Vitiligo is a disease where melanocytes are unable to produce melanin or there are not enough of them. Melanin is the substance that gives color to the skin, eyes and hair. In its absence, the skin would appear pale but mostly white. This is what happens in the case of vitiligo.
The first signs often appear on body areas exposed to the sun, such as the arms and face. The signs may be localized or gradually spread. For example, it may start with a spot which grows and joins with nearby similar spots to form a patch. Some vitiligo patches do not spread.
There is no known vitiligo cure. In fact, its exact cause is not known. Regardless, many treatment options are available. These options aim to improve symptoms by restoring skin color or evening up skin tone. Vitiligo does more damage psychologically than it does physically. Support therapies may therefore be incorporated in overall treatment.
Vitiligo types and facts
There are two identifiable types of vitiligo:
- Segmental – this type affects only one segment of the body. For example, loss of skin color may occur on the left eyebrow and stop at that. It is common in babies, where patches form, spread a bit and stop.
- Non-segmental – this is the most common type. Its main feature is symmetrical appearance of vitiligo signs. For example, if the left hand is affected, the right hand too will be affected. It is subdivided to other categories such as universal, mucosal and acrofacial vitiligo. Universal vitiligo a rare subtype where signs occur almost all over the body. Mucosal and acrofacial vitiligo develop on mucous membranes and finger/toes respectively. Non-segmental vitiligo will in most cases spread and trigger new cycles.
Below are facts worth knowing about vitiligo:
- Vitiligo is life-altering but not life-threatening. Although not dangerous, it goes beyond being a mere cosmetic problem.
- Statistics show that 1-2 percent of world population is affected. 30% of this is in children. Age, sex, and ethnicity are not considered risk factors. Most cases however begin prior to age of 20 and 40 years.
- Vitiligo is not contagious. Patients should not be isolated or discriminated. Touching a vitiligo-affected areas doesn’t cause pain to the patient.
- It is not known exactly what causes vitiligo. The disease is thought to be autoimmune or caused by a virus.
- There is no known cure for vitiligo. Options to manage the condition are available. Ongoing research may introduce more effective treatments in the future.
Vitiligo first signs and symptoms
First signs often appear on areas such as arms, lips and skin around eyes. They however can occur anywhere in the body. White patches caused by loss of skin color are usually the first to show up. In some people, it starts with a localized spot which then develops into a patch.
Depending on the type, the initial patch or spot may spread or join with other patches. This is how it starts to spread.
Affected areas have no defined borders. The center may be whiter than the edges. Blood vessels might give a pinkish appearance to the edges. Discoloration may also be present.
Unlike some skin conditions, vitiligo is not associated with skin dryness or scaling. There may be episodes of itchiness and mild inflammation.
When vitiligo affects hair roots, the hair becomes grey or white. Loss of color can also be experienced in the eyes and mucous membranes such as in the mouth.
Areas affected by vitiligo lack melanin. As a result, they become extremely sensitive to sun. Patients can develop agonizing sunburns even after being exposed to sun for a short period of time. Generally, signs can appear on:
- Skin around eyes
- Inside mouth
- Back of hands
- Groin region
- Genital region
- Rectal area
- On top of feet
How to identify it:
Vitiligo is not hard to identify. The first sign to look for is presence of white patches, either localized or widespread. However, loss of skin color can also be caused by some other diseases.
Another feature that may help with identification is the fact that vitiligo is not painful and not contagious. Not being contagious doesn’t mean that signs will not spread to adjacent areas.
Presence of risk factors such as thyroid disease, diabetes and genetic predisposition may also help with identification. If doubts exist, go for medical diagnosis.
What causes vitiligo?
Once vitiligo develops, it is very unlikely that it will disappear. One percent of world population may sound like a small number but actually translates to about 70 million people. Nearly half of these people develop vitiligo before their 20th birthday. But what causes the vitiligo skin disorder?
Much of what is known about vitiligo causes is that the disease develops when melanocytes are not present or are unable to make melanin. What triggers this disorder is not exactly known.
Vitiligo is mostly identified as an autoimmune disease. Autoimmune diseases occur when the immune system becomes overactive and attacks healthy cells. People diagnosed with diabetes, thyroid disease (Hashimoto’s disease) and anemia may be at higher risk of developing vitiligo.
Certain factors make it more likely that vitiligo will develop in some people. They include:
- Family history – vitiligo tends to run in families. If a close family member has been diagnosed with vitiligo or another autoimmune disease, it may be likely that other members from that family will develop vitiligo. So is vitiligo hereditary? Not necessarily. With genetically predisposed diseases, there is no guarantee that siblings will inherit them from parents.
- Sunburns and cuts – sunburns and cuts may destroy melanocytes. They can also trigger predisposed vitiligo.
- Stressful events – stressful events trigger vitiligo cycles. Examples include childbirth and getting a tattoo. Mental stress may also trigger the disease.
People with dark skins may have more noticeable vitiligo signs. This doesn’t mean that condition is more severe in them. It may be interesting to know that vitiligo can also occur in animals like cats. Vitiligo cat cases are, however, not very common.
Vitiligo and lupus
The similarity between vitiligo and lupus ends at the fact that both are autoimmune diseases. Having either is not likely to trigger the other.
Lupus can be confined to the skin or occur systematically. It is a life-threatening disease characterized by widespread inflammation. The fact that lupus is life-threatening is opposite of vitiligo. When confined to the skin, signs such inflammation are only present on the skin. The more dangerous type involves different parts of the body including vital organs like the heart and lungs. First signs include rash, pain in joints and fatigue.
It has been noted that vitiligo often occurs in people diagnosed with other autoimmune disorders such as pernicious anemia and thyroid disease. Thyroid disease is also often found in people with lupus. Regardless, lupus and vitiligo are not closely related.
Vitiligo diagnosis and treatment
Diagnosis is done by physically examining the patient for typical vitiligo symptoms. This may be done under special lighting. The patient will be required to provide their medical history details such as whether they are related to a person with vitiligo.
To rule out other skin conditions such as caused by fungi and viruses, the doctor may take skin biopsy. Blood tests can also be taken to check for signs of autoimmune diseases such as diabetes.
Treatment is mainly done to even skin tone or restore skin color. These are no easy tasks. They can be done with:
- Topical corticosteroids – these come in form of creams to be applied directly on affected areas. When treatment is started early, they may add some skin color. Results are often improved with other treatments. Vitiligo on face and in dark skinned people responds well to this treatment. Patients are encouraged to check with their doctors in the course of treatment. This mostly because corticosteroids come with a number of side effects such as skin thinness. Extra caution should be taken when using corticosteroids to treat vitiligo in children.
- Medications to suppress immunity – if vitiligo is being caused by overactive immune system, it can be treated with immunosuppressants. The main drawback is that such medications may encourage other diseases such as cancer.
- Use of light – light boxes or lasers is used in this case. If vitiligo is widespread, the patient sits in a light box and receives controlled dosages of light. Lasers are used for localized or small areas such as vitiligo on lips. Patients are required to go for appointments twice or thrice a week. While vitiligo laser treatment works in most patients, restored skin color often disappears after a few years.
- PUVA light therapy – in this case, UVA light and a plant-derived substance called psoralen are used. Psoralen can be taken by mouth or applied directly. This treatment works for localized and widespread vitiligo. It requires weekly appointments for a period of about 1 year. It is quite effective. Psoralen can cause harm when exposed to the eyes.
- Skin grafting – this involves removing colored skin from healthy body areas and using it to cover vitiligo affected areas. It is considered when other less crude methods have failed. The treatment is effective in about 90% of all cases. Main disadvantages include scarring, possibility of infection and cobblestone skin.
- Micropigmentation – this involves direct implantation of pigment to affected areas. It is ideal for vitiligo on lips and in dark skinned people. The main disadvantages include failure to get skin tone consistency right and risk of triggering other vitiligo cycles.
- Depigmentation – when vitiligo affects more than 50% of the body, some patients opt for depigmentation. This is where pigment is removed from unaffected areas to match the white areas. After the treatment, patients are left with completely white skin. The treatment can run a course of up to 4 years. Patients become very sensitive to sun after this treatment. Occasionally, spots of pigment appear which can be removed with creams.
Other possible treatments:
Ongoing research is seeking to introduce more vitiligo treatments. One example is use of drugs which promote growth of melanocytes. This may effectively treat even widespread vitiligo.
Vitiligo treatment at home and prevention
Ginkgo biloba vitiligo treatment is touted as an effective option. Enough evidence to fully support this claim is however lacking. In some clinical trials, the herb has been observed to restore skin color as well as prevent further loss of pigment.
Vitamins such as vitamin C and B-12 are also said to be of help in vitiligo treatment. These are nicknamed vitamins for vitiligo. Such claims have also been produced for some enzymes and minerals. Currently, there is no officially accepted home remedy for vitiligo treatment.
Sunscreens and colored cosmetics may help with prevention and concealing. Sunscreens keep affected areas from suffering severe sunburn. Extreme sunburns can destroy melanocytes and aggravate vitiligo. Colored cosmetics work by evening skin tone to conceal vitiligo. It requires patience to get the best concealer for vitiligo.
Vitiligo does more harm emotionally than physically. This can be improved by getting the right doctor, learning more about the disease and connecting with other patients.
Vitiligo is not among the diseases that worsen with time. While the disease may keep spreading to adjacent areas or recur, it is very unlikely to cause other health complications.
The main possible complication is severe sunburn. Melanin not only gives color to the skin but also protects from UV radiation. In its absence, the skin is particularly prone to sun burns even after being exposed for not long. This can be prevented with sunscreens.
Another possible complication is emotional distress. White patches on skin are not a common phenomenon. In fact, support therapy is as important as physical vitiligo treatment. Finding the right doctor can be very helpful in this regard.
Anyone can get vitiligo, the same way a person with vitiligo can be as productive as anyone else. Inspiration can be sourced from cases of celebrities with vitiligo such as the Jon Hamm vitiligo case.
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