Vitiligo is a condition where the immune system destroys the cells that give skin its color, leaving smooth white patches. It is not painful, not contagious and not caused by anything you did, and treatment can bring color back to many patches if it is given long enough. Tinea versicolor is a common, harmless rash caused by a yeast that already lives on everyone's skin. It leaves flat, finely scaly patches on the chest, back and shoulders that are lighter, darker or pinker than the skin around them. Treatment clears it quickly, the color takes months to even out, and it often returns in warm weather.
The same eight facts on every condition comparison.
It causes loss of pigment.
Defined white patches form when melanocytes are lost or stop working.
It is often autoimmune.
Nonsegmental vitiligo commonly involves autoimmune mechanisms.
Hair can turn white.
White hairs may grow within a patch.
Its impact is real.
The emotional effect can be significant regardless of how much skin is involved.
It is a surface yeast condition.
Also called pityriasis versicolor, it affects only the outer skin layer.
It changes skin color.
Small patches can merge across the upper chest, back, neck or upper arms.
Fine scale is a clue.
Surface scale helps distinguish active disease from other pigment changes.
Color returns more slowly.
Pigment can take longer to even out after the yeast has been treated.
Non-segmental vitiligo Patches on both sides; most common.
Segmental vitiligo One side or one area only.
Focal vitiligo A few patches in one area.
Universal vitiligo Generated illustration. Most of the body.
Hypopigmented tinea versicolor Lighter patches; most common.
Hyperpigmented tinea versicolor Darker or pinkish patches.
Immune activity contributes to the loss of pigment-producing cells in affected skin. With less melanin, pale patches become visible while the skin's texture usually remains normal.
Malassezia yeast overgrows in the outer skin and disturbs the usual pigment balance. Affected areas develop fine scale and may look lighter or darker than surrounding skin.
Vitiligo. Can begin at any age, commonly before early adulthood.
Tinea Versicolor. Most common in adolescents and young adults, especially in warm humid climates.
Vitiligo is an autoimmune condition. The immune system attacks the pigment cells in patches of skin, leaving them white.
Tinea versicolor is an overgrowth of Malassezia, a yeast that normally lives on the skin. The yeast interferes with pigment, leaving lighter or darker patches.
About 1 in 5 people with vitiligo have a relative with it.
It tends to run in families.
Evidence labels come from each condition’s own treatment list.
Ginkgo biloba and polypodium leucotomos extract are the two most often asked about. Small studies suggest they may slow spread a little or add slightly to light therapy, but the trials are small and the results are inconsistent. They are not a treatment on their own, and no supplement has been shown to bring color back.
Cover creams made for skin conditions, and self-tanning lotions containing dihydroxyacetone, color the surface of a white patch for a few days at a time. They change nothing underneath and they do not interfere with treatment. For many people they make daily life easier during the year or more that repigmentation takes.
The usual first choice, used as a body wash rather than on the hair. Lather it over the chest, back and shoulders, leave it on for about five minutes so it has contact time, then rinse, daily for one to two weeks. Contact time matters more than strength here — the 1% is on the shelf and the 2% is on prescription, and people who rinse straight off usually conclude it did not work.
The cream works well on a small number of patches, applied twice a day for a couple of weeks, but covering a whole back with it is impractical and expensive. The tablets are the odd exception in this condition. They clear athlete's foot and ringworm and do nothing at all here, because this is a yeast rather than the fungi those tablets are built for.
Sold for evening out patchy skin, and the wrong tool here, because the problem is a patch that is too light rather than skin that is too dark. They do not speed the pigment up. Creams bought without a prescription are also a common source of undisclosed strong steroids, which thin the skin over time. The patches recover on their own once the yeast is controlled.
Just as effective as ketoconazole for this and usually cheaper, spread over the affected area, left on for five to ten minutes and washed off. It has a noticeable sulfur smell that lingers, and it can discolor fabric and light hair, so old clothes and a thorough rinse are worth planning for.
A gentler wash, better suited to keeping this away than to clearing a flare. It is the one most people find easy enough to keep using twice a month right through the summer, which is the part that actually prevents the next episode. On a widespread flare it is slower than ketoconazole or selenium sulfide.
A JAK inhibitor cream approved specifically to restore pigment in vitiligo, applied twice a day. In trials about a third of people had most of the color back on the face by six months, and results keep improving past a year. It is slow, it is expensive, and color can be lost again if it is stopped, so it is usually continued about twice a week afterwards.
The usual choice for vitiligo on the face, eyelids, neck and skin folds, because it quiets the immune attack without thinning the skin, so it can be used in those places for months. It stings or feels warm for the first week or two in some people. It works best on the face and much less well on hands and feet.
Clobetasol Propionate. A strong steroid cream, the standard first treatment for a small number of patches on the body. It is used in courses with breaks, often a few weeks on and a few weeks off, because continuous use thins the skin and leaves stretch marks. It is not used on the face or eyelids, where tacrolimus is chosen instead.
A gentler relative of tacrolimus, used on the same delicate areas and often preferred for children or for people who find tacrolimus too stinging. It works the same way on the immune attack. It is generally a little less effective than tacrolimus for vitiligo.
A vitamin D cream sometimes added to a steroid or to light therapy, on the idea that it helps pigment cells return. On its own it does very little for vitiligo. Its value is as a partner treatment, and the evidence for even that is mixed.
Monobenzone cream removes the pigment that is left, so the skin ends up one even color. It is only considered when vitiligo already covers most of the body and repigmenting is not realistic. The change is permanent and cannot be reversed, and the skin afterwards has no protection from the sun at all, so it is a decision taken slowly and never as a first step.
Ciclopirox, econazole or ketoconazole 2% cream, applied to the patches for two to four weeks. They are a reasonable choice when only a small area is involved, or when a medicated wash has irritated the skin. Across a whole back they are expensive and hard to apply properly, which is the point at which tablets are the sensible option.
Tablets in the same family as ruxolitinib cream. Trials show real repigmentation, particularly when they are combined with light therapy, and they are the most active area of vitiligo research right now. They are not yet standard treatment for vitiligo, and they carry more risk than a cream, so they are used through a specialist or a trial.
Prednisone in short pulses. Low-dose steroid tablets taken on two days a week for a few months are used for one purpose in vitiligo: to stop pigment loss that is spreading quickly. It is a brake, not a way to bring color back, so it is paired with a cream or light therapy. Blood sugar, blood pressure and mood are watched while it is running.
The usual tablet when the area is too large to treat by hand or topical treatment has genuinely failed, given as a short course of a few days. It clears the yeast quickly and does nothing to speed up the color, which still takes months. It interacts with a long list of other medicines, so the prescriber needs your full list.
The other short-course tablet, sometimes given as a single dose repeated a week later. It works about as well as itraconazole for a widespread rash. Neither tablet stops it coming back, so the monthly wash is still the plan afterwards. If you are pregnant or breastfeeding, ask the doctor managing your pregnancy before taking either.
Narrowband UVB, two or three sessions a week in a cabinet at the clinic, is the mainstay for vitiligo that covers more than a few small patches. It calms the immune attack and coaxes pigment cells out of the hair openings. Expect three to six months before the face shows change and a year or more for a full course, and better results when it is combined with a cream.
The same wavelength as narrowband UVB delivered through a handpiece, so it treats one patch and leaves the skin around it alone. It suits a small number of patches, especially on the face, and it is the practical option for children who cannot stand still in a cabinet. Sessions are usually twice a week, and it is not used for widespread vitiligo.
Pigment cells are taken from normal skin and moved into a white patch, either as tiny grafts or as a cell suspension. It is the best option for segmental vitiligo and for patches that have been completely stable for a year or more, including patches where the hair has gone white. It is never done while vitiligo is spreading, because the graft is attacked in turn.
Vitiligo is unpredictable, which is one of the hardest things about it. Non-segmental vitiligo, the common type, moves in waves — an active spell, a long still period, then another. Segmental vitiligo spreads within one area on one side over roughly six months to two years, then stops for good.
Tinea versicolor is harmless, and treatment runs in two stages. The infection stops within a week or two; the color takes months longer. Patchy skin is not the same as infected skin.
Sunburn inside the patches
Skin inside a vitiligo patch has no melanin at all, so it burns quickly and can burn badly while the skin around it is fine. A burn is also an injury, and injuries can bring out new patches, so a bad burn can make things worse in two ways at once. Daily broad-spectrum sunscreen on exposed patches prevents it, and it counts as treatment rather than an extra.
Thyroid and other autoimmune disease
The same immune tendency that causes vitiligo makes other autoimmune conditions more likely, and thyroid disease is the common one. It is often silent for a long time, which is why a thyroid blood test is standard at the first visit and is sometimes repeated later. Type 1 diabetes, pernicious anemia and alopecia areata also appear more often than average.
The weight of being looked at
Vitiligo does not make you unwell, but it is visible, and being looked at all day is tiring. Anxiety, low mood and avoiding ordinary things are common, and they are worse where the contrast is greater or the patches are on the face and hands. This counts as a medical reason to treat, not a cosmetic one, and it is worth saying out loud at the appointment.
It persists and slowly spreads
Patches merge and cover more of the trunk over months. In temperate climates it often eases in winter and returns each summer.
The active infection stops fast
Within one to two weeks of a proper course the scaling stops and the patches stop expanding. The condition is treated at that point, even though the skin does not look normal.
Recurrence is the norm rather than the exception
A large share of people get it again, particularly in hot climates and in people who sweat heavily. The yeast is permanent, so treatment reduces it rather than removing it, and maintenance — a medicated wash once or twice a month in warm months — keeps most people clear.
Seek assessment of new white patches or spreading pigment loss. Discuss associated symptoms, sun protection and whether targeted autoimmune screening is appropriate.
Seek assessment if the diagnosis is uncertain or treatment fails. Color may take months to normalize after the yeast has been treated.
Often, at least partly. Face, neck and trunk repigment well for a substantial proportion of people. Hands, fingers, feet and lips do poorly, and patches where the hair has gone white usually do not refill, because the pigment cells that restock a patch live in the hair openings. Nobody can promise a result, which is why photographs at the start are worth taking.
Longer than almost anyone expects. The first visible change on the face usually takes about three to six months, and a full course often runs a year or more. Judging a treatment at week six is judging it before it has done anything.
Not to your body. It does not shorten life, damage organs or turn into anything else. Two points matter: depigmented skin burns easily, and autoimmune conditions such as thyroid disease are more common alongside it, which is why blood tests are usually done.
Most likely not. Vitiligo moves in waves, and losing pigment over almost the entire body is uncommon. Nothing predicts the course from the first patch, which is why active spread is treated promptly.
Higher than average, but still low. Vitiligo runs in families through a group of immune genes rather than one, so most children of a parent with vitiligo never develop it.
No — the underlying immune tendency is genetic. But major stress, illness or surgery frequently lines up with the start of an active spell. Managing stress is worth doing for its own sake, and it is not a substitute for treatment.
No. The yeast already lives on essentially everyone's skin. You cannot give it to a partner, a child or a housemate. Whether someone develops the rash depends on their own skin oil, the climate and their own susceptibility.
Because the color and the infection run on different timelines. Treatment stops the yeast within a week or two; the pigment takes months. Scratch a patch lightly — if fine scale lifts it is still active, and if the skin is smooth and simply a different color, the treatment worked.
Most likely, particularly in a hot, humid climate or if you sweat heavily. That is normal behavior, not treatment failure, because the yeast is a permanent resident. A medicated wash once or twice a month through the warm months prevents most recurrences and is far less work than treating a full flare.
No, and it makes it more obvious. The patches cannot tan, so the surrounding skin darkens and the gap widens. Sunscreen while the pigment recovers works better, along with time.
No. Athlete's foot comes from dermatophytes, picked up from the environment. This comes from Malassezia, a yeast that lives on everyone. That is why terbinafine tablets clear athlete's foot but do nothing for this, even though terbinafine cream helps.
Not usually — topical treatment clears most cases. Ask about tablets when a large area of the trunk is involved and applying a wash properly is impractical, when it keeps coming back, or when topical treatment has genuinely failed. They clear it faster but do not speed up the color or prevent recurrence, so you still need a maintenance plan.
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