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Vitiligo

Definition


Disease: Vitiligo Vitiligo
Category: Dermatological diseases

Disease Definition:

The condition in which a person loses melanin, the pigment that determines the color of the skin, eyes and hair, is called vitiligo. Causing slowly enlarging white patches of irregular shapes to appear on the skin, vitiligo occurs when the cells that produce melanin no longer form melanin, or if those cells die. Vitiligo is most obvious and disfiguring in people with darker skin, but this condition affects all races. Vitiligo often begins as small places of pigment loss that spread with time. Stress and concerns about the appearance of the person may result from these changes in the skin. Stopping or slowing the progression of pigment loss and if the person wants, attempting to return some of the color to the skin is the goal of treating vitiligo, but the condition has no cure.
 

Work Group:


Symptoms, Causes

Symptoms:

The pigment loss that produces milky-white patches (depigmentation) on the skin is the primary sign of vitiligo. Vitiligo has some other less common signs, such as: 

  • Loss of color in the tissues that line the inside of the mouth (mucous membranes)
  • Loss of or change in color of the inner layer of the eye (retina)
  • Premature whitening or graying of the hair or the scalp, beard, eyebrows or eyelashes

 

Usually, depigmentation initially develops on sun-exposed areas of the skin such as the hands, arms, face, feet and lips, though vitiligo could affect any part of the body. Vitiligo usually first shows between the ages of 10 and 30, but it can begin at any age. These are the patterns in which vitiligo usually appears: 

 

Focal:

In this pattern, depigmentation is limited to one or a few areas of the body.

 

Segmental:

Loss of skin color takes place on only one side of the body.

 

Generalized:

Pigment loss is widespread across several parts of the body, usually symmetrically.

 

It is difficult to predict the natural course of vitiligo. In some cases the patches stop forming without any treatment. But, in most cases, pigment loss spreads and could finally involve most of the surface of the skin. Though vitiligo has no cure. Treatments available that might help in stopping or slowing the development of depigmentation and attempting to return some color to the skin. When experiencing loss of color in the areas of the skin, hair or eyes, a person should consult a doctor.
 

Causes:

When the dark pigment in the epidermis giving the skin its normal color; melanin, isn’t produced or is destroyed, vitiligo occurs. The involved patch of skin later on becomes white. It isn’t known why this happens. Doctors and scientists have theories as to what causes vitiligo. Although none of these theories has been proven as a definite cause of vitiligo, but heredity might be a factor because there’s a high incidence of vitiligo in some families; some people have reported a single event, like sunburn or emotional distress that triggered the condition; or it might be because of an immune system disorder.
 

Complications

Complications:

None

Treatments:

Vitiligo doesn’t always need a medical treatment. The appearance of the skin could be improved with self-care steps, like the usage of sunscreen and applying of cosmetic camouflage cream. On the other hand, avoiding tanning could make the areas almost unnoticeable in the case of fair-skinned people. The person might decide to seek medical treatment depending on the number, size and location of the white patches. By restoring color (pigment) or by destroying the remaining color, medical treatments for this condition aim at leveling the skin tone. Before finding a treatment that works best, a person may have to try more than one type of treatment. Additionally, vitiligo treatment may take as long as 6 to 18 months.

 

MEDICAL THERAPIES:

Topical corticosteroids:

The color may return to skin (repigmentation) if a person takes corticosteroids, especially if it is started early in the course of the disease. Children and people with large areas of depigmented skin may be prescribed milder topical corticosteroid cream or ointment. Before seeing changes in the skin’s color, it may take as long as three months of treatment. Even though this treatment is easy and effective, but it has some side effects such as streaks or lines on the skin, a condition called skin striae; or thinning of the skin, a condition called atrophy. Because of this, the doctor will have to monitor the patient closely. The vitamin D derivative calcipotriene might also be used topically and is occasionally used with either ultraviolet light or corticosteroids.

 

Topical immunomodulators:

People who have small areas of depigmentations, particularly on their face and neck, may benefit from topical ointments that contain pimecrolimus or tacrolimus. This treatment could be used with UVB treatments, and it may have fewer side effects that corticosteroid therapy. On the down side, these treatments could be linked with an increased risk of skin cancer and lymphoma, and the studies conducted on these treatments have been small.

 

Topical psoralen plus ultraviolet A (PUVA):

In case less than 20% of the person’s body has depigmented patches, this treatment could be effective. The patient should visit the doctor once or twice a week to receive treatment. 30 minutes before the light exposure, the doctor or nurse will apply the topical psoralen, which makes the skin more sensitive to ultraviolet light. Then the skin is exposed to UVA light that turns the treated areas pink. And as the skin heals, a more normal skin color starts showing. This treatment is also called photochemotherapy. Severe sunburn and blistering are some of the possible side effects, the risk of which could be minimized by staying away from direct sunlight after each treatment. Hyperpigmentation, which means over darkening of the skin, is often temporary and finally lightens after stopping the treatment.

 

Oral psoralen photochemotherapy, or oral PUVA:

Oral psoralen may be recommended in the case of having depigmented areas covering more than 20% of the body. In this case, the person will have to take the oral psoralen about two hours before UVA light exposure. The treated skin will become pink after UVA exposure and will eventually fade to a more normal skin tone, as is the case with topical psoralen. Leaving at least a day between each treatment, the person will have to visit the doctor two to three times a week. In case a person doesn’t have access to a doctor’s office with the suitable equipment, this treatment could be done using natural sunlight. The doctor will want to frequently monitor the person’s skin changes and will let the patient know how much exposure they need. Potential short-term side effects of this treatment include nausea, sunburn, itching, abnormal hair growth, over-darkening of the skin and vomiting, whether done in the doctor’s office or by using natural sun. In long-term usage of this therapy, the risk of getting skin cancer might be increased. Due to a greater risk of damage to the eyes, like cataracts, children under the age of 10 aren’t recommended oral PUVA. Remaining away from direct sunlight for one or two full days after treatment might decrease the risk of skin cancer and sunburn. The risk of side effects could also be reduced with the use of sunscreen. Wearing UV-protective sunglasses for up to 24 hours after each treatment when exposed to sun might protect the eyes from serious damage, such as cataracts.

 

Narrowband ultraviolet B (UVB) therapy:

An alternative to PUVA is a narrowband UVB, which is a special form of UVB light. This kind of therapy could be administered same as PUVA and could be given up to three times a week. The treatment process is simpler because pre-application of psoralen isn’t needed. This treatment is gaining wide acceptance because of its simplicity. But to assess its long-term safety and to determine whether it is superior to PUVA, more research is needed. Using either laser or an intense light source (focal), narrowband wavelengths of light could also be delievered to smaller areas of vitiligo. Small trials have proven to give positive results. Still, they might not be available in all dermatologists’ offices because of the added expense of these devices.

 

Depigmentation:

If a person has vitiligo that covers more than half of the skin, depigmentation might be an option. The unaffected areas of the skin are lightened by depigmentation, matching the areas that have already turned white. The person applies a medication called monobenzene ether of hydroquinone twice a day to the areas of the skin that still have pigment. Until the darker areas of the skin match the already-depigmented areas, the treatment won’t stop. Potential side effects of depigmentation therapy include redness and swelling; additionally, the person should be cautious and avoid skin-to-skin contact with other people for at least two hours after they’ve applied the medication, so that it won’t transfer it to those other people. Itching and dry skin are other possible side effects.
Depigmentation is permanent and will make the person extremely sensitive to sunlight permanently. This treatment will make a person extremely sensitive to sunlight permanently because depigmentation is permanent.

 

SURGICAL THERAPIES:

Autologous skin grafts:

The person’s own tissues (autologous) are used in this type of skin grafting. The doctor removes tiny pieces of skin from one area of the body and attaches them to another. When a person has small patches of vitiligo, this procedure is sometimes used. Very small parts of the normal, pigmented skin, usually containing a small hair are removed only to be placed on areas that have lost pigment. Scarring, a cobblestone look, spotty pigmentation, or failure of the transferred skin to re-pigment are some of the potential complications of autologous skin grafting.

 

Blister grafting:

Mainly by using suction, the doctor creates blisters on the pigmented skin. The tops of the blisters are removed and transplanted where a blister of equal size has been created and removed in an area that doesn’t have a pigment. A cobblestone look and scarring might be caused by blister grafting, and the area might not re-pigment. Yet, there’s a decreased risk of scarring with this operation than with other kinds of skin grafting.

 

Tattooing (micropigmentation):

Around the lips and in people with dark skin, this method is most effective. Using a special surgical instrument, pigment is implanted into the skin by tattooing. Occasionally though, the tattoo color doesn’t match skin color closely enough. In addition, tattoo colors don’t tan and they fade.

 

EXPERIMENTAL TREATMENTS:

Better ways of treating vitiligo are still being researched. Autologous Melanocyte transplant is one of the newer alternative procedures. Researchers could grow melanocytes in the lab using a sample of the person’s normal skin. These newly grown melanocytes are then transplanted to the areas on the body lacking pigment. This treatment isn’t widely available and is still considered experimental.
Using a compound that is found in black pepper called piperine is another treatment that is still being developed. This substance has been found to be effective at causing repigmentation in trials on mice. However, when used with UV light, piperine has shown to be more effective. Some of the temporary side effects of this treatment include skin peeling and redness.

Prognosis:

Not available

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