Vitiligo is pretty common: in the USA it affects about 1% of the population. That’s 3 million people. What do you know about it?Â
The Pathology:
- Vitiligo is the complete absence of pigment from the skin.
- Melanocytes (melanin producing cells in the skin) are completely lost.
- It affects the skin but occasionally also the hair and eyes.
- The cause? Not completely clear yet, but vitiligo is most likely an autoimmune disease, meaning the body starts attacking its own melanocytes.
- It can be associated with other autoimmune diseases such as diabetes, thyroid disease, and alopecia areata.
- It can be preceded by emotional or physical trauma, such as pregnancy, major surgery, stress, or even a simple sunburn. It is hypothesized that any trauma causes an increase in melanin production, putting stress on already vulnerable melanocytes. Melanocytes are destroyed, which leads to the onset of vitiligo.
Who Gets Vitiligo?
- Vitiligo appears around the second decade of life.
- Family member affection is seen in a third of vitiligo patients.
What Does it Look Like?
- The skin has patches of chalk-white skin in the middle of normally pigmented skin. These patches have irregular but definite borders and can enlarge with time, joining each other to form even larger patches.
- Affection of the body can be symmetric: meaning that if one side of the chest is affected, the other side of the chest will be affected.
- In people with skin types I and II, vitiligo can go by undiagnosed, as the skin is so fair that lesions are indistinguishable from normal skin.
- Affected areas are not protected from UV rays (as they have no melanin) and are at higher risk of getting skin cancer. Therefore, sunscreen should be worn religiously.
- There are usually no associated symptoms, but some itching and redness can be seen. Also the affected areas get sun burned more easily than normal skin.
Treatment:
- How is treatment possible if melanocytes are lost? Deep in the skin some melanocytes can still be viable. That is why the earlier the treatment starts the better the chances of success are.
- Treatment takes a very long time and has frustrating results.
- The choice of treatment depends on how long vitiligo has been established, and how much of the body is affected. Some options include:
- Topical treatments such as corticosteroids or tacrolimus.
- Phototherapy (controlled exposure to UV rays). A session is preceded by oral intake of a photosensitizer (an agent that increases skin sensitivity to UV rays).
- Skin grafts.
- In patients whose skin is more than half affected, another course of action is de-pigmentation. The aim here is to homogenize the color of the skin. In this form of treatment the remaining melanocytes in normal skin are destroyed. The aim of this approach is decreasing the stress caused by the uneven skin tone caused by of vitiligo.
Camouflage:
- For darker skin tones, makeup can be used to cover lighter areas.
- For fairer skin tones, avoidance of the sun means that normal skin will not get darker and therefore will not contrast too much with vitiligo — affected skin that cannot tan.
Prognosis:
- Vitiligo is not associated with systemic manifestations. It only affects the skin and usually has no symptoms.
- Vitiligo poses a major cosmetic concern, leading to a lot of distress, embarrassment, and withdrawal.
- Medicine is yet to fully comprehend vitiligo, its causes, its treatment, and its real relation to skin cancer risk. New studies keep coming up with fascinating findings. So keep a look out for updates in the future.
Thank you for reading.
Sources:
RE. Boissy et al. On the Pathophysiology of Vitiligo: Possible Treatment Options. Indian Journal of Dermatology, Venereology and Leprology 2012; 78 (1): 24-9.
A Taieb, K. Ezzeldine. Vitiligo: The White Armor? Pigment Cell and Melanoma Research 2013.
Andrew Diseases of the Skin: Clinical Dermatology. Tenth Edition.
Rook’s Textbook of Dermatology. Eight Edition.
Photographs courtesy of dermatlas.med.jhmi.edu/