Vitiligo is a skin condition
resulting from loss of pigment which produces white patches. Any
part of the body may be affected. Usually both sides of the body are
affected. Common areas of involvement are the face, lips, hands,
arms, legs, and genital areas.
Who Gets Vitiligo?
Vitiligo affects one or two of every 100
people. About half the people who develop it do so before the age of 20;
about one - fifth have a family member with this condition. It may be an
autoimmune process (the body makes antibodies to its own pigment cells).
Most people with vitiligo are in good general health, although vitiligo may
occur with other autoimmune diseases such as thyroid disease.
What Determines Skin Color?
Melanin, the pigment that determines color
of skin, hair, and eyes, is produced in cells called melanocytes. If these
cells die or cannot form melanin, the skin becomes lighter or completely
How Does Vitiligo Develop?
Typical vitiligo shows areas of
milky-white skin. However, the degree of pigment loss can vary within each
vitiligo patch. There may be different shades of pigment in a patch, or a
border of darker skin may circle an area of light skin. Vitiligo often
begins with a rapid loss of pigment. This may continue until, for unknown
reasons, the process stops. Cycles of pigment loss, followed by times where
the pigment doesn't change, may continue indefinitely. It is rare for skin
pigment in vitiligo patients to return on its own. Some people who believe
they no longer have vitiligo actually have lost all their pigment and no
longer have patches of contrasting skin color. Although their skin is all
one color, they still have vitiligo. The course and severity of pigment loss
differ with each person. Light-skinned people usually notice the contrast
between areas of vitiligo and suntanned skin in the summer. Year round,
vitiligo is more obvious on people with darker skin. Individuals with severe
cases can lose pigment all over the body. There is no way to predict how
much pigment an individual will lose.
How is Vitiligo Treated?
Sometimes the best treatment for vitiligo
is no treatment at all. In fair-skinned individuals, avoiding tanning of
normal skin can make areas of vitiligo almost unnoticeable because the (no
pigment) white skin, of vitiligo has no natural protection from sun. These
areas are easily sunburned, and people with vitiligo have an increased risk
to skin cancer. They should wear a sunscreen with a SPF of at least 30
should be used on all areas of vitiligo not covered by clothing. Avoid the
sun when it is most intense to avoid burns. 23-year-old woman has areas of
total depigmentation on the legs. Disguising vitiligo with make-up,
self-tanning compounds or dyes is a safe, easy way to make it less
noticeable. Waterproof cosmetics to match almost all skin colors are
available. Stains that dye the skin can be used to color the white patches
to more closely match normal skin color. These stains gradually wear off.
Self-tanning compounds contain a chemical called dihydroxyacetone that does
not need melanocytes to make the skin a tan color. The color from
self-tanning creams also slowly wears off. None of these change the disease,
but they can improve appearance. Micropigmentation tatooing of small areas
may be helpful. If sunscreens and cover-ups are not satisfactory, your
doctor may recommend other treatment. Treatment can be aimed at returning
normal pigment (repigmentation) or destroying remaining pigment
(depigmentation). None of the repigmentation methods are permanent cures.
Treatment of Vitiligo in Children
Aggressive treatment is generally not used
in children. Sunscreen and cover-up measures are usually the best
treatments. Topical corticosteroids can also be used, but must be monitored.
PUVA is usually not recommended until after age 12, and then the risks and
benefits of this treatment must be carefully weighed.
Topical Corticosteroids — Creams
containing corticosteroid compounds can be effective in returning pigment to
small areas of vitiligo. These can be used along with other treatments.
These agents can thin the skin or even cause stretch marks in certain areas.
They should be used under your dermatologist's care. This 67-year-old man
has multiple lesions of depigmentation of the face.
PUVA is a form of repigmentation therapy
where a type of medication known as Psoralen is used. This chemical makes
the skin very sensitive to light. Then the skin is treated with a special
type of ultraviolet light call UVA. Sometimes, when vitiligo is limited to a
few small areas, Psoralens can be applied to the vitiligo areas before UVA
treatments. Usually, however, Psoralens are given in pill form. Treatment
with PUVA has a 50 to 70% chance of returning color on the face, trunk, and
upper arms and upper legs. Hands and feet respond very poorly. Usually at
least a year of twice weekly treatments are required. PUVA must be given
under close supervision by your dermatologist. Side effects of PUVA include
sunburn-type reactions. When used long-term, freckling of the skin may
result and there is an increased risk of skin cancer. Because Psoralens also
make the eyes more sensitive to light, UVA blocking eyeglasses must be worn
from the time of exposure to Psoralen until sunset that day to prevent an
increased risk of cataracts. PUVA is not usually used in children under the
age of 12, in pregnant or breast feeding women, or in individuals with
certain medical conditions.
Narrow Band UVB (NBUVB)
This is a form of phototherapy that
requires the skin to be treated two, sometimes three, times a week for a few
months. At this time this form of treatment is not widely available. It may
be especially useful in treating children with vitiligo.
Transfer of skin from normal to white
areas is a treatment available only in certain areas of the country and is
useful for only a small group of vitiligo patients. It does not generally
result in total return of pigment in treated areas.
Other Treatment Options
Other treatment options include a new
topical class of drugs called immunomodulators. Due to their safety profile
they may be useful in treating eyelids and children. Excimer lasers may be
tried as well.
For some patients with extensive
involvement, the most practical treatment for vitiligo is to remove
remaining pigment from normal skin and make the whole body an even white
color. This is done with a chemical called monobenzylether of hydroquinone.
This therapy takes about a year to complete. The pigment removal is
Is Vitiligo Curable?
At this time, the exact cause of vitiligo
is not known, however, there may be an inherited component. Although
treatment is available, there is no single cure. Research is ongoing in
vitiligo and it is hoped that new treatments will be developed. .
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