Vitiligo is a long-term condition in which pale white patches develop on the skin. It is caused by a lack of melanin, the pigment in the skin. You can find more information below.
What is vitiligo disease?
Vitiligo disease consists of white patches of skin caused by the loss of the pigment melanin, which is a major contributor to the skin. Melanin is produced by special cells called melanocytes. In those with vitiligo, these cells are destroyed by the body.
The cause of vitiligo disease is unknown, but evidence strongly suggests that vitiligo is an autoimmune disorder in which the body’s immune system mistakenly targets and injures these specific cells.
Vitiligo disease can cause minor or extensive changes in the skin. In some people it may be hardly noticeable, in others it is obvious. In dark-skinned people, patches of vitiligo are clear as they contrast with normal skin.
Fair-skinned people may have less cosmetic concerns, but non-pigmented spots may become evident in the summer, as there are areas of skin that are not affected while vitiligo skin does not tan.
Vitiligo occurs in about 1 percent to 2 percent of the population. About 30 percent of patients have the same condition in their families, and about half of patients begin to show symptoms before the age of 20.
Those with vitiligo have an increased risk of developing autoimmune thyroid disease and other autoimmune diseases such as type 1 diabetes . Also, people with these conditions have an increased risk of developing this disease.
What are the types of vitiligo disease?
There are two main types of vitiligo disease:
- Segmental vitiligo
- non-segmental vitiligo
In rare cases, it’s also possible for vitiligo to affect your entire body.
In the case of segmental vitiligo (also known as unilateral or localized vitiligo), the white patches affect only one area of the body. Segmental vitiligo is less common than non-segmental vitiligo, although it is more common in children. It usually starts earlier and affects 3 out of 10 children with vitiligo.
In the case of non-segmental vitiligo (also known as bilateral vitiligo), symptoms usually appear as symmetrical white patches on both sides of the body. These symmetrical patches may appear in the following areas:
- back of hands
- Around the eyes
Non-segmental vitiligo is the most common type of vitiligo, affecting 9 out of 10 people with this condition.
What causes vitiligo disease?
Vitiligo occurs when pigment-producing cells (melanocytes) stop producing melanin, the pigment that gives color to skin, hair, and eyes. Related skin patches become lighter or whiter. What causes these pigment cells to fail or die is unclear but may be related to:
- Immune system disorder (autoimmune condition)
- Family health (hereditary predisposition)
- A triggering event, such as stress, severe sunburn, or contact with a chemical
Who is at risk?
The risk of developing non-segmental vitiligo is high if:
- Having the same disease in other family members
- Having other autoimmune conditions in the family (for example, if a parent has pernicious anemia )
- Presence of another autoimmune disease in the person concerned
- Presence of skin cancers such as melanoma
- Having certain changes in genes known to be associated with non-segmental vitiligo
What are the symptoms of vitiligo disease?
The skin areas most affected by vitiligo include:
- mouth and eyes
- fingers and wrists
- reproductive organs
Sometimes it can develop in places where there are hair follicles, such as the scalp. A lack of melanin in the skin can make the hair in the affected area turn white or gray.
Vitiligo disease often begins as a pale patch of skin that gradually turns completely white. The center of a patch may be pale skin or white. If there are blood vessels under the skin, the patch may also be slightly pink instead of white.
The edges of the patch may be straight or irregular. Sometimes it can become inflamed and have brownish or reddish discoloration (hyperpigmentation).
Vitiligo disease does not cause discomfort such as dry skin , but the patches can sometimes be itchy.
The situation varies from person to person. Some people have just a few small white patches, but others have larger white patches that spread over large areas of their skin.
There is no way to predict how much the skin will be affected. White spots are usually permanent.
When should you see a doctor?
In case of discoloration of the skin, hair or mucous membranes, a doctor should be consulted. There is no treatment that targets vitiligo. But treatment can stop or slow the discoloration process and give your skin some color.
How is vitiligo diagnosed?
The doctor will be able to diagnose vitiligo after examining the affected areas of skin. He or she may also ask the following questions:
- Is there a family history of vitiligo?
- Is there a family history of other autoimmune conditions?
- Have the affected areas of skin ever been injured in any way?
- Do you tan easily in the sun?
- Will any areas of the skin get better or worse without treatment?
- Have any treatments been tried before?
The doctor may also ask about the impact of vitiligo on the patient’s life. For example, these are questions such as how much it affects the self-confidence and self-esteem of the person concerned, and whether it affects their job.
In some cases, the doctor may use an ultraviolet (UV) lamp, called a Wood’s lamp, to look at the skin in more detail. You will need to be in a dark room and the lamp will be held 10 to 13 cm away from your skin.
Patches of vitiligo will be easier to see under UV light, which will help the doctor distinguish vitiligo from other skin conditions such as pityriasis versicolor (a disease where there is loss of pigment due to a fungal infection ).
Diagnosing other autoimmune conditions
Because non-segmental vitiligo is closely related to other autoimmune conditions, the doctor may want to find out if the person concerned has any symptoms that indicate an autoimmune condition, such as:
- Fatigue and lack of energy can be a sign of Addison’s disease
- Thirst and the need to urinate frequently can be a sign of diabetes
A blood test may also be needed to check how well the thyroid gland is working.
How is vitiligo disease treated?
The choice of treatment depends on the age of the patient, how much of the skin is affected, where it is, how quickly the disease progresses, and how it affects his life.
Medications and light-based therapies are available to help restore skin tone or even out skin tone, but results can vary and are unpredictable. Some treatments have serious side effects. For this reason, the doctor may suggest that you first try to change the appearance of your skin by applying a tanning product or make-up.
If the patient and doctor decide to treat the condition with a medication, surgery or therapy, it can take months to be sure of the effectiveness of the process. More than one approach or a combination of approaches may be tried before finding the most appropriate treatment for the patient.
Even if the treatment is successful for a while, the results may take a long time or new patches may appear. The doctor may prescribe a medication that is applied to the skin as maintenance therapy to prevent recurrence.
No drug can stop the vitiligo disease process. But certain medications used alone, in combination, or with light therapy can help restore certain skin tones.
- Medications to control inflammation: Applying corticosteroid cream to the affected skin can turn the color. This is effective when vitiligo is still in its early stages. This type of cream is effective and easy to use, but skin color changes may not appear for several months. Possible side effects include thinning of the skin or lines on the skin. Milder forms of the drug can be prescribed for children and people with large areas of discolored skin. Corticosteroid pills or injections may be an option for people whose condition is rapidly progressing.
- Medications that affect the immune system: Calcineurin inhibitor ointments such as tacrolimus or pimecrolimus may be effective for people with small areas of depigmentation, especially on the face and neck. The U.S. Food and Drug Administration (FDA) has warned of a possible link between these drugs and lymphoma and skin cancer.
Remember, your doctor will decide which medicine to take and how.
Available non-surgical treatments include:
- Light therapy: Phototherapy with narrow band ultraviolet B (UVB) has been shown to stop or slow the progression of active vitiligo. It may be more effective when used with corticosteroids or calcineurin inhibitors. Treatment will be needed two to three times a week. It may take one to three months for the patient to notice any changes, and it may take six months or longer to achieve the full effect. Possible side effects of narrowband ultraviolet B therapy include redness, itching, and burning. These side effects usually go away after a few hours of treatment.
- Combining psoralen and light therapy: This treatment gives color by combining a plant-derived substance called psoralen with light therapy (photochemotherapy). Exposure to ultraviolet A (UVA) light after taking psoralen by mouth or applying it to the affected skin. While this approach is effective, it is more difficult to implement.
- Depigmentation: This treatment may be an option if the patient has extensive vitiligo and other treatments have not worked. A depigmenting agent is applied to unaffected skin areas. Therapy is done once or twice a day for nine months or more. Side effects may include redness, swelling, itching and dry skin. Depigmentation is permanent.
If light therapy and medications haven’t worked, some people with stable disease may be candidates for surgery. The following techniques are intended to even out skin tone by restoring color:
- Skin grafting: In this procedure, the doctor transfers very small sections of healthy, pigmented skin to areas that have lost pigment. This procedure is sometimes used if there are small patches of vitiligo.
- Blister grafting: In this procedure, the doctor usually creates blisters on the pigmented skin and then transplants the tops of the blisters into the discolored skin.
- Cellular suspension transplant: In this procedure, the doctor takes some tissue from the pigmented skin, puts the cells in a solution, and then prepares it and transplants it into the affected area. The results of this repigmentation procedure begin to appear within four weeks.
potential future treatments
The treatments reviewed include:
- A drug to stimulate color-producing cells (melanocytes): This potential treatment, called afamelanotide, is implanted under the skin to stimulate the growth of melanocytes.
- A drug to help control melanoctyes: Prostaglandin E2 is being tested as a way to correct skin color in people with uncommon or non-disseminated vitiligo. It is applied to the skin as a gel.