Vitiligo

Vitiligo is a skin disorder in which smooth white areas (called macules or patches) appear on a person’s skin. It generally starts on the hands, forearms, feet and face. Globally, about 1% or so of the population has vitiligo.

Causes of Vitiligo #

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.

Types of Vitiligo #

• 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.

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.

Diagnosis of Vitiligo #

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.

Conditions that resemble vitiligo #

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.

Treatment of Vitiligo #

Camouflage therapy #

• 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.

Repigmentation therapy #

• 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.

Light therapy #

• 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.

Surgery #

• 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.