Vitiligo is a chronic medical condition that results in dispigmentation of skin in patches due to the destruction or inability of melanocytes, the cells that cause skin pigmentation. Some people have a few spots that may lighten or become fully white. Vitiligo attacks 0.5-2% of the world population, generally at the age of 20 years. It is more common in people with autoimmune diseases.
Vitiligo affects both male and female including all races, but is more prominent in people with darker complexion. The intimate “blood relatives” of a person with vitiligo has greater risk of also having the disease. Persons with vitiligo are more likely to develop other autoimmune disorders such as thyroid disease, rheumatoid arthritis, psoriasis, and others. Vitiligo may also be inherited. Children whose parents have this disease are at greater risk to develop vitiligo. In fact, 30% of people with vitiligo have the history of a family member suffering from this disease. However, only 5% to 7% of children will get affected by this vitiligo even if a parent has it, and in most of the cases people with vitiligo do not have a family history of the disorder.
Causes
Researchers have discovered that vitiligo develops if melanocyte cells die or are damaged by the body\’s immune function. As the cells die, a particular area of skin or hair becomes white as the cells become cannot produce pigment. Human bodies generate proteins called cytokines that change their pigment-producing cells and cause these cells to die.
Signs and symptoms
The most prominent symptom of vitiligo involves depigmentation of patches of skin that occurs on the extremities. Although patches remain primarily small, they often spread and change shape. When skin lesions appear, they are most visible on the face, hands and wrists. Depigmentation is predominantly evident around body orifices, such as the mouth, eyes, nostrils, genitalia and umbilicus. Some lesions may have hyper pigmentation surrounding the edges. Considering psychological damage; vitiligo can have an important effect on the mental state of a patient. Psychological stress may even be viewed in an individual becoming more prone to vitiligo. Patients stigmatized for their condition may go into depression and similar mood disorders.
Vitiligo generally appears in one of the three following patterns:
1. Focal pattern – In this type of vitiligo the depigmentation remains confined to one or only a few areas.
2. Segmental pattern – In this type of vitiligo depigmented patches occur on only one side of the body. This type tends to begin at an early age. It progresses for a year or two, and then stops suddenly. Segmental vitiligo is also termed as unilateral vitiligo because it appears on one side of the body especially on the face, arm, trunk, or leg.
3. Generalized pattern – It is the most common type of vitiligo in which depigmentation develops symmetrically on both sides of the body. It commonly spreads on the face, lips, hands, arms, legs, or genitals. This type is also called bilateral vitiligo because it causes fading of skin color on both sides of the body.
Trichrome Vitiligo
This is a special type of vitiligo where three shades of color — brown, tan, and white develop on the skin.
Along with the white patches on the skin, people with vitiligo may have premature graying of the scalp hair, eyelashes, eyebrows, and beard. People with dark skin may observe a loss of color inside their mouths too.
Treatment
There is no specific cure for vitiligo, but there are a number of treatments that can decelerate or improve the condition. In case of fair-complexioned people, avoiding tanning of normal skin can turn patches of vitiligo much less perceptible. Treatment options are classified into 4 groups:
LIGHT THERAPY AND MEDICATIONS
When avoiding a tan and camouflaging do not produce pleasing results, a dermatologist may advise medical treatment. The objective of medical treatment is to provide a uniform skin tone by either bringing back color (repigment) or eliminating the remaining color (depigment). The treatment type depends on the type of vitiligo, its severity, as well as the patient\’s preference, health, and age. Medical treatment for vitiligo includes the following:
Narrow Band Ultraviolet B (NB-UVB):
This therapy uses light to repigment the skin. NB-UVB requires 2 to 3 treatment sessions a week for few months. A standard phototherapy unit may be appointed to treat the patient. NB-UVB treatments can be done in some doctor\’s offices, as well as from home units, if prescribed. Another source of NB-UVB includes excimer lasers that tend to deliver the best results on the face. The hands and feet seem least responsive to this treatment. Laser treatment can be very expensive and prolonged.
PUVA:
This therapy uses Ultraviolet A (UVA) light and a medication called psoralen to restore skin color. The psoralen can either be applied to the skin or consumed as a pill. Psoralen, which is the \”P\” in PUVA, turns the skin quite sensitive to light. This treatment is 50 to 75 percent effectual in restoring color of the skin of the face, trunk, upper arms, and upper legs. The hands and feet are likely to respond poorly. PUVA is also time-consuming as it needs at least one year of treatments given twice a week. PUVA treatments should be given under the supervision of a dermatologist.
Creams and ointments:
Medications that are recommended for the skin include topical corticosteroids, tacrolimus, and calcipotriol. These can be used to restore pigmentation in small areas. Topical corticosteroids are effective especially in people with darkly pigmented skin and often give good result on the face. They also can produce pigment on the neck, arms, and legs. To achieve quicker results, a topical corticosteroid may be prescribed with calcipotriol. Tacrolimus often shows best result if combined with NB-UVB light. Patients using creams and ointments need to be carefully monitored.
Depigmentation:
In case of the patients with severe vitiligo, removing the remaining pigment from the skin may prove to be an effective means to achieve single skin color. To eliminate pigment, a dermatologist may recommend a chemical called monobenzone. This treatment is said to be permanent.
Surgery:
Surgical treatment incorporates transferring skin which has not been affected by vitiligo to the sites of patches where vitiligo occurs. This treatment is also called a skin graft and tends to be most suitable for people having segmental vitiligo. It can deliver excellent results. But grafting is only available in particular areas of the United States.
Autologous melanocyte transplants:
In this method, the doctor collects a sample of your normal pigmented skin and places it in a laboratory dish with a special cell-culture solution to produce melanocytes. When the melanocytes in the culture solution become multiplied, they are transplanted to your depigmented skin patches. However, this treatment is presently experimental and is unrealistic for the routine care of patients of vitiligo. It is also very dear, and its side effects are still unknown.
Along with the medical and surgical therapies, there are many things to follow to protect your skin on your own, reduce the appearance of white patches, and deal with the emotional aspects of vitiligo:
Sunscreens:
People, who have vitiligo, particularly those with fair skin complexion, should avoid sun exposure and use a sunscreen that blocks both UVA and ultraviolet B light to penetrate your skin. Tanning makes the contrast between normal and depigmented skin more prominent. Sunscreen gives protection to the skin from sunburn and lasting damage.
Cosmetics:
Some patients with vitiligo hide depigmented patches with stains, makeup, or self-tanning lotions which can be specifically effective for people with limited vitiligo in the exposed parts of the body.
Counseling and support groups:
Many people with vitiligo find it supportive to get counseling from a mental health professional with whom they can share their problems that are normally difficult to discuss with anyone else. A mental health counselor can give support and help in coping with vitiligo. Additionally, it may prove helpful to join a vitiligo support group.