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Vitiligo is a condition that causes the skin to lose its color in patches, which often enlarge over time. This disorder can impact any area of the body, including the hair and the inside of the mouth.
Melanin typically determines the color of hair and skin. Vitiligo occurs when the body’s immune system attacks and destroys melanocytes, the cells responsible for producing melanin. This condition affects individuals of all skin tones but is more noticeable in those with brown or Black skin. While vitiligo is neither life-threatening nor contagious, it can be a source of stress and affect self-esteem.
It is categorized in several types:
- Universal: More than 80% or almost all of the skin will be pigment-free.
- Generalized: The discolored patches frequently spread symmetrically over related body parts. This is the most prevalent kind of vitiligo.
- Segmental: This affects only one side or portion of the body, such as the hands or face. This usually appears earlier in life, advances for a year or two, and then stops.
- Focal: Within a year to two, the macules develop in a small or a few areas and do not spread in a specific pattern.
- Acrofacial: Skin on body openings like ears, nose, and eyes, as well as hands and face are targeted by this type of vitiligo.
Treatment options can help restore color to the affected skin areas, but they do not stop the ongoing loss of skin color or prevent the condition from recurring.
Symptoms
Symptoms can vary from mild, affecting a small area, to severe, covering a large part of the skin. The progression of vitiligo can also be unpredictable. Sometimes, the patches stop forming on their own, but in most cases, the loss of pigment spreads to large part of the skin.
Signs and symptoms of vitiligo may include:
- Diminished color in the tissues lining the inside of the mouth and nose.
- Irregular fading of skin color, typically starting on the hands, face, around body openings, and genital area.
- Early turning white or gray of hair on the scalp, eyelashes, eyebrows, or beard.
If any of the signs of vitiligo occur, consult a healthcare provider for proper diagnosis, especially if the color loss spreads to a large area, or if these changes affect mental health. Treatments can sometimes slow down or stop the loss of color and even bring back some color to the skin. However, there is no definite cure for this condition.
Causes
Vitiligo is characterized by the loss of skin pigmentation due to a deficiency in melanin, yet its precise cause remains elusive. Various studies propose several potential factors contributing to vitiligo:
- Autoimmune condition: The immune system attacks healthy pigment-producing cells (melanocytes).
- Genetic mutation: Studies show that around 30% of vitiligo cases are linked to genetics, meaning the condition can be inherited. This suggests that if someone in the family has vitiligo, there is a chance one might inherit it too.
- Environmental triggers: The melanocyte cells’ ability to operate can be impacted by things like severe sunburn and exposure to harmful chemicals.
- Stress: Regular mental or physical stress, particularly following an accident, can alter the amount of pigment the melanocyte cells generate.
Risk factors
Vitiligo affects people of all races and genders equally, but it is more noticeable on darker skin tones. It can start at any age, but most often appears before age 30. Other risk factors include:
- Has an autoimmune disease, such as Addison’s disease, anemia, type 1 diabetes, lupus, psoriasis, rheumatoid arthritis, and thyroid disease
- Have a medical family history of the illness
- Frequently come into direct touch with substances that contain phenol, such as those included in certain detergents
Diagnosis
Diagnosing vitiligo entails reviewing an individual’s medical background and family medical history, along with performing a visual inspection. As part of this examination, a specialized lamp like the Wood’s lamp may be employed. This device emits ultraviolet (UV) light onto the skin, aiding in the identification of vitiligo and the exclusion of other skin disorders.
Healthcare providers might also do a skin biopsy, which involves taking a small sample of skin, and blood tests as part of the evaluation.
Treatment
Treatment for vitiligo is not always needed since it does not harm the body, but if it affects one’s emotional well-being, several treatment may be suggested. Generally, the treatment for vitiligo depends on various factors like age, the extent and location of the affected skin, how fast the condition is spreading, and its impact on one’s life.
In some cases, it could take many months to see results, and one might need to try different or combined approaches to find what works best. Even if a treatment is initially effective, the results might not last, or new patches could appear. To help prevent relapse, skin-applied medication as maintenance therapy may be recommended.
Treatment options include:
- Medications: Some medications can help restore some color when used alone, in combination, or in conjunction with light therapy. However, specific prescription that can stop vitiligo from causing damage the skin.
- Corticosteroids: Children or individuals with extensive areas of discolored skin may receive prescriptions for mild corticosteroid creams. In cases where vitiligo is rapidly spreading, corticosteroid pills or injections could be advised. Corticosteroid creams are effective in reinstating skin color, particularly during the initial phases of vitiligo. Despite their user-friendly application, noticeable changes may take several months to manifest.
- Calcineurin inhibitor: Small areas of depigmentation, particularly on the face and neck may be treated with calcineurin inhibitor ointments like tacrolimus or pimecrolimus.
- Therapies
- Light therapy: Also known as phototherapy, this treatment is used to help restore color to skin affected by vitiligo. Narrow band ultraviolet B (UVB) phototherapy can help slow down or stop the progression of active vitiligo. It might take several sessions to see results. Smaller portable or handheld UVB devices may also be available for home use.
This therapy involves sessions two to three times a week. It works better when combined with corticosteroids or calcineurin inhibitors. Using calcineurin inhibitors with UVB phototherapy might increase the risk of skin cancer, so it is important to discuss the risks and benefits with the healthcare provider.
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- Combining psoralen and light therapy: Another approach, called PUVA, combines an oral medication called psoralen with ultraviolet A (UVA) light. PUVA is used to treat larger areas of skin with vitiligo, especially on the head, neck, trunk, and upper arms and legs. Although this method is beneficial, it is more challenging to execute.
- Depigmentation therapy: This treatment evens out the skin tone by removing its natural color, making it match areas affected by vitiligo. On skin sections that are unaffected, a depigmenting chemical called monobenzone, is applied. The skin becomes lighter with time, blending in with the discolored patches. This is usually an alternative if other treatments have failed and the vitiligo is extensive.
- Surgery
- Skin grafting: This treatment may be recommended for minor patches of vitiligo. With skin grafts, skin from one part of the body is moved to another part to cover areas with vitiligo. However, this can lead to complications such as scarring, infection, or not achieving repigmentation.
- Blister grafting: The procedure involves creating a blister using suction, then transferring the top layer of that blister to a vitiligo-affected area. However, this, too, carries risks like scarring or infection.
- Cellular suspension transplant: It usually takes four weeks for the effects of this repigmentation process to become visible. This involves taking a sample from the skin that still has color, dissolving the cells in a solution, and then transplanting those cells onto the affected areas.
- Ongoing treatment research
- Prostaglandin E2: This drug may help restore skin color in people with vitiligo that is not rapidly spreading as this helps control melanocytes. This is being tested as a gel applied to the skin.
- Afamelanotide: This is inserted beneath the skin to encourage the development of melanocytes.
