Q. I have vitiligo, with whitish areas of skin on my face and hands. I've used make-up to darken the spots on my face, but it rubs off too easily.

Is there anything else I can use?

A. You have several options to choose from. What's best for you depends on how much of your skin is affected and how noticeable the light areas are. Obviously, vitiligo is more noticeable in people with dark skin than those with light skin.

Vitiligo is a condition in which various areas of the skin lack pigment, the substance that gives color to the skin. Without any pigment, the skin is a very light, pinkish white. Vitiligo is different from albinism, in which the skin has pigment-producing cells that simply don't work.

Doctors don't know what causes vitiligo, although it may be a problem of your immune system not working properly. People with vitiligo have a higher risk of some other immune system diseases, such as certain types of thyroid problems, malfunction of the adrenal gland and pernicious anemia. Vitiligo can also run in some families.

The light spots of vitiligo tend to appear on the face, hands, groin and over bony points of the body. When cuts and bruises heal, they sometimes lose skin color in the area of injury.

If you have just a few small areas of vitiligo, no treatment may be needed, especially if you're fair skinned. For larger areas or spots on the face, you have several options:

Reversible bleaching. You can use a bleaching agent to blur the margins between normal colored skin and the vitiligo spots so they don't stand out so much. These are the same type of creams used to make dark spots fade, such as Eldoquin, Eldopaque and Esoterica.

Irreversible bleaching. People with extensive areas of vitiligo may wish to remove all pigment in a certain area, particularly if there are more areas affected by vitiligo than there is normal skin. Dermatologists use a medicine called Benoquin to do this.

Sun block. If you're light-skinned, you may be able to make the vitiligo less noticeable by using sun-block lotions to prevent your normal skin from tanning. As your normal skin fades, it blends more with the areas of vitiligo.

Phototherapy. You can increase the color in areas of vitiligo by using a combination of natural or artificial sunlight and a medicine that boosts the skin's tanning response. This treatment is sometimes known as PUVA therapy, which stands for the combination of Psoralen (the medicine used) and Ultraviolet-A light.

For quarter-size areas of vitiligo, you might be able to use a psoralen cream. For larger areas, you'll need to take psoralen pills. You can get the ultraviolet light exposure from sunlight or from special lights dermatologists use to mimic sunlight. It takes from 100 to 300 treatments over one to two years for full effect.

Phototherapy has risks similar to getting too much sunlight, such as an increased risk of skin cancer. Researchers are currently investigating new phototherapy agents, such as one known as khellin, that they hope will work just as well as psoralen with fewer side effects.

Make-up. If you'd prefer to use make-up, I'd suggest trying Covermark or Dermablend. Some dermatologists also recommend using Dy-o-Derm or Vitadye, two skin-coloring agents that also contain an artificial tanning compound.

Jay Siwek, a family physician from Georgetown University, practices at the Fort Lincoln Family Medicine Center and Providence Hospital in Northeast Washington. Consultation is a health education column and is not a substitute for medical advice from your physician.

Send questions to Consultation, Health Section, The Washington Post, 1150 15th St. NW, Washington, D.C. 20071. Questions cannot be answered individually.