Vitiligo is a disease in which the pigment cells of the skin, melanocytes, are destroyed in certain areas.
Symptoms and signs of vitiligo include loss of skin color in the form of depigmented, or white, patches of skin in any location on the body.
Vitiligo can be focal and localized to one area, or it may affect several different areas on the body.
The exact cause of vitiligo is unknown, although most experts believe that it is an autoimmune condition in which the body's immune system mistakenly attacks and destroys certain cells within the body.
Most people who have vitiligo will develop the condition prior to age 40; about half develop it before age 20.
Vitiligo may have a genetic component, as the condition tends to run in families.
Vitiligo is sometimes associated with other medical conditions, including thyroid dysfunction.
There is no way to determine if vitiligo will spread or remain confined to one location.
Vitiligo is not painful and does not have significant health consequences; however, it can have emotional and psychological consequences.
Some medical treatments can reduce the severity of the condition, but it can be difficult to cure.
There is no known way to prevent vitiligo.
There are no proven home remedies to cure vitiligo, but the use of sunscreens as well as makeup or dyes to cover the light areas of skin may improve appearance.
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Vitiligo is a long-term problem in which growing patches of skin lose their color. It can affect people of any age, gender, or ethnic group.
The patches appear when melanocytes within the skin die off. Melanocytes are the cells responsible for producing the skin pigment, melanin, which gives skin its color and protects it from the sun's UV rays.
The total area of skin that can be affected by vitiligo varies between individuals. It can also affect the eyes, the inside of mouth, and the hair. In most cases, the affected areas remain discolored for the rest of the person's life.
Here are some key points about vitiligo. More detail is in the main article.
Vitiligo can affect people of any age, gender, or ethnicity.
There is no cure, and it is usually a lifelong condition.
The exact cause is unknown, but it may be due to an autoimmune disorder or a virus.
Vitiligo is not contagious.
Treatment options may include exposure to UVA or UVB light and depigmentation of the skin in severe cases.
medicalnewstoday.com Vitiligo causes melanocytes to die, leaving patches of pale skin.
The only symptom of vitiligo is the appearance of flat white spots or patches on the skin. The first white spot that becomes noticeable is often in an area that tends to be exposed to the sun.
It starts as a simple spot, a little paler than the rest of the skin, but as time passes, this spot becomes paler until it turns white.
The patches are irregular in shape. At times, the edges can become a little inflamed with a slight red tone, sometimes resulting in itchiness.
Normally, however, it does not cause any discomfort, irritation, soreness, or dryness in the skin.
Vitiligo is photosensitive. The areas that are affected will be more sensitive to sunlight than those that are not.
It is hard to predict whether the patches will spread, and by how much. The spread might take weeks, or the patches might remain stable for months or years.
If the first white patches are symmetrical, this suggests a type of vitiligo known as non-segmental vitiligo. The development will be slower than if the patches are in only one area of the body.
The effects of vitiligo vary between people. Some people may have only a handful of white dots that develop no further, while others develop larger white patches that join together and affect larger areas of skin.
The lighter patches tend to be more visible in people with dark or tanned skin.
The exact causes of vitiligo are unclear. A number of factors may contribute.
an autoimmune disorder, in which the immune system becomes overactive and destroys the melanocytes
Vitiligo is not contagious. One person cannot catch it from another.
It can appear at any age, but studies suggest that it is more likely to start around the age of 20 years.
There are two types of vitiligo, non-segmental and segmental.
Non-segmental vitiligo is the most common type, accounting for up to 90 percent of cases.
The patches often appear equally on both sides of the body, with some measure of symmetry. They often appear on skin that is commonly exposed to the sun, such as the face, neck, and hands.
Common areas include:
backs of the hands
armpit and groin
genitals and rectal area
However, patches can also appear in other areas.
Non-segmental vitiligo is further broken down into sub-categories:
Generalized: There is no specific area or size of patches. This is the most common type.
Acrofacial: This occurs mostly on the fingers or toes.
Mucosal: This appears mostly around the mucous membranes and lips.
Universal: Depigmentation covers most of the body. This is very rare.
Focal: One, or a few, scattered white patches develop in a discrete area. It most often occurs in young children.
Segmental vitiligo spreads more rapidly but is considered more constant and stable and less erratic than the non-segmental type. It is much less common and affects only about 10 percent of people with vitiligo. It is non-symetrical.
It is more noticeable in early age groups, affecting about 30 percent of children diagnosed with vitiligo.
Segmental vitiligo usually affects areas of skin attached to nerves arising in the dorsal roots of the spine. It responds well to topical treatments.
The American Academy of Dermatology (AAD) describe vitiligo as "more than a cosmetic problem." It is a health issue that needs medical attention.
A number of remedies can help decrease the visibility of the condition.
The AAD recommend using a sunscreen, because the lighter patches of skin are especially sensitive to sunlight and they can burn easily. A dermatologist can advise on a suitable type.
Phototherapy with UVB light
Exposure to ultraviolet B (UVB) lamps is a common treatment option. Home treatment requires a small lamp and allows for daily use, which is more effective.
If the treatment is done in a clinic, this will need 2 to 3 visits a week and the treatment time will be longer.
If there are white spots across large areas of the body, UVB phototherapy may be used. This involves full-body treatment. It is done in a hospital.
UVB phototherapy, combined with other treatments, can have a positive effect on vitiligo. However, the result is not totally predictable, and there is still no treatment that will fully re-pigment the skin.
Phototherapy with UVA light
UVA treatment is usually conducted in a health care setting. First, the patient takes a drug that increases the skin's sensitivity to UV light. Then, in a series of treatments, the affected skin is exposed to high doses of UVA light.
Progress will be evident after 6 to 12 months of twice-weekly sessions.
In cases of mild vitiligo, the patient can camouflage some of the white patches with colored, cosmetic creams and makeup. They should select tones that best match their skin features.
If creams and makeup are correctly applied, they can last 12 to 18 hours on the face and up to 96 hours for the rest of the body. Most topical applications are waterproof.
When the affected area is widespread, covering 50 percent of the body or more, depigmentation can be an option. This reduces the skin color in unaffected parts to match the whiter areas.
Depigmentation is achieved by applying strong topical lotions or ointments, such as monobenzone, mequinol, or hydroquinone.
The treatment is permanent, but it can make the skin more fragile. Long exposure to the sun must be avoided. Depigmentation can take 12 to 14 months, depending on factors such as the depth of the original skin tone.
Corticosteroid ointments are creams containing steroids. Some studies have concluded that applying topical corticosteroids to the white patches can stop the spread. Others have reported total restoration of the original skin color. Corticosteroids should never be used on the face.
If there is some improvement after a month, the treatment should be paused for a couple of weeks before starting it again.
If there is no improvement after a month, or if side effects occur, treatment should stop.
Calcipotriene is a form of vitamin D used as a topical ointment. It may be used with corticosteroids or light treatment. Side effects include rashes, dry skin, and itching.
Drugs affecting the immune system
Ointments containing tacrolimus or pimecrolimus, drugs known as calcineurin inhibitors, can help with smaller patches of depigmentation. However, the United States (U.S.) Food and Drug Administration (FDA) warn of a connection between these drugs and skin cancer and lymphoma.
Psoralen may be used with UVA or UVB light therapy, as it makes the skin more susceptible to UV light. As the skin heals, a more normal coloration sometimes returns. Treatment may need to be repeated two or three times a week for 6 to 12 months.
Psoralen increases the risk of sunburn and skin damage, and therefore also skin cancer in the long term. It is not recommended for children under 10 years.
In a skin graft, a surgeon carefully removes healthy patches of pigmented skin and uses them to cover affected areas.
This procedure is not very common, because it takes time and can result in scarring in the area where the skin came from and the area where it is placed.
Blister grafting involves producing a blister on normal skin using suction. The top of the blister is then removed and placed on an area where pigment has been lost. There is a lower risk of scarring.
Possible cures for the future
Research into potential cures or treatments for vitiligo is ongoing. Here are some of the most promising findings.
Vitiligo does not develop into other diseases, but people with the condition are more likely to experience:
changes to vision and tear production
A person with vitiligo is more likely to have another autoimmune disorder, such as thyroid problems, Addison's disease, Hashimoto's thyroiditis, type 1 diabetes, or pernicious anemia. Most people with vitiligo do not have these conditions, but tests may be done to rule them out.
Overcoming social challenges
If the skin patches are visible, the social stigma of vitiligo can be difficult to cope with. Embarrassment can lead to problems with self-esteem, and in some cases, anxiety and depressioncan result.
People with darker skin are more likely to experience difficulties, because the contrast is greater. In India, vitiligo is known as "white leprosy."
Increasing awareness about vitiligo, for example, by talking to friends about it, can help people with the condition to overcome these difficulties. Connecting with other who have vitiligo may also help.
Anyone with this condition who experiences symptoms of anxiety and depression should ask their dermatologist to recommend someone who can help.
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