Vitiligo is an autoimmune disease where melanin is not produced. Melanin gives color to skin and hair. The skin would look pale or milky-white in its absence. This is what happens with vitiligo. However, it is harmless as far as general health is concerned.
Signs can appear anywhere on the skin. In fact, the eyes and mucous membranes can be involved. In most cases, signs appear on body areas that mirror each other.
There is no known cure for vitiligo. Experts are also not sure what causes the disorder. Regardless, many treatment options are available. Better results are achieved when treatment is started early before vitiligo advances to later stages.
Vitiligo stages and spread
It is not that the vitiligo skin disorder follows defined stages as it spreads. In the beginning, a spot or speck appears which later develops into larger patches. This depends on the type of vitiligo being dealt with.
Signs often show up on areas exposed to the sun such as hands, arms and face. It is not common for them to appear spontaneously. At times, there will be multiple spots which spread and join together. This is in fact the most common result.
Most people are diagnosed with vitiligo before their twentieth or fortieth birthday. It is not common for vitiligo to develop in kids below the age of 3 years.
Early stages of vitiligo are marked with patches that may be whiter in the middle but pinkish at edges. The pink coloration is caused by presence of blood vessels. Sometimes, discoloration may be present.
Vitiligo is not associated with skin dryness, plaques or scaling. Some people experience itchiness and inflammation on affected areas. These are, however, mild and not that common. Applying sunscreens may help prevent such complications since vitiligo affected areas are particularly prone to sunburn.
Later vitiligo stages may involve widespread loss of skin color. Rarely, more than 50% of the body will be affected. Such cases are sometimes treated by removing pigment in unaffected areas for uniformity. All the same, it may stay localized. This is commonly seen in focal vitiligo which often occurs in children.
Types of vitiligo; segmental and non-segmental
Vitiligo is mainly categorized into segmental and non-segmental. Basically, segmental describes the vitiligo that develops on localized body areas while non-segmental describes symmetrical and widespread vitiligo.
There are various subdivisions which sometimes depend on your source of information. For example, types of vitiligo can be described in the following manner:
- Segmental – this is the type that occurs discreetly. Here, loss of skin color occurs on one or more body areas. It for example can appear on one side of the neck or in the genital region. This is type is most common in children. It is not associated with family history of vitiligo or autoimmune diseases like diabetes type 1.
- Focal – in focal vitiligo, few spots appear on a confined area. The spots may but don’t always join to form larger patches. If it is to spread, focal vitiligo turns into generalized vitiligo which is much harder to treat.
- Mucosal – as the name suggests, this is vitiligo of mucous membranes. Melanocytes also occur in soft linings of orifices such as the anus and nostrils.
Generalized vitiligo is the most common type. It is characterized by widespread vitiligo signs which are often consistent. The main feature is occurrence of depigmentation on body areas that mirror each other. Subtypes include:
- Acrofacial – this type appears on fingers, toes and lips. It is sometimes referred to as lip-tip vitiligo. Since small body areas are involved, treatment is more likely to be successful.
- Mixed – in this case, depigmentation presents as scattered patches in different body areas. This includes hair affected by vitiligo.
- Universal – this is a rare type. Depigmentation occurs on most or all of the body.
Vitiligo can also be categorized as segmental, perinevoid and bilateral. Bilateral accounts for most vitiligo cases. It is where patches occur on both right and left parts of the body in a symmetrical fashion. For example, patches can appear on hands, elbows or knees. Perinevoid is not common. Here, loss of skin color begins around a mole and spreads.
As you can see, all these subtypes are narrower categories of non-segmental and segmental vitiligo. The main difference is that the former occurs in a systematic manner.
Opposite of vitiligo; re-vitiligo
When less or no melanin is being produced, it is referred to as hypopigmentation. This makes the opposite of vitiligo hyperpigmentation or reverse vitiligo. Just like melanocytes may stop making melanin, the same can make excess melanin. There also are other ways in which loss of normal skin color can occur.
Among other things, melanin protects us from sun poisoning. It is therefore to be expected that spending a lot of time in the sun will make the skin appear darker. Diseases such as Addison’s disease can also cause hyperpigmentation. Sometimes, signs present as brown spots rather than widespread hyperpigmentation.
Birthmarks or beauty marks:
Most people have birthmarks which have always been there. Some birthmarks can become so big as to cause cosmetic problems or be located on body areas such as the face where they are very conspicuous. Birthmarks are generally not harmful but can be removed with lasers or creams.
It is creative to have blue colored people dominating the scenes of an Avatar movie. But when the phenomenon occurs in real life, something must be terribly wrong. Blue skin is a medical emergency caused by lack of oxygen in affected areas. Some chemicals, medications and dyes can cause this disorder.
Jaundice is a serious disease caused by accumulation of bilirubin. It indicates that the liver is not functioning properly, causing waste products from cells to not be efficiently disposed. The disease presents as yellowing of the skin and the white part of eyes.
Most infections cause some form of color change. For example, bacterial infection often results in red streaking and darkening of affected areas. Red streaks develop when lymphatic vessels become infected. Darkening indicates death of fat tissue due to toxins produced by bacteria. This is a serious complication of bacterial infections known as necrotizing fasciitis.
Hormones are body chemicals that govern many process and systems. A number of them are involved in production of eggs in the ovary and pregnancies. It is their fluctuations that cause the peculiar behaviors in women such as mood swings. Hormones sometimes lead to production of more melanin. The excess melanin results in mild hyperpigmentation which usually manifests on chest and face. This can also be caused by oral contraceptives. After pregnancy or quitting contraceptives pills, the effect should gradually disappear.
It is not likely that re-vitiligo will result in widespread hyperpigmentation. In fact, check with your doctor if signs of hyperpigmentation appear even on localized areas. It can be a case of medical emergency.
How does vitiligo occur?
In simple terms, vitiligo occurs once melanin stops being produced. How the whole process occurs and what triggers it is not well understood.
The largely accepted theory is that vitiligo is an autoimmune disease. Autoimmune diseases develop when an active immune system attacks healthy cells. There are many diseases that occur this way. In fact, it is the main similarity between vitiligo and lupus. Non-segmental vitiligo is the type that results from destruction of melanocytes by the immune system.
Naturally, immune cells are able to recognize normal body cells and keep from attacking them. Factors or substances that take away this ability are known as triggers. In case of vitiligo, genetic factors are common triggers. It is for example common for children born of parents diagnosed with diabetes type 1 or Hashimoto’s thyroid disease to develop vitiligo. Signs of diabetes include being thirsty and the frequent urge to urinate. Thyroid disease causes extreme fatigue and sluggishness. Such symptoms may be present prior to manifestation of vitiligo symptoms.
Sunburns and cuts are also common vitiligo triggers. They can easily cause loss of melanocytes which may or may not spread.
Mental stress and physical trauma have also been identified as potential vitiligo triggers. For example, a complicated childbirth can cause segmental vitiligo in babies. Getting tattooed can cause enough skin trauma to trigger vitiligo cycles. The same can be said of mental stress. A good example is the Jon Hamm vitiligo case which is thought to have been triggered by stress.
An interesting fact is that vitiligo is not a disease for humans alone. For example, vitiligo cat or dog cases are possible.
What types of vitiligo are curable?
So what should you do once you have discovered that you have vitiligo? The first important thing is to understand that vitiligo is not a serious health problem. It is also not contagious, so there will be no need for segregation or withdrawal.
It is a good idea to go for medical diagnosis. This helps rule out other possible causes of skin color loss such as fungal infections. Diagnosis may also help identify the actual cause of the vitiligo such as diabetes, anemia or thyroid disease.
After diagnosis, a variety of treatment options may be suggested by your doctor. They include:
The common medications used for vitiligo treatment are corticosteroids which come in form of vitiligo cream to be applied directly. Occasionally, they are used alongside light therapy for better results. Corticosteroids come with side effects such as skin thinning. Extra caution should be taken when using corticosteroids to treat vitiligo in toddlers.
Phototherapy for vitiligo is perhaps the most successful vitiligo treatment. Simple therapies involve use of lasers to restore skin color on small areas such as on the lips. For widespread vitiligo, light boxes bring better results.
A more advanced and effective therapy involves use of psoralen and UVA light. Psoralen is a substance derived from plants and with the ability to restore skin color. It can be taken orally or be applied directly. Once applied, UVA light is then shone on the affected areas. This treatment works for about 75% of all cases.
Therapies may also involve direct manipulation of pigment. One way to achieve this is by directly implanting pigment to affected areas. Another way is to remove pigment from healthy body areas so that they can match with widespread depigmentation caused by universal vitiligo.
Surgery is a fairly crude vitiligo treatment option. It is considered when other treatments have not worked. The treatment involves harvesting colored skin from elsewhere on the body and covering depigmented areas with it.
Home treatments such as vitiligo makeup and vitamins may not have dramatic effects but can help. It is always a good idea to check with your doctor before trying such treatments. The herb known as ginkgo biloba has also been identified as a potential cure.
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