Vitiligo is a skin condition of white patches resulting from loss of pigment. Any part of the body may be affected. Usually both sides of the body are similarly affected by a few too many milky-white patches. Common areas of involvement are the face, lips, hands, arms, legs and genital areas.
Vitiligo affects one or two of every 100 people. About half the people who develop it do so before the age of 20; about one fifth have a family member with this condition. Most people with vitiligo are in good general health.
Melanin, the pigment that determines color of skin, hair, and eyes, is produced in cells called melanocytes. If these cells die or cannot form melanin, the skin becomes lighter or completely white. Vitiligo is the result of the disappearance of the skin’s melanocytes. No one knows why, but four main theories exist:- Abnormally functioning nerve cells may make toxic substances that injure melanocytes
- The body’s immune system may destroy melanocytes. Researchers think pigment may be destroyed as the body responds to a substance it perceives as foreign
- Pigment-producing cells may self-destruct. While pigment is forming, toxic byproducts could be produced and destroy melanocytes
- There is a genetic defect that makes the melanocytes susceptible to injury
The course and severity of pigment loss differ with each person. Light-skinned people usually notice the contrast between areas of vitiligo and suntanned skin in the summer. Year round, vitiligo is more obvious on people with darker skin. Individuals with severe cases can lose pigment virtually everywhere. There is no way to predict how much pigment an individual will lose.
Typical vitiligo shows areas of milky-white skin. However, the degree of pigment loss can vary within each vitiligo patch. There may be different shades of pigment in a patch or a border of darker skin may circle an area of light skin.
Vitiligo often begins with a rapid loss of pigment. This may continue until, for unknown reasons, the process stops. Cycles of pigment loss, followed by times where the pigment doesn’t change, may continue indefinitely.
It is rare for skin pigment in vitiligo patients to return on its own. Some people who believe they no longer have vitiligo actually have lost all their pigment and no longer have patches of contrasting skin color. While their skin is all one color, they still have vitiligo.
Sometimes the best treatment for vitiligo is no treatment at all. Disguising vitiligo with make-up, self-tanning compounds or dyes is a safe, easy way to make it less noticeable. Waterproof cosmetics to match almost all skin colors are available at many large department stores. Stains that dye the skin can be used to dye the white patches to more closely match normal skin color. These stains gradually wear off. Self-tanning compounds contain a chemical called dihydroxyacetone that does not need melanocytes to make the skin a tan color. The color from self-tanning creams also slowly wears off. None of these change the disease, but they can improve appearance. Micropigmentation tattooing of small areas may be helpful.
If sunscreens and cover-ups are not satisfactory, your doctor may recommend other treatments. Treatment can be aimed at returning normal pigment (repigmentation) or destroying remaining pigment (depigmentation). None of the repigmentation methods are total, permanent cures.
Conventional Treatments:
Creams containing corticosteroid compounds can be effective in returning pigment to small areas of vitiligo. These can be used along with other treatments. These agents can thin the skin or even cause stretch marks in certain areas. They should be used under your dermatologist’s care.
PUVA is a form of repigmentation therapy where a type of medication known as psoralen is given. This chemical makes the skin very sensitive to light. Then the skin is treated with a special type of ultraviolet light call UVA. Special medical equipment is needed for this treatment. Sometimes, when vitiligo is very limited, psoralens can be applied to the skin before UVA treatments. Usually, however, psoralens are given in pill form. Treatment with PUVA has a 50-70% chance of returning color on the face, trunk, and upper arms and upper legs. Hands and feet respond very poorly. Usually at least a year of twice weekly treatments are required. PUVA must be given under very close supervision by your dermatologist. Side effects of PUVA include sunburn-type reactions. When used long-term, freckling of the skin may result and there is an increased risk of skin cancer. Because psoralens also make the eyes more sensitive to light, UVA blocking eyeglasses must be worn from the time of exposure to psoralen until sunset that day. This eye protection is needed to prevent an increased risk of cataracts. PUVA is not usually used in children under the age of 12, in pregnant or breast feeding women or in individuals with certain medical conditions.
Transfer of skin from normal to white areas is a treatment available only in certain areas of the country and is useful for only a small group of vitiligo patients. It does not generally result in total return of pigment in treated areas.
For some patients with severe involvement, the most practical treatment for vitiligo is to remove remaining pigment from normal skin and make the whole body an even white color. This is done with a chemical called monobenzylether of hydroquinone. This therapy takes about a year to complete. The pigment removal is permanent.
Aggressive treatment is generally not used in children. Sunscreen and cover-up measures are usually the best treatments. Topical corticosteroids can also be used, but must be monitored. PUVA is usually not recommended until after age 12, and then the risks and benefits of this treatment must be carefully weighed.
Research is ongoing in vitiligo and it is hoped that new treatments will be developed. At this time, the exact cause of vitiligo is not known and although treatment is available, there is no single cure.
Signs, symptoms & indicators of Vitiligo
Genital sores
Conditions that suggest Vitiligo
Risk factors for Vitiligo
Vitiligo suggests the following may be present
Recommendations for Vitiligo
Picrorhiza (Picrorhiza kurroa)
Picrorhiza, in preliminary research and in combination with the drug methoxsalen and sun exposure, was reported to hasten recovery in people with vitiligo, compared to using methoxsalen and sun exposure alone. [Bedi KL, Zutshi U, Chopra CL, Amla V. Picrorhiza kurroa, an Ayurvedic herb, may potentiate photochemotherapy in vitiligo. J Ethnopharmacol 1989;27: pp.347-52]
Sun Exposure Reduction / Sunscreen
In fair-skinned individuals, avoiding tanning of normal skin can make areas of vitiligo almost unnoticeable. The white skin of vitiligo has no natural protection from the sun. These areas are very easily sunburned. A sunscreen with a SPF of at least 15 should be used on all areas of vitiligo not covered by clothing. Avoid the sun when it is most intense to avoid burns.
Key
| Weak or unproven link |
| Strong or generally accepted link |
| May do some good |
| Likely to help |
Glossary
Melanin
A dark pigment produced in the skin. Dark-skinned individuals produce more melanin, and melanin production increases in response to sunlight, causing the skin to become darker.
Immune System
A complex that protects the body from disease organisms and other foreign bodies. The system includes the humoral immune response and the cell-mediated response. The immune system also protects the body from invasion by making local barriers and inflammation.
Corticosteroid
Steroid hormone produced by the adrenal cortex.
Psoralen
A chemicals which can cause toxic effects when exposed to sunlight.
Psoralens
Chemicals which can cause toxic effects when exposed to sunlight.
Cancer
Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.
Cataract
A steadily worsening disease of the eye in which the lens becomes cloudy as a result of the precipitation of proteins. Most cataracts are caused by the functions of the body breaking down. Eye trauma, such as from a puncture wound, may also result in cataracts.
Topical
Most commonly 'topical application': Administration to the skin.