Vitiligo: Understanding and causes and treatment

Vitiligo is a long-term issue where growing skin patches lose their color. People of any age, gender, or ethnic group can be affected by it.

When melanocytes within the skin die off, the patches appear. The cells responsible for creating the skin pigment, melanin, which gives the skin its color and protects it from the UV rays of the sun, are melanocytes.

Globally, between 0.5 and 2 percent of individuals tend to be affected.

Important facts about vitiligo

  • People of any age, gender, or ethnicity can be affected by Vitiligo.
  • There is no treatment, and it is typically a lifelong disease.
  • It is unclear the exact cause, but it could be due to an autoimmune condition or a virus.
  • Vitiligo is not contagious.
  • In extreme cases, treatment choices may include UVA or UVB light exposure and skin depigmentation.
Vitiligo on a lady's face

Definition

Vitiligo is a skin condition in which skin patches lose their color.

The total skin area that can be affected by vitiligo varies between people. The eyes, the inside of the mouth, and hair can also be affected. In most cases, for the rest of the life of the person, the affected areas remain discolored.

The condition is photosensitive. This implies that sunlight would be more sensitive to the areas that are impacted than those that are not.

It is difficult to determine when, and by how much, the patches will spread. It could take weeks to spread, or the patches could stay stable for months or years.

In individuals with dark or tanned skin, the lighter patches appear to be more noticeable.

Treatment

Vitiligo is defined by the American Academy of Dermatology (AAD) as’ more than a cosmetic concern.’ It is a health issue that requires medical attention.

A variety of remedies can help reduce the condition’s visibility.

Sunscreen Use

Sunscreen is recommended by the AAD because the lighter patches of the skin are extremely vulnerable to sunlight and can easily burn. On a suitable type, a dermatologist may advise.

UVB light phototherapy

A common treatment choice is exposure to ultraviolet B (UVB) lamps. Home treatment involves a small lamp and allows for more effective, everyday usage.

This would take 2 to 3 visits a week if the procedure is conducted in a clinic, and the treatment period will be longer.

UVB phototherapy can be used if there are white spots around large regions of the body. This requires full-body rehabilitation. In a hospital, it is completed.

Combined with other therapies, UVB phototherapy may have a beneficial impact on vitiligo. The result is not entirely predictable, however, and there is still no remedy that can fully re-pigment the skin.

UVA light phototherapy

In a health care environment, UVA treatment is normally performed. First, the patient takes a drug that increases the skin’s sensitivity to UV light. Then, the infected skin is exposed to high doses of UVA light in a series of treatments.

After 6 to 12 months of twice-weekly sessions, improvement will be apparent.

Skin camouflage

The patient will camouflage some of the white patches with color, cosmetic creams and makeup in cases of moderate vitiligo. They should pick tones that fit their skin features best.

They will last 12 to 18 hours on the face and up to 96 hours on the rest of the body if creams and makeup are correctly applied. The majority of topical applications are waterproof.

Depigmenting

Depigmentation may be a choice when the affected region is widespread, covering 50 percent of the body or more. In unaffected sections, this decreases the skin color to match the whiter regions.

By applying heavy topical lotions or ointments, such as monobenzone, mequinol, or hydroquinone, depigmentation is achieved.

It is a lifelong procedure, but it may make the skin more fragile. Long-term sun exposure must be avoided. Depigmentation, depending on factors such as the depth of the original skin tone, will take 12 to 14 months.

Topical corticosteroids

Creams containing steroids are corticosteroid ointments. Some research has concluded that the spread can be prevented by adding topical corticosteroids to the white patches. Total restoration of the original skin color has been documented by others. They should never be used on the face with corticosteroids.

If there is some change after a month, it is important to postpone the treatment for a few weeks before beginning again.

Treatment should stop if there is no change after a month, or if side effects occur.

Calcipotriene (Dovonex)

A type of vitamin D that is used as a topical ointment is calcipotriene. Corticosteroids or light therapy can be used. Rashes, dry skin, and scratching are among the side effects.

Drugs that influence the immune system

Tacrolimus or pimecrolimus-containing ointments, medications known as calcineurin inhibitors, may help with smaller depigmentation patches. However, the Food and Drug Administration (FDA) of the United States (U.S.) is advising of a correlation between these drugs and lymphoma and skin cancer.

Psoralen

With UVA or UVB light therapy, Psoralen may be used, as it makes the skin more sensitive to UV light. A more natural coloration also returns as the skin heals. For 6 to 12 months, treatment can need to be repeated two or three times a week.

Psoralen raises the risk of sunburn and damage to the skin and, thus, long-term skin cancer as well. For children under 10 years, it is not recommended.

Skin grafts

A surgeon carefully eliminates healthy patches of pigmented skin in a skin graft and uses them to cover infected areas.

This procedure is not very common because it takes time and can lead to scarring in the region from which the skin originated and the area where it is placed.

Using suction, blister grafting involves creating a blister on normal skin. Then remove the top of the blister and place it on an area where the pigment has been lost. There is a lower risk of scarring.

Tattooing

To implant pigment into the skin, surgery is used. Especially in people with darker skin, it works best around the lips.

Drawbacks can include trouble matching the skin color and the fact that tattoos fade but do not tan. Often, tattooing-induced skin damage can cause another vitiligo patch.

It is unknown the precise causes of vitiligo. A range of variables can contribute.

These include:

  • 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 occur at any age, but studies indicate that it is more likely to begin at around 20 years of age.

Symptoms

The presence of flat white spots or patches on the skin is the only sign of vitiligo. In an area which appears to be exposed to the light, the first white spot that becomes visible is often.

It begins as a simple spot, a little paler than the rest of the skin, but this spot grows paler as time passes before it becomes white.

In shape, the patches are irregular. At times, with a slight red tone, the edges can become a little inflamed, often resulting in itchiness.

However, it typically does not cause any skin discomfort, irritation, pain, or dryness.

Vitiligo’s symptoms differ between individuals. Some individuals can have only a handful of white dots that do not expand any more, while others develop larger white patches that interact and affect larger skin areas.

Types

There are two types of vitiligo, non-segmental and segmental.

Non-segmental vitiligo

Vitiligo on a lady's face
Vitiligo often appears in a semi-symmetrical pattern.

This suggests a form of vitiligo known as non-segmental vitiligo, if the first white patches are symmetrical. The growth would be slower than if there is only one region of the body where the patches are.

The most common form is non-segmental vitiligo, accounting for up to 90 percent of cases.

On both sides of the body, the patches also appear similarly, with some measure of symmetry. They almost always appear on skin that is frequently exposed to the sun, such as the face, neck, and hands.

Areas that are common include:

  • backs of the hands
  • arms
  • eyes
  • knees
  • elbows
  • feet
  • mouth
  • armpit and groin
  • nose
  • navel
  • 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

Segmental vitiligo spreads more easily, but is known to be more consistent and predictable than the non-segmental form and less erratic. It is much less common and only about 10% of people with vitiligo are affected. It is non-symetrical.

In early age groups, it is more noticeable, affecting about 30 percent of children diagnosed with vitiligo.

Segmental vitiligo typically affects nerve-attached areas of the skin that occur in the dorsal roots of the spine. It responds well to topical treatments.

Complications

Vitiligo does not evolve into other diseases, but it is more likely that individuals with the disorder will experience:

  • painful sunburn
  • hearing loss
  • changes to vision and tear production

A person with vitiligo is much more likely to have yet another autoimmune disorder, such as thyroid problems, Addison’s disease, Hashimoto’s thyroiditis, type 1 diabetes, or pernicious anemia. Most individuals with vitiligo do not have these disorders, but to rule them out, testing can be performed.

Overcoming social challenges

The social stigma of vitiligo can be difficult to deal with if the skin patches are noticeable. Embarrassment can lead to self-esteem issues, and anxiety and depression can result in some situations.

Individuals with darker skin are much more likely to have difficulties, because the contrast is higher. Vitiligo is known as “white leprosy” in India.

For example, by talking to friends about it, increasing knowledge of vitiligo will assist individuals with the condition to resolve these difficulties. It can also help to communicate with people who have Vitiligo.

Whoever develops signs of anxiety and depression with this disorder should ask their dermatologist to suggest someone who can help.

Sources

  • Craiglow, B. G. & King, B. A. (2015, October). Tofacitinib citrate for the treatment of vitiligo: A pathogenesis-directed therapy [Abstract]. JAMA Dermatology 151(10), 1110-2, Retrieved from
    (LINK)
  • Grimes, P. E. (2013, January). The efficacy of afamelanotide and narrowband UV-B phototherapy for repigmentation of vitiligo. JAMA Dermatology 149(1), 68-73
    (LINK)
  • Fitzpatrick, T. B. (n.d.). Vitiligo treatments
    (LINK)
  • Is vitiligo a medical condition? (n.d.)
    (LINK)
  • Kruger, C. & Schallreuter, K. U. (2012, October). A review of the worldwide prevalence of vitiligo in children/adolescents and adults [Abstract]. International Journal of Dermatology 51(10), 1206-12
    (LINK)
  • Ongenae, K., Van Geel, N., & Naeyaert, J. M. (2003, April). Evidence for an autoimmune pathogenesis of vitiligo [Abstract]. Pigment Cell Research 16(2), 90-100
    (LINK)
  • Schallreuter, K. U., Salem, M. A. E. L., Holtz, S., & Panske, A. (2013, April 29). Basic evidence for epidermal H2O2/ONOO−-mediated oxidation/nitration in segmental vitiligo is supported by repigmentation of skin and eyelashes after reduction of epidermal H2O2 with topical NB-UVB-activated pseudocatalase PC-KUS [Abstract]. FASEB Journal
    (LINK)
  • Vitiligo discomfort with sunscreen use. (n.d.)
    (LINK)
  • Understanding the symptoms of vitiligo (LINK)
  • Vitiligo overview. (n.d.)
    (LINK)
  • What is vitiligo? (2014, November)
    (LINK)

Related Articles

Back to top button