Last Updated on 4th October 2022 by Caroline Haye
Similarities and differences between vitiligo and piebaldism
We see animals with patches of white on their skin, fur or feathers all the time. We probably think those markings are striking and beautiful. Either that, or we take them so much for granted that we don’t think about them at all. After all, we know that magpies and pandas are meant to be black and white. Humans, on the other hand, are usually one uniform colour. So, when we see white patches on a person’s skin or hair a common reaction is surprise. Unless, of course, we are already aware of the pigmentary conditions that can cause them. Two of these conditions look so alike that one is sometimes mistaken for the other. So in this article I am going to answer the question, is piebaldism the same as vitiligo?
Since you are reading a vitiligo blog, I shall assume you know something about vitiligo. (If not, you might want to take a quick look at the page What is Vitiligo?) So, for now, I will take it as read that you know vitiligo is a pigmentary disorder that causes white patches of skin and, sometimes, loss of hair colour too. But what is piebaldism?
Piebaldism
Like me, you may already be familiar with the word in an equine context. I remember, as a child, admiring photographs of piebald and skewbald horses in my numerous horsey books. But I didn’t know that people could be piebald too. The word piebald, in case you wondered, is derived from “pie” (as in magpie) and “bald” (meaning marked with white, as in the bald eagle).
Piebaldism is a hereditary phenomenon that is common in animals, partly due to the genetic consequences of selective breeding, but rare in humans. It is the result of a genetic mutation which affects the migration of melanocytes (pigment producing cells) during the unborn baby’s early development in the womb. This results in an absence of pigment in certain areas of the skin and hair… Typically, a central, triangular portion of the scalp and forehead, creating a white forelock and a lack of skin colour that can extend down to include the eyebrows. Often, the trunk and limbs also have de-pigmented patches, usually mirrored symmetrically on both sides of the body.
On a pale skin, the absence of pigment may not be very apparent unless the individual gets a sun tan. But the contrast is more conspicuous on deeper complexions. And the appearance of a piebald forelock is obvious on all but the lightest blond heads. But, whilst it is easy enough to cover this by dying the hair, some people, understandably, choose to show it off as an attractive fashion statement.
Leaving aside the distinctive shape and location of de-pigmentation on the head in piebaldism, the white patches look so exactly like vitiligo that it can be hard to tell the difference. So, it’s not surprising that people sometimes confuse the two pigmentary conditions.
To help clarify what they have in common and what distinguishes one from the other, I have compiled a list of the main similarities and differences below. (I always try to ensure the information I give is completely accurate. So, please feel free to contact me if you find any errors that need correcting.)
Similarities between vitiligo and piebaldism
- There are genetic causes in both cases.
- Both conditions can be inherited.
- Irregular patches of white skin (a.k.a. leukoderma or leucism) are the most obvious symptom.
- Not only skin, but hair too, can lose its colour.
- Patches are often symmetrical on both sides of the body.
- Both vitiligo and piebaldism are difficult to treat.
Differences between piebaldism and vitiligo
- Piebaldism is present at birth, whereas vitiligo is not.
- The genetics of the two conditions are completely different. A mutation in the c-kit gene is responsible for piebaldism, whereas over 30 different genes (but primarily NLRP1 and PTPN22) may contribute to vitiligo.
- Piebaldism is autosomal dominant (meaning it only requires the abnormal gene to pass from one parent). The genetics of vitiligo, on the other hand, are much more complex and many sufferers have no known family members with any history of it.
- The melanocytes in piebaldsm are completely absent in the de-pigmented patches, whereas they are present in vitiligo lesions (just not working properly).
- Vitiligo is usually progressive… It spreads and can come and go. Piebaldism, by contrast is nearly always unchanging.
- Vitiligo is an autoimmune condition, which piebaldism is not.
- The two disorders tend to have completely different comorbidities (i.e. conditions that occur together, often interacting with each other). For example, Waardenburg syndrome and hearing loss sometimes accompany piebaldism, whereas vitiligo is more often associated with thyroid disease, among other autoimmune conditions.
Why does it matter that these two pigmentary conditions are not the same?
It is important to know the difference because knowledge is power. An accurate diagnosis as to which condition you have affects what you can expect to happen in the future. And that will influence what you may, or may not, decide to do about it. It can indicate whether or not treatment is appropriate and what options are available. Not just that, but your diagnosis may impact you differently psychologically too.
Many people feel that vitiligo warrants medical treatment. In fact, the majority of patients are keen for a cure. There are already various treatment options for vitiligo and a lot of research is currently going into developing more. Psychological support for vitiligo sufferers may also be more appropriate because of the changing, progressive nature of the disorder. And there are many organisations and support groups that reflect this need.
Piebaldism, on the other hand, has not generated the same level of medical or media interest. The general lack of awareness may be because there is little demand for it. Since it is not progressive and not really a disease, most people may not view piebaldism as something that needs fixing. In reality, it is more like having a birthmark than an active skin disorder. So, treatment may not be considered relevant and, in any case, options are limited and rather extreme (a combination of dermabrasion and skin grafting).
Added to which, from a psychological perspective, stories like Rebecca Heckard’s early experiences of bullying seem, thankfully, to be rare. In fact, my search for support groups for people with piebaldism only led me to the British Skewbald and Piebald Association, which is for horse enthusiasts and owners! (There is a good public group for people with the condition on Facebook though on this link: https://www.facebook.com/groups/108658871043/ )
Final thoughts
Researching this topic has been a fascinating exercise. It genuinely came as a surprise to me that two skin conditions could look so alike yet, in reality, be so different. And yet it strikes me that the differences are probably more relevant in a scientific and medical context than they are to the individuals themselves who have these white patches on their skin. To them, a lot of their real life experiences and decisions are very similar. The knowledge that you have a visible difference… Coping with this in your own mind… Dealing with the scrutiny and curiosity of others… And deciding whether or not to camouflage or treat your white skin and hair, whether to show it off proudly, or simply forget about it. These are typically the daily concerns that people have in common, whether their de-pigmentation is due to vitiligo or to piebaldism.
Foot note:
During the preparation of this post, I tried to find out if both vitiligo and piebaldism ever occur together. I came across this article, which appears to suggest it can happen but is extremely rare.
