Healthy Living

What is Vitiligo?

What is Vitiligo?

Key Takeaways

  • Vitiligo is a long-term skin condition.
  • Vitiligo causes the depigmentation of the skin.

Vitiligo is a long-term skin condition in which depigmentation results in white patches on different parts of the body. Some people may have white patches in many areas at the same time. Hair grown on the affected areas may also be decolorized. This skin condition is more common in people with dark skin. Depigmentation starts with a small area of white patches that gradually spreads to the neighboring areas. A complete cure for this condition is not available. However, there are different treatment options available to try to contain the spread of white patches, while some other methods try to bring back the color to the depigmented areas.

Vitiligo is caused by the destruction of pigment-producing cells called melanocytes. Many theories have been put forward to explain the development of this condition. Some report that vitiligo is developed due to sunburn or emotional distress. But none of the theories are proved as the real cause of the condition. Those with a family history of vitiligo are found to have an increased risk of developing it later in life. Autoimmune disorders are also thought to enhance the risk of developing this skin condition.

The most common symptom of vitiligo is the presence of milky white patches in different parts of the body.

Melanocytes produce melanin which causes skin color. A person with vitiligo loses pigment in patches. The normal pigmented skin is replaced by white patches and irregular borders. Usually it affects the area that is exposed to sun such as hands, face, arms and feet. Gentile may also be affected. Vitiligo is painless and not contagious and is not a dangerous medical condition.

Types of vitiligo

There are of two types: non segmental and segmental vitiligo

Non segmental vitiligo- up to 90% of people get this type of vitilgo. It is very common.  Patches appear equally on both the sides of the body in non-segmental vitiligo. Areas exposed to the sun such as face, neck and hands may develop symmetrical patches although other areas may also develop white patches such as arms, eyes, back, knees, feet, elbow, feet and mouth.

Non segmental vitiligo is further divided into sub categories:

  • Generalized vitiligo- it is the common type. No specific area or patch size.
  • Acrofacial vitiligo- it appears in the fingers and toes
  • Mucosal vitiligo- the pigment loss appears around the mucous membrane and lips
  • Focal vitiligo- in discrete areas one or few scattered white patches appear. Very common in young children
  • Universal vitiligo- most of the body gets depigmented. It is a very rare type.

Segmental vitiligo- it spreads rapidly and quickly but is more constant and stable then the other type. This type is not very common and generally only about 10% of people have this type. It usually affects skin areas which are attached to nerve which arises in the dorsal root of the spine. It is non symmetrical. This type responds well to topical treatment and it is more stable.

 Some of the less common symptoms of this condition include:

  • Premature greying of hair, eyelashes, and eyebrows
  • Loss of color in the membrane lining of mouth
  • Loss of color in the retina of the eye

The symptoms are usually visible in the areas that are exposed to the sun, including the legs, face, hands, and lips. Vitiligo can develop between the ages of 10-years-old and 30-years-old.

The symptoms are seen in particular patterns including:

  • Symmetrically spreading to different parts of the body, called generalized vitiligo
  • Pigmentation loss in one side of the body, which usually starts at a young age, called segmental vitiligo
  • Focal vitiligo that has symptoms limited to few regions in the body

The most common type of vitiligo is generalized pattern. Depigmentation in any of the above patterns may appear on the face, arms, legs, underarms, legs, hands, feet, lips, groin.

Return of pigmentation in areas where it is lost once is very rare. Treatment for this condition may not be needed as such. Appearance of the skin can be improved by using camouflage cream and sunscreen.

Vitiligo

Causes of vitiligo

Because the skin has lost melanin it doesn’t have its characteristic color. We don’t know why exactly the melanocytes are destroyed. Vitiligo has been noticed more in dark-skinned people. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the exact cause of vitiligo is unknown. The researchers think it could be an autoimmune response in which the body destroys its own melanocytes hence the pigment is lost.

Vitiligo is caused by the destruction of pigment-producing cells called melanocytes. Many theories have been put forward to explain the development of this condition. Some report that vitiligo is developed due to sunburn or emotional distress. But none of the theories are proved as the real cause of the condition. Those with a family history of vitiligo are found to have an increased risk of developing it later in life. It has been found that in almost 30% of people suffering from vitiligo has a family history with the same condition. Autoimmune disorders are also thought to enhance the risk of developing this skin condition. Links between vitilgo and other autoimmune diseases such as alopecia areata, Addison’s disease, hyperthyroidism pernicious anemia exists.

Other causes may be:

  • Genetic oxidative stress imbalance
  • A stressful event
  • Exposure to some chemicals
  • Neural cause
  • A viral cause

Almost 2% of the population has this condition. In America estimated 2 to 5 million have this condition irrespective of the gender. Majority of the cases develops early in life and show up by the age of 40. A person is more likely to get it if someone in the family has it already. A person might also get it when people in the family get gray hair prematurely.

Diagnosis

Doctor will do a physical exam by looking at the skin and make a diagnosis. Doctor will review the medical history of the patient. The doctor will take a sample of the skin to test the sample for vitiligo. A skin biopsy will confirm the diagnosis Family history of the patient is to be taken into consideration along with sunburns or blisters. It has been found by researchers that sun damage may trigger this condition. Overactive thyroid and vitamin B12 deficiency has been found to be associated with vitiligo hence the doctor might ask you to perform the blood test to check the label of vitamin B12 and thyroid function. This condition cannot be cured or prevented but the skin appearance can be improved with the help of cosmetics and corticosteroid creams.

The most common symptom of vitiligo is the presence of milky white patches in different parts of the body.

Depigmentation occurs on several skin areas. White patches may stay for sometime later they become bigger. Cycles of pigment loss and stability may occur. Commonly body folds that have been injured in the past, around moles, or around body openings areas exposed to sun, eyelids, hair can be affected by vitiligo.

Some of the common therapies suggested for vitiligo include:

  • Corticosteroid therapy – Topical corticosteroid is supposed to help in the return of the pigmentation when started early. But this therapy may have few side effects like formation of streaks on skin and thinning of skin in one area. It is an effective way of repigmentation of the white patches. It can be used for children and adults. These steroids must be applied daily on the skin for three months.
  • Immunomodulators – This method is found to be effective in treating depigmentation in a small area of the skin. This therapy has fewer side effects when compared to others. Immunomodulators are ointments. They contain tacrolimus or pimecrolimus an active ingredient. Usually if the pigment loss occurs on a small area of face and neck then immunomodulators give the best results.
  • Photochemotherapy – This therapy is suitable if the patches account to less than 20% of the body. A thin coating of chemical is applied half an hour before exposure to the UVA light. Psoralen-this medicine needs to be taken often, in order to make the skin sensitive to the light treatment. Psolaren is available in oral and topical form. Psoralen in combination with UVA rays known as PUVA treatment darkens the light areas of the skin. This treatment can be taken several times per week in the doctor’s clinic. Protect the rest of the body with sunscreen since your body is sensitive to psoralen.
  • Depigmenattion- this option can be used only when more than half of the body shows vitiligo. If repigmentation fails, then rest of the body can be depigmented by this treatment option. The aim is to match the normal skin to the affected skin. In order to lighten the pigmented areas a medication called monobezone is applied to the skin. After application of this medication avoid skin-to –skin contact for two hours.
  • Non invasive management- this includes make up and sunless tanners.  Some white patches can be camouflaged using cosmetics colored creams and make up. These can last 12-18 hours on the face. Most of them are waterproof.

Surgery options

Skin grafting- this should be done in severe cases. Surgery is done to restore normal skin tone. Surgery includes skin grafting. In this the affected area is grafted with a healthy skin. This is done for those people whose vitiligo has not improved for several years despite consistent treatment. The surgery causes scarring and is expensive.

Blister grafting- with the help of suction, doctor creates blisters on the pigmented skin. The top of the blisters is then removed and transplanted to an area of discolored skin. Risks include; failure to recolor the area, scarring, cobblestone appearance and skin damage.

Tattooing- pigment is implanted into the skin. It is effective in people with darker complexion. However, it is difficult to match the skin color

Future treatment

These include:

  • Drug to stimulate melanocytes- the drug afamelanotide is implanted under the skin. It will promote the growth of melanocytes.
  • Drug that controls melanocytes- to restore skin color in people with vitiligo that is not spreading prostaglandin E2 is being tested. It is used as a gel.
  • Drug that reverses color loss- tofacitinib has shown some potential as a treatment of vitiligo. It is the same drug typically used for rheumatoid arthritis.

Complications

People with vitiligo are susceptible to:

  • Social or psychological distress
  • Eye problems such as inflammation of the iris
  • Hearing loss
  • Sunburn and skin cancer
  • Autoimmune diseases such as thyroid problems, Addison’s disease
  • Hashimotos thyroiditis
  • Type 1 diabetes or pernicious anemia

In the affected area there is increased risk of sunburn, hearing loss and inflammation of the iris which can cause eye problems.

In some cases, the person may go into depression since vitiligo is noticeable so the embarrassment may set in, which can have led to self esteem problems.