Overview of the condition
Vitiligo is a skin condition characterized by loss of skin pigmentation. This occurs as a result of the destruction of the cells responsible for skin coloration. These calls are known as melanocytes and the pigment they produce is called melanin. Following their destruction, skin areas will turn white or lose their color.
According to studies, over one percent of the global population has vitiligo.
The common areas where this loss of pigmentation occurs include:
- Skin areas exposed to the sun such as hands, feet, arms, and face
- Back of the eye
- Inner ear
- Inside the mouth or other mucus membranes
The hair over an affected skin area may also turn white or grey.
Vitiligo is however not contagious.
Symptoms of vitiligo
The primary manifestation is white patches on the skin of any body part. These patches can be small or large and usually occur in the following pattern:
- Segmental or focal: Here, the vitiligo is located in one area on one side of the body. The white patches are smaller and appear only in a few areas. This pattern has a slower progression than the generalized pattern. It can last up to a year before stopping.
- Non-segmental or generalized: Here, white patches appear symmetrically on both sides of the body. The white patches are larger and can affect any body part. It often starts and stops many times throughout a person’s lifetime and the timing or progression of the patch is usually hard to ascertain.
A study has shown that about 75% of people with vitiligo will have depigmentation of the face and hands. Other common areas are body folds such as skin under the arms and around the groin.
Risk factors for vitiligo
There is no known cause of vitiligo. It is not inherited too but a family history of the condition increases one’s risk of developing vitiligo.
Some genes such as NLRP1 and PTPN22 have been linked to vitiligo thus one is more likely to have vitiligo if they have any of the genes.
Vitiligo is thought to be an autoimmune disorder though the exact mechanism of action is unknown. However, studies have shown that 20% of people with vitiligo have one other autoimmune disorder. These autoimmune disorders associated with vitiligo include:
- Scleroderma: a connective tissue disorder in the body
- Thyroiditis: an inflammation of the thyroid gland
- Type 1 diabetes
- Pernicious anemia where there is the failure of vitamin B12 absorption
- Addison’s disease
- Rheumatoid arthritis
Vitiligo can also occur after episodes of severe sunburns or cut, exposure to chemicals and toxins, and extreme stress.
Complications of vitiligo
Only a few physical side effects are seen in vitiligo. The primary one is the loss of skin pigment and this can increase one’s risk of sunburn but sunscreen and protective clothing can be used to protect the skin. Other very serious side effects include ear and eye complications although they rarely occur.
Vitiligo has been found to cause some major psychological effects. Scientific reviews show that more than half the number of people with vitiligo have experienced a negative effect on their relationship. Some reported being obsessed with a thought about the condition especially as it pertains to unpredictability. Other effects that have been reported include:
- Withdrawing from social conditions
- Avoiding physical activities
- Feeling disfigured
- Emotional burden
Do well to speak to a doctor if you experience any of the symptoms above. Also, proper enlightenment about the condition will help the coping process.
Testing for vitiligo
A doctor will obtain a medical history, conduct a physical exam, and request for investigations. Be sure to give appropriate information as regards risk factors such as recent sunburns, premature graying of hairs, a family history of the condition, or the presence of other autoimmune diseases. Other questions that may be asked include:
- What was the first body part affected?
- Presence of vitiligo in any family member?
- Presence of autoimmune disorder in any family member?
- What treatment has been given so far?
- Any improvement in symptoms?
To differentiate between vitiligo and other skin conditions, the doctor will carry out a skin examination with the aid of a Wood’s lamp.
A skin biopsy can also be taken and sent to the lab for study. It helps show the presence or absence of melanocytes in a body area. Blood tests can help diagnose other problems that may coexist with vitiligo such as thyroid diseases, diabetes, or anemia.
Treatment options for vitiligo
Vitiligo treatment aims to achieve a color balance. Treatment will either add pigmentation or remove it but these depend on:
- The severity of the condition
- Site and site of patches
- Number of patches
- The extent of spread of patches
- Response to treatment
Treatment can be medical, surgical, or a combination of both. Not all treatments are effective for everyone and there may be some associated side effects.
Do well to speak to a doctor if you experience any side effects during treatment.
Medical treatment will be on for at least three months for the effects to be seen. They include:
Topical creams: Some corticosteroid creams can cause loss of pigmentation especially in the initial stages. Other creams can slow growth. Some of these creams will require a prescription and they also have some side effects such as hair shrinkage, thinning, excessive hair growth, or skin irritation.
Oral medications: Some prescription-only medications such as steroids and some antibiotics are useful for the treatment of vitiligo.
Psolaren and ultraviolet A (PUVA) therapy: Psolaren is taken either as a pill or applied topically to the skin. Thereafter, the doctor exposes one to ultraviolet-A light to activate the drug and this will help to restore skin color. Following this, minimal sun exposure is advised and the use of protective sunglasses too.
Side effects of PUVA include sunburn, itching, nausea, and hyperpigmentation.
Narrowband UVB light: It is an alternative to PUVA therapy. The light therapy here is more focused and has fewer side effects. It can also be used for home treatment under a doctor’s supervision.
Excimer laser treatment: This method is done for less than four months at a frequency of two to three times per week. It is particularly useful for small patches.
Depigmentation: This is indicated if more than 50% of the skin is affected and attempts to return skin pigment has failed. It aims to balance one’s skin by fading the rest of the skin to match the areas that have lost color. It can take up to two years for the result to show.
Medication such as monobenzone is used but the major side effect of depigmentation includes inflammation. This treatment is irreversible and also increases sensitivity to the sun.
When medications and light therapy have failed, surgery is then indicated. Surgery is recommended by the doctor if the vitiligo was not caused by sunburns or if there is an absence of a new or worsening white patch. The surgical options available include:
Skin grafting: Here, healthy pigmented skin from one part of the body is transferred to a de-pigmented area. Another option is skin grafting using blisters where the surgeon creates blisters on healthy skin and then transfers the top of the blisters to a de-pigmented area. The risks associated with skin grafting include infection, scar formation, or failure to re-pigment.
Melanocytes transplant: melanocytes are harvested from normal skin and grown in a lab. The cells are then transplanted to the de-pigmented areas of the skin.
Micro-pigmentation: pigment is being tattooed into the skin. It works best for the lip area but it may be difficult to match the skin color.
While undergoing treatment, results may be slow so the following treatments can be combined:
Sunscreen: the skin can remain even if sun exposure is reduced. Tanning adds contrast to the skin and makes affected areas more visible. De-pigmented areas are more susceptible to sunburns and damage thus sunscreen is beneficial.
Cosmetics: the use of makeup or self-tanning lotions will help even out the skin tone although tanning has a long-lasting effect.
Managing mental health: quality of life can be effectively improved by medication and psychotherapy. Talk to your doctor if you experience negative mental health effects.
How to cope with the emotional aspects of vitiligo
People with vitiligo have issues with self-esteem and emotional stress. According to studies, parents of children with vitiligo have a lower quality of life. Vitiligo is non-contagious and those who have it can live a normal healthy life.
Finding a therapist who understands this condition and its effect on mental health is of utmost benefit.
Early cognitive behavior therapy for an individual with vitiligo will:
- Boost self-esteem
- Prevent depression
- Improve the patient’s quality of life
Finding support groups for people with vitiligo also helps. It provides support to the individual and enables them to express themselves freely with people that have the same condition.
Advances in treatment for vitiligo
Research on vitiligo has been on the rise. Newer technology shows how vitiligo work by conducting genetic research.
Vitiligo triggers such as stress and trauma, effects of genetics on vitiligo, and the role of chemical signals in the immune system, are also being studied. The most recent clinical trials are available at ClinicalTrials.gov.