What is vitiligo?
There is no known cause for vitiligo, but it may be an autoimmune disease or a disorder in which one or more genes contribute to its development. The white patches that develop on the skin are caused when melanocytes in the skin, cells that produce melanin, are destroyed. The color of the skin is determined by the amount of melanin that the body produces. Contributing factors to the development of vitiligo may include emotional distress, sunburn, or preexisting autoimmune diseases such as hyperthyroidism, but they are not considered causative.
Vitiligo usually develops before the age of forty and affects all races and sexes equally, with up to 2 percent of the population affected. The disorder may run in families; those with a family history of vitiligo or premature graying of the hair are at an increased risk.
The primary symptom of vitiligo is the loss of pigment in the skin leading to the development of widespread, irregularly shaped white patches on the body. The white patches are more evident in dark-skinned individuals and are much less noticeable in fair-skinned individuals. The patches may develop rapidly. Cycles of depigmentation followed by stable periods may occur throughout the lifetime of the affected individual. The areas commonly affected are the areas exposed to the sun, body folds such as the armpit and groin area, body openings, the area around moles, and areas of previous injury to the skin. Premature graying of the hair, including eyelashes, eyebrows, and beards, may also be symptomatic of vitiligo. The course of the disease is difficult to predict, and the spread of the white patches may spontaneously stop, but in most cases, the entire surface of the body is ultimately affected.
If an individual notices areas of skin that are losing color, early graying of hair, or loss of eye color, then a doctor should be consulted. A dermatologist, a doctor who specializes in disease of the skin, is usually the physician of choice to treat vitiligo, but other specialists may be involved. There is no cure for vitiligo. The goal of treatment is to restore color to the skin and stop future depigmentation, if possible.
The diagnosis of vitiligo begins with a thorough patient examination and history, including any family history of vitiligo or autoimmune disease, unusual sun exposure, sunburn or other skin condition in the period of time just prior to onset of the white patches, and recent stress or physical illness. Blood may be drawn to determine if there are thyroid or other blood-related dysfunctions. A referral to an ophthalmologist (a doctor who specializes in the eye) for a comprehensive eye examination for inflammation may be indicated.
Treatment depends on the site and extent of the discolored areas. Therapeutic cosmetics may be used to camouflage white patches and are readily available in most department stores. The use of sunscreen is important to prevent normal skin from becoming increasingly darker than the vitiligo patches, especially in fair-skinned individuals. Sunless tanning preparations may also be used to tint areas of skin.
Topical corticosteroids may be useful in the early stages of the disease. Vitamin D derivatives may be used in conjunction with corticosteroids or with ultraviolet light. Other topical ointments may be used in small areas of vitiligo, although studies are small and side effects including an increased risk of lymphoma and skin cancer are possible. Topical psoralen with ultraviolet A (PUVA therapy), or photochemotherapy, may be effective, although severe sunburn, blistering, and other complications may occur. If more than 20 percent of the body is involved, oral PUVA may be used. Regardless of medical treatment, frequent visits to the doctor’s office and careful monitoring are needed.
Narrowband ultraviolet B (UVB) therapy is a newer approach to treating vitiligo. No medicine is needed prior to application of the ultraviolet light. More research is needed, although small clinical trials have shown promise. Depigmentation therapy using monobenzyl ether of hydroquinone twice a day lightens all areas of the skin to match the areas of vitiligo in individuals with depigmentation that affects more than half the body. Autologous skin grafts and tattooing are options that may restore pigmentation or provide color to affected areas.
Support for the individual experiencing vitiligo is important, as the altered appearance caused by visible white patches may cause emotional distress. The extent of treatment may be determined by the psychological impact of the disease on the individual. Younger people and dark-skinned individuals may find the discoloration more disruptive in their daily lives and seek more aggressive therapies. Support groups are also available in many areas or online through organizations related to vitiligo therapy.
Research is being done to grow melanocytes in the laboratory from the patient’s own skin that can be transplanted into the areas of depigmentation. Studies are also being conducted with other medicines, and piperine found in black pepper has been found to be effective at repigmentation of skin in mice. While there are no significant clinical trials, alternative medicines have been tried in individuals with slow-spreading vitiligo. Patients should talk to their doctors before trying any over-the-counter treatments.
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