Understanding the symptoms of vitiligo
The patches appear when melanocytes within the skin die off. Melanocytes are the cells responsible for producing the skin pigment, melanin, which gives skin its color and protects it from the sun's UV rays.
Globally, it appears to affect between 0.5 and 2 percent of people.
Here are some key points about vitiligo. More detail is in the main article.
- Vitiligo can affect people of any age, gender, or ethnicity.
- There is no cure, and it is usually a lifelong condition.
- The exact cause is unknown, but it may be due to an autoimmune disorder or a virus.
- Vitiligo is not contagious.
- Treatment options may include exposure to UVA or UVB light and depigmentation of the skin in severe cases.
What is vitiligo?
Vitiligo is a skin condition in which patches of skin loses their color.
The total area of skin that can be affected by vitiligo varies between individuals. It can also affect the eyes, the inside of mouth, and the hair. In most cases, the affected areas remain discolored for the rest of the person's life.
The condition is photosensitive. This means that the areas that are affected will be more sensitive to sunlight than those that are not.
It is hard to predict whether the patches will spread, and by how much. The spread might take weeks, or the patches might remain stable for months or years.
The lighter patches tend to be more visible in people with dark or tanned skin.
Image credit: James Heilman, MD, 2010.
The American Academy of Dermatology (AAD) describe vitiligo as "more than a cosmetic problem." It is a health issue that needs medical attention.
A number of remedies can help decrease the visibility of the condition.
The AAD recommend using a sunscreen, because the lighter patches of skin are especially sensitive to sunlight and they can burn easily. A dermatologist can advise on a suitable type.
Phototherapy with UVB light
Exposure to ultraviolet B (UVB) lamps is a common treatment option. Home treatment requires a small lamp and allows for daily use, which is more effective.
If the treatment is done in a clinic, this will need 2 to 3 visits a week and the treatment time will be longer.
If there are white spots across large areas of the body, UVB phototherapy may be used. This involves full-body treatment. It is done in a hospital.
UVB phototherapy, combined with other treatments, can have a positive effect on vitiligo. However, the result is not totally predictable, and there is still no treatment that will fully re-pigment the skin.
Phototherapy with UVA light
UVA treatment is usually conducted in a health care setting. First, the patient takes a drug that increases the skin's sensitivity to UV light. Then, in a series of treatments, the affected skin is exposed to high doses of UVA light.
Progress will be evident after 6 to 12 months of twice-weekly sessions.
In cases of mild vitiligo, the patient can camouflage some of the white patches with colored, cosmetic creams and makeup. They should select tones that best match their skin features.
If creams and makeup are correctly applied, they can last 12 to 18 hours on the face and up to 96 hours for the rest of the body. Most topical applications are waterproof.
A range of treatments are available for vitiligo, although many people choose not to treat it.
When the affected area is widespread, covering 50 percent of the body or more, depigmentation can be an option. This reduces the skin color in unaffected parts to match the whiter areas.
Depigmentation is achieved by applying strong topical lotions or ointments, such as monobenzone, mequinol, or hydroquinone.
The treatment is permanent, but it can make the skin more fragile. Long exposure to the sun must be avoided. Depigmentation can take 12 to 14 months, depending on factors such as the depth of the original skin tone.
Corticosteroid ointments are creams containing steroids. Some studies have concluded that applying topical corticosteroids to the white patches can stop the spread. Others have reported total restoration of the original skin color. Corticosteroids should never be used on the face.
If there is some improvement after a month, the treatment should be paused for a couple of weeks before starting it again.
If there is no improvement after a month, or if side effects occur, treatment should stop.
Calcipotriene is a form of vitamin D used as a topical ointment. It may be used with corticosteroids or light treatment. Side effects include rashes, dry skin, and itching.
Drugs affecting the immune system
Ointments containing tacrolimus or pimecrolimus, drugs known as calcineurin inhibitors, can help with smaller patches of depigmentation. However, the United States (U.S.) Food and Drug Administration (FDA) warn of a connection between these drugs and skin cancer and lymphoma.
Psoralen may be used with UVA or UVB light therapy, as it makes the skin more susceptible to UV light. As the skin heals, a more normal coloration sometimes returns. Treatment may need to be repeated two or three times a week for 6 to 12 months.
In a skin graft, a surgeon carefully removes healthy patches of pigmented skin and uses them to cover affected areas.
This procedure is not very common, because it takes time and can result in scarring in the area where the skin came from and the area where it is placed.
Blister grafting involves producing a blister on normal skin using suction. The top of the blister is then removed and placed on an area where pigment has been lost. There is a lower risk of scarring.
Surgery is used to implant pigment into the skin. It works best around the lips, especially in people with darker skin.
Drawbacks can include difficulty matching the color of skin and the fact that tattoos fade but do not tan. Sometimes, skin damage caused by tattooing can trigger another patch of vitiligo.
Possible cures for the future
Research into potential cures or treatments for vitiligo is ongoing. Here are some of the most promising findings.
In 2013, researchers announced that they had found a new compound that may provide a cure for the loss of skin color associated with vitiligo.
Participants in a study who were treated with a modified pseudocatalase (PC-KUS) recovered pigmentation in their skin and their eyelashes. The compound also appeared to restore original hair color among people with gray hair.
Low melanin levels in some people with vitiligo might be due to lower levels of α-melanocyte-stimulating hormone (alpha-MSH). Afamelanotide is a synthetic compound that mimics alpha-MSH.
In combination with UVB treatment, afamelanotide seems to be effective.
The exact causes of vitiligo are unclear. A number of factors may contribute.
- an autoimmune disorder, in which the immune system becomes overactive and destroys the melanocytes
- a genetic oxidative stress imbalance
- a stressful event
- harm to the skin due to a critical sunburn or cut
- exposure to some chemicals
- a neural cause
- heredity, as it may run in families
- a virus
Vitiligo is not contagious. One person cannot catch it from another.
It can appear at any age, but studies suggest that it is more likely to start around the age of 20 years.
The only symptom of vitiligo is the appearance of flat white spots or patches on the skin. The first white spot that becomes noticeable is often in an area that tends to be exposed to the sun.
It starts as a simple spot, a little paler than the rest of the skin, but as time passes, this spot becomes paler until it turns white.
The patches are irregular in shape. At times, the edges can become a little inflamed with a slight red tone, sometimes resulting in itchiness.
Normally, however, it does not cause any discomfort, irritation, soreness, or dryness in the skin.
The effects of vitiligo vary between people. Some people may have only a handful of white dots that develop no further, while others develop larger white patches that join together and affect larger areas of skin.
There are two types of vitiligo, non-segmental and segmental.
Vitiligo often appears in a semi-symmetrical pattern.
If the first white patches are symmetrical, this suggests a type of vitiligo known as non-segmental vitiligo. The development will be slower than if the patches are in only one area of the body.
Non-segmental vitiligo is the most common type, accounting for up to 90 percent of cases.
The patches often appear equally on both sides of the body, with some measure of symmetry. They often appear on skin that is commonly exposed to the sun, such as the face, neck, and hands.
Common areas include:
- backs of the hands
- armpit and groin
- genitals and rectal area
Non-segmental vitiligo is further broken down into sub-categories:
- Generalized: There is no specific area or size of patches. This is the most common type.
- Acrofacial: This occurs mostly on the fingers or toes.
- Mucosal: This appears mostly around the mucous membranes and lips.
- Universal: Depigmentation covers most of the body. This is very rare.
- Focal: One, or a few, scattered white patches develop in a discrete area. It most often occurs in young children.
Segmental vitiligo spreads more rapidly but is considered more constant and stable and less erratic than the non-segmental type. It is much less common and affects only about 10 percent of people with vitiligo. It is non-symetrical.
It is more noticeable in early age groups, affecting about 30 percent of children diagnosed with vitiligo.
Segmental vitiligo usually affects areas of skin attached to nerves arising in the dorsal roots of the spine. It responds well to topical treatments.
Vitiligo does not develop into other diseases, but people with the condition are more likely to experience:
- painful sunburn
- hearing loss
- changes to vision and tear production
A person with vitiligo is more likely to have another autoimmune disorder, such as thyroid problems, Addison's disease, Hashimoto's thyroiditis, type 1 diabetes, or pernicious anemia. Most people with vitiligo do not have these conditions, but tests may be done to rule them out.
Overcoming social challenges
If the skin patches are visible, the social stigma of vitiligo can be difficult to cope with. Embarrassment can lead to problems with self-esteem, and in some cases, anxiety and depression can result.
People with darker skin are more likely to experience difficulties, because the contrast is greater. In India, vitiligo is known as "white leprosy."
Increasing awareness about vitiligo, for example, by talking to friends about it, can help people with the condition to overcome these difficulties. Connecting with other who have vitiligo may also help.
Anyone with this condition who experiences symptoms of anxiety and depression should ask their dermatologist to recommend someone who can help.