression of the disease.
That’s not necessarily a bad thing. If you discover something as simple as, say, a new moisturizer causing your vitiligo to flare up, you can switch to a different one and, in the process, take charge of the health and appearance of your skin.
For 80 percent of people with vitiligo, the disease is inherited, according to a review published in February 2021 in the Journal of Investigative Dermatology. “Multiple genes have been linked to vitiligo, particularly some related to immune function,” according to Shoshana Marmon, MD, PhD, a clinical assistant professor of dermatology at New York Medical College in New York City.
Exposure to certain things in the environment can trigger vitiligo flares in people with or without a genetic predisposition to the disease. “Vitiligo is one of the few diseases where we know there are environmental triggers,” says John Harris, MD, PhD, founding director of the Vitiligo Clinic and Research Center and chair of the department of dermatology at the University of Massachusetts Chan Medical School, in Worcester.
In his own research, for example, Dr. Harris has found that women who start coloring their hair before age 30 or use hair dye for more than five years at any age have a 50 percent higher risk of developing what is known as chemical vitiligo — a form of the disease that does not have a genetic component.
Monobenzone, once used to make rubber gloves, is another known chemical vitiligo trigger. Ironically, it became the linchpin of one of the earliest vitiligo treatments, known as depigmentation, in which unaffected skin adjacent to white patches is lightened to make the difference in color less stark.
Not everyone with vitiligo is susceptible to the same triggers, but there are several common ones.
Cuts, burns, and even the friction that occurs when skin rubs against skin have been found to set off vitiligo flares. This is due to a reaction called the Koebner phenomenon, which also occurs in other skin conditions, such as psoriasis and lichen planus.
To minimize your risk of an injury that might trigger a vitiligo flare, Dr. Marmon recommends handling your skin with a hefty dose of TLC. Don’t scrub too hard in the tub or shower; try not to scratch itchy areas; and, if you scrape an elbow or cut yourself while shaving, tend to these minor wounds right away to prevent infection and help them heal.
According to a review published in May 2023 in Phytomedicine Plus, the lack of melanin in skin affected by vitiligo makes it especially sensitive to sunburn and the inflammation that comes with it. Doctors advise people with vitiligo to steer clear of ultraviolet rays as much as possible and take the same precautions everyone should out in the sun: Wear sunscreen with an SPF of at least 30 and cover as much skin as possible with a hat, sunglasses, and clothing.
Certain components of hair dye, bleaching agents, and skin-care products can set off a vitiligo flare. Marmon advises choosing products labeled hypoallergenic that are free of harsh chemicals, fragrances, and irritants. Test any new product you want to try on a small area of unaffected skin before using it on large swaths.
Psychological factors, such as stress, low self-esteem, anxiety, and depression — which, research shows, affects as many as half of people living with vitiligo — can play a role in how often vitiligo flares occur and how severe they are.
If you find this is the case for you, make stress management and relaxation techniques part of your daily routine. Yoga, meditation, and deep breathing exercises are proven ways to help counter anxiety and promote calmness, according to the National Center for Complementary and Integrative Health. For more intensive mental health support, tell your doctor what’s going on and consider seeing a therapist.
Fluctuations in hormones, such as during puberty, pregnancy, and menopause, have been associated with triggering vitiligo flare-ups. A review published in October 2021 in the Annals of Medicine & Surgery (London) found that for approximately 18 percent of pregnant women and 28 percent of new moms, their vitiligo got worse.
In the case of women still in the postpartum period, researchers believe the stress of childbirth may also play a role in vitiligo outbreaks. No matter what brings on new or larger vitiligo patches, chances are it’s something that can be identified and avoided.
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