Vitiligo

Vitiligo usually begins with a few small white patches that may gradually spread over the body over the course of several months. Vitiligo typically begins on the hands, forearms, feet, and face but can develop on any part of the body, including the mucous membranes (moist lining of the mouth, nose, genital, and rectal areas), the eyes, and inner ears.

Sometimes the larger patches continue to widen and spread, but usually they stay in the same place for years. The location of smaller macules shifts and changes over time, as certain areas of skin lose and regain their pigments. Vitiligo varies in the amount of skin affected, with some patients experiencing few depigmented areas and others with widespread loss of skin color.

Neurogenic factors: A substance that is toxic to melanocytes may be released at nerve endings in the skin.

Self-destruction: A defect in the melanocytes causes them to destroy themselves.

Causes

What causes vitiligo is unknown but there are a few theories about its etiology.

Some possible causes include:

• genetics: an estimated 20% of those diagnosed with vitiligo have a first degree relative with the condition, according to a review
• autoimmune response: the body’s immune system attacks and kills melanocytes
• oxidative stress: when people have an imbalance of oxygen molecules and antioxidants, it may lead to vitiligo
• environmental factors: such as emotional distress, sunburn, or chemical exposure
• Vitiligo may also be triggered by certain events, such as physical or emotional stress. Because none of the explanations seem to completely account for the condition, it’s possible that a combination of these factors is responsible for vitiligo.

What other conditions resemble vitiligo?

There are other conditions that make the skin change or lose pigmentation. These include:

• Chemical leukoderma: Exposure to some industrial chemicals cause damage to the skin cells, resulting in linear or splotchy white areas of skin
• Tinea versicolor: This yeast infection can create dark spots that show on light skin, or light spots that show on darker skin.
• Albinism: This genetic condition means that you have lower levels of melanin in the skin, hair and/or eyes.
• Pityriasis alba: This condition starts off with red and scaly areas of skin, which fade into scaly lighter patches of skin.

Management & Treatment

How is vitiligo treated?
There is no cure for vitiligo. The goal of medical treatment is to create a uniform skin tone by either restoring color (repigmentation) or eliminating the remaining color (depigmentation). Common treatments include camouflage therapy, repigmentation therapy, light therapy and surgery. Counseling may also be recommended.

Camouflage therapy:

• Using sunscreen with an SPF of 30 or higher. Also, the sunscreen should shield ultraviolet B light and ultraviolet A light (UVB and UVA). Use of sunscreens minimizes tanning, thereby limiting the contrast between affected and normal skin.
• Makeups help camouflage depigmented areas. One well-known brand is Dermablend®.
• Hair dyes if vitiligo affects the hair.
• Depigmentation therapy with the drug monobenzone can be used if the disease is extensive. This medication is applied to pigmented patches of skin and will turn them white to match the areas of vitiligo.

Repigmentation therapy:

• Corticosteroids can be taken orally (as a pill) or topically (as a cream put on the skin). Results may take up to 3 months. The doctor will monitor the patient for any side effects, which can include skin thinning or striae (stretch marks) if used for a prolonged period.
• Topical vitamin D analogs.
• Topical immunomodulators such as calcineurin inhibitors.

Light therapy:

• Narrow band ultraviolet B (NB-UVB) requires two to three treatment sessions per week for several months.
• Excimer lasers emits a wavelength of ultraviolet light close to that of narrow band UVB. This is better for patients who do not have widespread or large lesions since it is delivered to small, targeted areas.
• Combining oral psoralen and UVA (PUVA) is used to treat large areas of skin with vitiligo. This treatment is said to be very effective for people with vitiligo in the areas of the head, neck, trunk, upper arms and legs.

Surgery:

• Autologous (from the patient) skin grafts: Skin is taken from one part of the patient and used to cover another part. Possible complications include scarring, infection or a failure to repigment. This might also be called mini grafting.
• Micropigmentation: A type of tattooing that is usually applied to the lips of people affected by vitiligo.

Counseling:
Vitiligo can cause psychological distress and has the ability to affect a person’s outlook and social interactions. If this happens, your caregiver may suggest that you find a counselor or attend a support group.