Melanin is responsible for giving the skin its color. Vitiligo is said to occur in people when cells that are responsible to produce melanin dies or stop functioning. Vitiligo is a non-threatening/non-contagious disease of the skin that causes loss of skin color in patches. The condition can affect any of the body; the discolored part gets bigger with time.
Causes of Vitiligo
- Autoimmune disorder: A person’s immune system may develop antibodies that destroy melanocytes.
- Genetic factors: About 30% of cases of vitiligo run in family and this increases the chance of getting vitiligo.
- 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
Vitiligo is caused by the lack of melanin pigment in the skin. Melanin is produced by cells present in the skin called melanocytes, and it gives your skin its color. In Vitiligo, there are not enough working melanocytes to produce enough melanin in your skin.
Risk factors of Vitiligo
- Present in other family members.
- Family members with vitiligo or hair turning gray early
- Certain autoimmune diseases, such as those that affect the thyroid gland
- Family history of other autoimmune conditions.
- Someone who has melanoma (a type of skin cancer) or non-Hodgkin lymphoma (cancer of the lymphatic system)
Symptoms of Vitiligo
The main symptom associated with Vitiligo is white patches on the skin. These patches may be of different sizes or found at different locations of the body. The patches may be focal (only a few areas) or be more widely spread (generalized)
Nonsegmental (most common):
- Present on both sides of the body.
- More likely to be generalized and spread.
- May involve the hair.
- Usually autoimmune, with flare-ups.
- Present on one side of the body
- May develop quickly, but then stop spreading
- Not usually autoimmune
- Some common sites of pigment loss include:
Types of Vitiligo
- Generalized: This is the most common type, in this case, macules appear in various places on the body.
- Segmental: This is restricted to one side of the body or one area, such as the hands or face.
- Mucosal: It affects mucous membranes of the mouth and/or the genitals.
- Focal, which is a rare type in which the macules are in a small area and do not spread in a certain pattern within one to two years.
- Trichome, which means that there is a white or colorless center, then an area of lighter pigmentation, and then an area of normally colored skin.
- Universal, another rare type of vitiligo, and one in which more than 80% of the skin of the body lacks pigment.
Diagnosis of vitiligo
- Medical History taking and Physical Examination
- A wood lamp is used to check if a patient has vitiligo, the lamp shines ultraviolet (UV) light onto the skin to help differentiate from other skin conditions.
- Skin biopsy and blood tests
Treatment of Vitiligo
The choice of treatment depends on the age of an individual, how much skin is involved and where, how quickly the disease is progressing, and how it’s affecting one’s life. Treatment of the condition can be done with a drug, surgery, or therapy; the process may take many months to know its effectiveness. Even if treatment is successful for a while, the results may not last or new patches may appear on the body. Medication is most times recommended to be applied to the skin as maintenance therapy to help prevent it from coming back.
No drug can stop the process of vitiligo the loss of pigment cells (melanocytes). But some drugs, used alone, in combination, or with light therapy, can help restore some skin tone.
- Drugs that control inflammation. Applying a corticosteroid cream to affected skin might return color. This is most effective when vitiligo is still in its early stages.
- Medications that affect the immune system. Calcineurin inhibitor ointments, such as tacrolimus (Protopic) or pimecrolimus (Elidel) might be effective for people with small areas of depigmentation, especially on the face and neck.
Light therapy. Phototherapy with narrowband ultraviolet B (UVB) has been shown to stop or slow the progression of active vitiligo. It might be more effective when used with corticosteroids or calcineurin inhibitors given the FDA warning regarding the possible risk of skin cancer with the use of calcineurin inhibitors, talk with your doctor about the risks and benefits of using these drugs with phototherapy.
- Combining psoralen and light therapy. This treatment combines a plant-derived substance called psoralen with light therapy (photochemotherapy) to return color to the light patches.
- Removing the remaining color (depigmentation). This therapy may be an option if your vitiligo is widespread and other treatments haven’t worked. A depigmenting agent is applied to unaffected areas of the skin. This gradually lightens the skin so that it blends with the discolored areas.
If light therapy and medications haven’t worked, some people with stable diseases may be candidates for surgery. The following techniques are intended to even out skin tone by restoring color:
- Skin grafting. In this procedure, very small sections of your healthy, pigmented skin are transferred to areas that have lost pigment. This procedure is sometimes used in small patches of vitiligo.
- Blister grafting. In this procedure, blisters are created on your pigmented skin, usually with suction, and then transplant the tops of the blisters to discolored skin
- Cellular suspension transplant. In this procedure, some tissue is taken on your pigmented skin, puts the cells into a solution, and then transplants onto the prepared affected area.