Vitiligo

Last reviewed by Dr.Mary on August 7th, 2018.

What is Vitiligo?

This is a skin condition where the skin loses the pigmentation that regulates the tint of an individual’s eyes, skin and hair. This occurs when the cells which create melanin either can no longer create melanin or die causing enlarged patches of white irregular shapes to slowly develop on the skin.

Vitiligo appears in all races but is normally more noticeable as well as disfiguring in individuals who have darker skin. It normally starts as a very small area of lost pigmentation that with time spreads. These deviations in the skin may result in worries and stress about appearance.

Vitiligo Symptoms

The major symptoms or sign of vitiligo is:

Loss of pigment that leaves patches of milky-white skin – depigmentation

Other signs less common may include:

Early graying or whitening of the hair on the eyelashes, scalp, beard or eyebrows
Color loss in the tissues lining the inside of the mouth – mucous membranes
Change or loss in color of the inner layer of the eye – retina

While almost any area of the body can be affected by vitiligo, depigmentation normally develops first on sun-exposed areas of the skin, such as feet, hands, lips, arms, and face. Vitiligo can begin on any age but usually first appears between the ages of 10 and 30 years of age. Generally vitiligo develops in 1 of 3 patterns:

* Segmental – Loss of skin color develops on just one side of the body
* Focal – Depigmentation is restricted to one or only a few areas of the body
* Generalized – The pigment loss is widespread across numerous areas of the body which is often symmetrical.

The normal course of vitiligo is extremely problematic to foretell. Often the patches will stop to form without any treatment. Nevertheless, in many cases, the loss of pigment spreads and ultimately involves the majority of the skin surface.

An individual should see a physician when areas of the hair, eyes, or skin lose coloring. While there is no cure of vitiligo, there exist treatments which can help to stop or at least slow the process of depigmentation as well as attempt to return some color to the skin.

Vitiligo Causes

Vitiligo normally occurs when the melanin – the dark pigmentation in the epidermis that contributes to the skin its normal color – is not produced or is destroyed. The patch of skin that is involved becomes white. Now why this occurs is not known.

Medical professionals have different theories as to exactly what causes vitiligo to occur. It could be because of an immune system condition. Genetics could be a factor due to the fact that there is an ever enlarged rate of vitiligo occurrences in some families. Many individuals have recounted single events such as emotional distress or sunburns that had prompted the condition. But, there is no theory that has been confirmed to be a definite basis of vitiligo.

Vitiligo Cure

Vitiligo cannot be cured or stopped, but the local manifestations can be managed using oral or topical treatments. If the disease is limited and not widespread, topical treatment can have advantages. There are also trial studies being done is small groups on different possible cures for vitiligo.

Vitiligo Treatment

If the physician believes and individual has vitiligo, he/she will discuss medical history as well as examine the individual. Significant features in a medical history consist of:

History in the family of vitiligo or other autoimmune disease
History of sensitivity to sun or other skin disorders
Sunburn, rash or other skin disturbance in 2 to 3 months of the beginning of the loss of pigmentation
Early graying of hair – before the age of 35
Physical illness or stress

The physician also will examine the individual to eliminate other medical conditions or skin problems, such as psoriasis or dermatitis.

Together with gathering the family and personal medical history as well as examining the skin, the physician will also:

Obtain a tiny sample or biopsy of the skin that is affected
Draw a blood sample to check cell count, functioning of thyroid and to search for any existence of “anti-nuclear antibodies” (autoantibody type) that could be an indication of an autoimmune syndrome.

Furthermore, the physician will recommend that the individual see an eye physician– ophthalmologist – for an eye exam in order to look for inflammation in the eyes – uveitis.

Medical therapy for vitiligo is not always necessary. There are home care steps for instance using sunscreen as well as applying cosmetic creams, to improve the look of the skin. For those individuals with fair skin, evading tanning or bronzing can cause these regions to be almost inconspicuous.

Contingent on the size, location and number of the patches of white, the individual can choose to seek medical therapy. The goal of medical therapy for vitiligo is to smooth out the tone of the skin, by restoring pigmentation or by destroying any remaining color. Any therapy for vitiligo can take up to six to eighteen months, and might need to tried more than one therapy before you will find the one that works best.

Medical treatments

Topical corticosteroid treatment

Corticosteroids can aid the color to return to the skin – repigmentation – especially if the drug is begun timely in the ailment. Topical corticosteroid ointment or creams which are milder can be recommended for youngsters as well as for individuals who have huge areas of skin that is depigmented.

Topical immunomodulators

Ointments which are topical and that contain pimecrolimus or tacrolimus are normally effective for individuals with small regions of depigmentations specifically on the face or the neck. This treatment can have very few side effects as compared to corticosteroids and may be used together with UVB therapy.

PUVA or topical psoralen plus ultraviolet A

An option that is also known as photochemotherapy, and can be effective when 20% or less of the body have patches that are depigmented.

Oral PUVA or Oral psoralen photochemotherapy

If there are depigmented areas covering greater than 20% of the body, the physician can endorse oral psoralen. With this treatment, the individual consumes psoralen orally approximately 2 hours prior to contact to UVA light.

UVB or narrowband ultraviolet B treatment

Narrowband UVB, is an exceptional type of UVB light, and is an option to PUVA. This kind of therapy may be managed like PUVA and given as many as 3X each week. But, no preapplication of oral psoralen is necessary, which shortens the therapy process.

Depigmentation

This can be a possibility if the individual has vitiligo covering at least half of the skin. This treatment lightens the natural areas of the skin to equal the areas which already have turned white.

Surgical treatments

Autologous skin grafts

This kind of grafting usage the individuals own tissue (autologous). The physician removes tiny areas of skin in one area of the body and fastens them to a different area that is affected.

Blister grafting

The physician generates blisters on the pigmented skin, usually by using suction. The tops of these new blisters are detached and replaced with a blister of equal size which has been produced and detached in an area of no pigment.

Tattooing or micro pigmentation

Tattooing transplants pigment in the skin with a distinctive surgical device. This tattooing is most effective round lips and in individuals with dark skin.

Therapies that are experimental

Physicians are enduring to try and find new ways that are better for the treatment vitiligo. One innovative possibility is a method called an “autologous melanocyte transplant”. A section of normal skin is taken to cultivate melanocytes in the laboratory. These freshly developing melanocytes are at that time transferred to the zones on the body that lacks pigment.

Another treatment being developed uses a composite found in pepper this is black referred to as piperine. In studies with mice, this piperine was established to be very nominal in causing repigmentation.

Vitiligo in Children

The way that a child reacts to vitiligo normally depends to a great extent on the child’s age. Very small children – under age 4 – seem nearly oblivious of this condition. But an inappropriate episode for instance name-calling can unexpectedly make them mindful of their disorder but these are quickly forgotten. The joy of little children is entrenched in the family, the presence loved and being treated well.

For those children in the years – ages 5 to 10 – the emphasis of life remains to be the family but the peer set is becoming more important but the children of this age typically have rather shallow standards for the recognition or non-acceptance of a peer. Vitiligo may cause some anxiety for the elementary school years. After some primary instances, children with vitiligo are normally acknowledged and their disease ultimately turns out to be “invisible” to friends.

Children may undergo treatments but some treatments are not suitable for children. The managements that can be used in the treatment of children may be creams and ointments, PUVA with topical psoralen, and NB-UBV. Other UVA therapies are not suggested.