The ABC's of Vitiligo
What is vitiligo?
Vitiligo (vit-il-EYE-go) is a skin disorder that causes the skin to lose its color. Smooth white areas (called macules if less than 5mm or patches if 5mm or larger) appear on a person’s skin. If you have vitiligo in a place that has hair, the hair on your body may also turn white.
The condition occurs when melanocytes (the skin cells that produce melanin, the chemical that gives skin its color, or pigmentation) are destroyed by the body’s immune system.
How does vitiligo progress?
Vitiligo usually begins with a few small white patches that may gradually spread over the body over the course of several months. Vitiligo typically begins on the hands, forearms, feet, and face but can develop on any part of the body, including the mucous membranes (moist lining of the mouth, nose, genital, and rectal areas), the eyes, and inner ears.
Sometimes the larger patches continue to widen and spread, but usually they stay in the same place for years. The location of smaller macules shifts and changes over time, as certain areas of skin lose and regain their pigments. Vitiligo varies in the amount of skin affected, with some patients experiencing few depigmented areas and others with widespread loss of skin color.
What are the types of vitiligo?
Vitiligo can be:
Generalized, which is the most common type, when macules appear in various places on the body.
Segmental, which is restricted to one side of the body or one area, such as the hands or face.
Mucosal, which affects mucous membranes of the mouth and/or the genitals.
Focal, which is a rare type in which the macules are in a small area and do not spread in a certain pattern within one to two years.
Trichome, which means that there is a white or colorless center, then an area of lighter pigmentation, and then an area of normally colored skin.
Universal, another rare type of vitiligo, and one in which more than 80% of the skin of the body lacks pigment.
How common is vitiligo?
Vitiligo occurs in about 1% or slightly more of the population throughout the world. Vitiligo affects all races and genders equally; however, it is more visible in people with darker skin. Although vitiligo can develop in anyone at any age, it most commonly appears in people ages 10 to 30 years. Vitiligo rarely appears in the very young or very old.
SYMPTOMS AND CAUSES
What causes vitiligo? Although the causes of vitiligo aren’t completely understood, there are a number of different theories:
Autoimmune disorder: The affected person’s immune system may develop antibodies that destroy melanocytes.
Genetic factors: Certain factors that may increase the chance of getting vitiligo can be inherited. About 30% of vitiligo cases run in families.
Neurogenic factors: A substance that is toxic to melanocytes may be released at nerve endings in the skin.
Self-destruction: A defect in the melanocytes causes them to destroy themselves.
Vitiligo may also be triggered by certain events, such as physical or emotional stress. Because none of the explanations seem to completely account for the condition, it’s possible that a combination of these factors is responsible for vitiligo.
Is vitiligo painful? Vitiligo is not painful. However, you can get painful sunburns on the lighter patches of skin. It is important to protect yourself against the sun with measures like using sunscreen, staying out of the sun during the hours that it is strongest, and wearing protective clothing. Some people with vitiligo have reported having itchy skin sometimes, including before the depigmentation starts.
Can I inherit vitiligo? Vitiligo is not necessarily inherited. However, about 30% of people who have vitiligo do have at least one close relative who also has vitiligo.
What are the signs and symptoms of vitiligo? Signs and symptoms of vitiligo include the following:
Patches of skin lose color. This can include the eyes and/or the mucous membranes in your mouth or nose.
Patches of hair on your head or face turn prematurely gray or white.
What problems are associated with vitiligo? Although vitiligo is mainly a cosmetic condition, people with vitiligo may experience a variety of problems:
Because they lack melanocytes, macules are more sensitive to sunlight than the rest of the skin, so they will burn rather than tan.
People with vitiligo may have some abnormalities in their retinas (the inner layer of the eye that contains light-sensitive cells) and some variation of color in their irises (the colored part of the eye). In some cases, there is some inflammation of the retina or iris, but vision is usually not affected.
People with vitiligo may be more likely to get other autoimmune diseases (in which the body’s immune system causes it to attack itself), such as hypothyroidism, diabetes, pernicious anemia, Addison’s disease, and alopecia areata. Also, people with autoimmune diseases are more at risk for developing vitiligo.
People with vitiligo may feel embarrassed or anxious about their skin. Sometimes people are rude – they may stare or say unkind things. This could cause a person with vitiligo to develop low self-esteem. This in turn could create anxiety or depression issues and make someone want to isolate. If this happens, you should talk to your healthcare provider or your family and friends to help you find a solution.
DIAGNOSIS AND TESTS How is vitiligo diagnosed? Usually the white patches are easily visible on the skin, but healthcare providers can use a Wood’s lamp, which shines ultraviolet (UV) light onto the skin to help differentiate from other skin conditions.
What other conditions resemble vitiligo? There are other conditions that make the skin change or lose pigmentation. These include:
Chemical leukoderma: Exposure to some industrial chemicals cause damage to the skin cells, resulting in linear or splotchy white areas of skin
Tinea versicolor: This yeast infection can create dark spots that show on light skin, or light spots that show on darker skin.
Albinism: This genetic condition means that you have lower levels of melanin in the skin, hair and/or eyes.
Pityriasis alba: This condition starts off with red and scaly areas of skin, which fade into scaly lighter patches of skin.
MANAGEMENT AND TREATMENT How is vitiligo treated? There is no cure for vitiligo. The goal of medical treatment is to create a uniform skin tone by either restoring color (repigmentation) or eliminating the remaining color (depigmentation). Common treatments include camouflage therapy, repigmentation therapy, light therapy and surgery. Counseling may also be recommended.
Using sunscreen with an SPF of 30 or higher. Also, the sunscreen should shield ultraviolet B light and ultraviolet A light (UVB and UVA). Use of sunscreens minimizes tanning, thereby limiting the contrast between affected and normal skin.
Makeups help camouflage depigmented areas. One well-known brand is Dermablend®.
Hair dyes if vitiligo affects the hair.
Depigmentation therapy with the drug monobenzone can be used if the disease is extensive. This medication is applied to pigmented patches of skin and will turn them white to match the areas of vitiligo.
Corticosteroids can be taken orally (as a pill) or topically (as a cream put on the skin). Results may take up to 3 months. The doctor will monitor the patient for any side effects, which can include skin thinning or striae (stretch marks) if used for a prolonged period.
Topical vitamin D analogs.
Topical immunomodulators such as calcineurin inhibitors.
Narrow band ultraviolet B (NB-UVB) requires two to three treatment sessions per week for several months.
Excimer lasers emits a wavelength of ultraviolet light close to that of narrow band UVB. This is better for patients who do not have widespread or large lesions since it is delivered to small, targeted areas.
Combining oral psoralen and UVA (PUVA) is used to treat large areas of skin with vitiligo. This treatment is said to be very effective for people with vitiligo in the areas of the head, neck, trunk, upper arms and legs.
Autologous (from the patient) skin grafts: Skin is taken from one part of the patient and used to cover another part. Possible complications include scarring, infection or a failure to repigment. This might also be called mini grafting.
Micropigmentation: A type of tattooing that is usually applied to the lips of people affected by vitiligo.
Vitiligo can cause psychological distress and has the ability to affect a person’s outlook and social interactions. If this happens, your caregiver may suggest that you find a counselor or attend a support group.
PREVENTION How can I prevent vitiligo? Since no one knows for certain what causes vitiligo, no one can tell you how to prevent it. In general, it is smart for everyone to practice safe sun exposure habits and to take good care of your skin.
OUTLOOK / PROGNOSIS What is the outlook for people with vitiligo? About 10% to 20% of people who have vitiligo fully regain their skin color. People with the best chance of regaining skin color are those who are young, whose vitiligo reaches its peak in less than six months and is located mainly on the facial area. People who are less likely to regain their color are those who get vitiligo later in life on their lips and limbs, especially the hands.
Is vitiligo fatal? No. And it is not in any way contagious, either.
What should I know about living with vitiligo? In reading about vitiligo, you might find this thought showing up in many places, that ‘vitiligo is not life-threatening, but it is life-altering.’ The fact that vitiligo develops over time is one reason for this. Another factor is that many societies believe that appearance is very important, and that being different is to be avoided. This is often very true for women. It is important for everyone to take ownership of their health. Educating yourself about vitiligo and finding a doctor who really knows about the disease and treatment options is key. If you develop any new symptoms that cause you worry, or if you have questions, make sure your voice is heard.