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 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 the white patches, while 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 develops due to sunburn or emotional distress. But none of the theories are proven to be 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 on 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 areas that are exposed to the sun, such as the hands, face, arms, and feet. Vitiligo is painless and not contagious, nor is it a dangerous medical condition.
Types of Vitiligo
There are two types of vitiligo: non-segmental and segmental.
Non-segmental vitiligo: Up to 90% of people get this type of vitiligo; it is very common. Patches appear equally on both sides of the body in non-segmental vitiligo. Areas exposed to the sun, such as the face, neck, and hands, may develop symmetrical patches, although other areas may also develop white patches, such as the arms, eyes, back, knees, feet, elbows, and mouth. Non-segmental vitiligo is further divided into sub categories:
- Generalized vitiligo: This is the common type. It has no specific area or patch size.
- Acrofacial vitiligo: This appears on the fingers and toes.
- Mucosal vitiligo: Pigment loss appears around the mucous membrane and lips.
- Focal vitiligo: One or a few scattered white patches appear in discrete areas. This type is very common in young children.
- Universal vitiligo: Most of the body becomes depigmented. This is a very rare type.
- Segmental vitiligo: This spreads rapidly and quickly, but is more constant and stable than the other type. This type is not very common and generally only about 10% of people have it. It usually affects skin areas attached to nerves that arise in the dorsal root of the spine. It is non-symmetrical. This type responds well to topical treatment and is more stable.
Some of the less common symptoms of the condition include:
- Premature graying of the hair, eyelashes, and eyebrows
- Loss of color in the membrane lining of the 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 and 30 years old.
The symptoms appear in particular patterns, including:
- Symmetrically spreading to different parts of the body, called generalized vitiligo
- Pigmentation loss on one side of the body, which usually starts at a young age, called segmental vitiligo
- Focal vitiligo that has symptoms limited to a few regions of the body
The most common type of vitiligo is a generalized pattern. Depigmentation in any of the above patterns may appear on the face, arms, legs, underarms, hands, feet, lips, or groin.
Return of pigmentation in areas where it is lost is very rare. Treatment for this condition may not be needed as such. The appearance of the skin can be improved by using camouflage cream and sunscreen.
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. 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 develops due to sunburn or emotional distress. But none of the theories are proven to be the real cause of the condition. Those with a family history of vitiligo have an increased risk of developing it later in life; it has been observed that almost 30% of people suffering from vitiligo have a family history of it. Autoimmune disorders are also thought to up the risk of developing this skin condition. Links between vitiligo and other autoimmune diseases, such as alopecia areata, Addison’s disease, hyperthyroidism, and pernicious anemia, have been noted.
Other causes may be:
- Genetic oxidative stress imbalance
- A stressful event
- Exposure to some chemicals
- A neural cause
- A viral cause
Almost 2% of the population has vitiligo. In America, an estimated two to five million have it, irrespective of gender. A majority of cases develop early in life, showing up by age 40. A person is more likely to get vitiligo if someone in their family has it already or if people in the family get gray hair prematurely.
The doctor will perform a physical exam by looking at the skin and review the patient’s medical history before making a diagnosis. The doctor will take a sample of the skin to test for vitiligo. A skin biopsy will confirm the diagnosis. Family history of the patient is also taken into consideration, along with any sunburns and/or blisters. It has been observed by researchers that sun damage may trigger this condition. An overactive thyroid and vitamin B12 deficiency have been found to be associated with vitiligo, hence, the doctor may ask you to undergo a blood test to check the status of vitamin B12 and thyroid function. This condition cannot be cured or prevented, but 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 on different parts of the body.
Depigmentation occurs on several skin areas. White patches may stay for some time, then later become bigger. Cycles of pigment loss and stability may occur. Commonly, body folds that have been injured in the past, around moles or body areas exposed to sun, the eyelids, and hair are affected by vitiligo.
Some of the common therapies suggested for vitiligo include:
- Corticosteroid therapy: Topical corticosteroids help return pigmentation when started early. However, this therapy may have some side effects like streaks forming on the skin and thinning of the skin in one area. It is an effective way to regain pigmentation on 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 skin. This therapy has fewer side effects compared to others. Immunomodulators are ointments. They contain tacrolimus or pimecrolimus as an active ingredient. Usually, if the pigment loss occurs on a small area of the face and neck, immunomodulators offer the best results.
- Photochemotherapy: This therapy is suitable if the patches cover less than 20% of the body. A thin coating of a chemical called psoralen is applied half an hour before exposure to UVA light. Psoralen is a medicine that needs to be taken often in order to make the skin sensitive to the light treatment. It is available in oral and topical forms. Psoralen in combination with UVA rays, known as PUVA treatment, darkens the light areas of the skin. This treatment can be done several times per week in a 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, the rest of the body can be depigmented with 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 monobenzone 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, and most are waterproof.
- Skin grafting: This should be done only in severe cases. Surgery is done to restore normal skin tone and includes skin grafting. In this procedure, the affected area is grafted with healthy skin. This is done for 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, a doctor creates blisters on the pigmented skin. The tops of the blisters are 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 a darker complexion. However, it is difficult to match skin color.
Future treatments include:
- Drug to stimulate melanocytes: The drug afamelanotide is implanted under the skin to 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 for vitiligo. It is the same drug typically used for rheumatoid arthritis.
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 and Addison’s disease
- Hashimoto’s thyroiditis
- Type 1 diabetes
- Pernicious anemia
In the affected area, there is an increased risk of sunburn, hearing loss, and inflammation of the iris, which can cause eye problems.
In some cases, a person may go into a depression since vitiligo is noticeable, so the embarrassment may set in, which can lead to self-esteem problems.