Vitiligo (vit-ih-LIE-go) is a disease that causes the loss of skin color in blotches. The extent and rate of color loss from vitiligo is unpredictable. It can affect the skin on any part of your body. It may also affect hair, the inside of the mouth and even the eyes.
Normally, the color of hair, skin and eyes is determined by melanin. Vitiligo occurs when the cells that produce melanin die or stop functioning.
Vitiligo affects people of all skin types, but it may be more noticeable in people with darker skin. The condition is not life-threatening or contagious. It can be stressful or make you feel bad about yourself. Treatment for vitiligo may improve the appearance of the affected skin but does not cure the disease.
Surprisingly, the causes of vitiligo are yet to be precisely established, but most of the research so far points to the following:
- An autoimmune disorder – the patient’s immune system becomes overactive, and destroys the melanocytes
- Genetic oxidative stress imbalance
- A stressful event
- Harm to the skin due to a critical sunburn or cut
- Exposure to certain chemicals
- A neural cause
- A viral cause
Vitiligo is not transmittable; people cannot catch it from each other.
Less than 1% of the population is affected by the appearance of Vitiligo in their skin, meaning, it is not too common. It has no age, sex or ethnic discrimination, but studies have concluded that a larger percentage of the cases has been detected starting the age of 20.
Vitiligo signs and symptoms varies considerably from person-to-person. It is by far more perceptible in people with dark or tanned skinned. Some people may only acquire a handful of white dots which develops no further, while others develop larger white patches that join together affecting larger areas of the skin.
Vitiligo is a multifactorial polygenic disorder with a complex pathogenesis. It is related to both genetic and nongenetic factors. Although several theories have been proposed about the pathogenesis of vitiligo, the precise cause remains unknown. Generally agreed upon principles are an absence of functional melanocytes in vitiligo skin and a loss of histochemically recognized melanocytes, owing to their destruction. However, the destruction is most likely a slow process resulting in a progressive decrease of melanocytes. Theories regarding destruction of melanocytes include autoimmune mechanisms, cytotoxic mechanisms, an intrinsic defect of melanocytes, oxidant-antioxidant mechanisms, and neural mechanisms.
A symptom is felt by the patient, such as a headache dizziness or pain, and described to other people, including doctors and nurses. A sign can be spotted by everybody, including the patient, such as lighter patches of skin, a rash, or loss of hair.
The only sign of Vitiligo is the appearance of flat white spots or patches on the skin. Most of the times, the first white spot that becomes noticeable is usually on an area of the body that is exposed continuously to the sun.
At first, the vitiligo starts as a simple spot, a little paler than the rest of the skin. But gradually, as time passes, this spot will become much paler until reaching the white color.
The shape of these patches are completely irregular, and at times the edges can become a little inflamed with a slight red tone, and may sometimes result in itchiness. Other than the negative appearance and some itchiness of vitiligo, it does not cause any discomfort, irritation, soreness or dryness in the skin.
Vitiligo is photosensitive; the patient should avoid prolonged skin exposure to direct sunlight.
To predict whether Vitiligo will spread, and by how much is particularly difficult. The spreading of the white patches to some might occur considerably in a matter of weeks, and to others it can rest without growing for months or even years.
If the first symptoms of the white patches are symetrical (non segmentalvitiligo,) in other words, in the same areas of both parts of the body, the development is much slower than if the patches are in only one area of the body (segmental vitiligo).
- There is a history of vitiligo in your family
- There is a history of other autoimmune conditions in your family
- You have injured the affected area of skin – for example, you have had sunburn or a severe rash there
- You tan easily in the sun, or whether you burn
- Any areas have got better without treatment, or whether they are getting worse
- You have tried any treatments already
Many treatments are available to help restore skin color or even out skin tone. Results vary and are unpredictable. Some treatments have serious side effects. So your doctor may suggest that you first try improving the appearance of your skin by applying self-tanning products or makeup.
If you and your doctor decide to treat your condition with a drug or other therapy, the process may take many months to judge its effectiveness. And you may have to try more than one approach before you find the treatment that works best for you.
No drug can stop the process of vitiligo — the loss of pigment cells (melanocytes). But some drugs, used alone or with light therapy, can help improve your skin’s appearance.
- Creams that control inflammation. A topical corticosteroid may help return color to (repigment) your skin, particularly if you start using it early in the disease. You may not see a change in your skin’s color for several months.
This type of cream is effective and easy to use. But it can cause side effects, such as skin thinning or the appearance of streaks or lines on your skin.
Milder forms of the drug may be prescribed for children and for people who have large areas of discolored skin.
- A form of vitamin D. Topical calcipotriene (Dovonex) is a cream that can be used with corticosteroids or ultraviolet light. Possible side effects include dry skin, rash and itching.
- Medications that affect the immune system. Ointments containing tacrolimus or pimecrolimus (calcineurin inhibitors) may be effective for people with small areas of depigmentation, especially on the face and neck. This treatment may have fewer side effects than corticosteroids and can be used with ultraviolet B (UVB) light. The Food and Drug Administration (FDA) has warned about a possible link between these drugs and lymphoma and skin cancer.
- Combined medication and light therapy. This treatment combines a drug called psoralen with light therapy (photochemotherapy) to return color to the light patches. After you take psoralen by mouth or apply it to the affected skin, you’re exposed to ultraviolet A (UVA) or UVB light. Because the drug makes your skin more sensitive to the light, your skin turns pink. As the skin heals, a more normal skin color appears. You may need to repeat treatments up to three times a week for six to 12 months.
Possible side effects include severe sunburn, blistering, itching, overdarkening of the skin, and an increased risk of cataracts and skin cancer. It may help if for one to two days after each treatment you apply sunscreen, wear UV-protective sunglasses and avoid direct sunlight. Oral psoralen with UVA radiation is not recommended for children under 12.
- Light therapy. This treatment uses narrow band UVB light. You may receive treatment in a doctor’s office up to three times a week. And unlike photochemotherapy, it doesn’t require psoralen, which simplifies the process. The best results are achieved on the face, trunk and limbs.
- Laser therapy. This procedure brings color back to patches of light skin by treating them with an excimer laser, which uses a specific wavelength of UVB light. It can be used only on small areas, and it’s often used in combination with a drug applied to the skin. Side effects can include redness and blistering.
- Removing the remaining color (depigmentation). This therapy may be an option if your vitiligo is widespread and other treatments haven’t worked. A medication with monobenzone is applied to unaffected areas of skin. This gradually lightens it so that it blends with the discolored areas. The therapy is done twice a day for nine months or longer. You’ll need to avoid skin-to-skin contact with other people for at least two hours after you’ve applied the drug, so you don’t transfer it to them.
Side effects can include redness, swelling, itching and dry skin. Depigmentation is permanent, and you’ll always be extremely sensitive to sunlight.
Surgery may be an option for you if light therapy and drugs don’t work. Surgery can also be used with those therapies. The goal of the following techniques is to even out your skin tone by restoring color.
- Skin grafting. In this procedure, your doctor removes very small sections of your normal, pigmented skin and attaches them to areas that have lost pigment. This procedure is sometimes used if you have small patches of vitiligo. Possible risks include infection, scarring, a cobblestone appearance, spotty color and failure of the area to recolor.
- Blister grafting. In this procedure, your doctor creates blisters on your pigmented skin, usually with suction. He or she then removes the tops of the blisters and transplants them to an area of discolored skin. Possible risks include scarring, a cobblestone appearance and failure of the area to recolor. The risk of scarring is less with this procedure than with other types of skin grafting.
- Tattooing (micropigmentation). In this technique, your doctor uses a special surgical instrument to implant pigment into your skin. It’s most effective around the lips, especially in people with darker skin. Drawbacks include difficulty matching the skin color, the tendency of tattoos to fade and their inability to tan. Also, the skin damage caused by tattooing may trigger another patch of vitiligo.