What is Vitiligo?
Vitiligo is a condition in which you lose the pigment of your skin. Pigment causes skin color and is produced by cells called “melanocytes.” Another word for pigment is “melanin.”
Most people with vitiligo lose pigment in patches of normally pigmented skin, which is replaced by flat white patched with irregular borders. This loss of pigmentation can occur in small patches, on one side of the body or in large areas covering over 50% of the body. These patches are usually areas of your body that are exposed to the sun, such as your hands, face, arms, and feet, but the genitalia can also be affected.
Vitiligo can be treated, but not cured. You will need to manage the disorder throughout your life. The National Vitiligo Foundation estimates that 0.5 to one percent of the general population suffers from vitiligo (NVF).
The condition is not contagious, does not cause pain, and is not medically dangerous. Vitiligo affects males and females of all races equally. However, the loss of pigment, called depigmentation, is more noticeable in people with dark skin.
What Causes Vitiligo?
The exact cause of vitiligo is unknown, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). However, links exist between vitiligo and other autoimmune diseases, such as alopecia areata, hyperthyroidism, Addison’s and the genetic disease pernicious anemia.
Researchers think that vitiligo could be an autoimmune response, meaning that the body attacks itself. In this case, your body destroys its own melanocytes so that the pigment is lost (NIAMS).
Vitiligo also appears to be an inherited condition. Up to 30 percent of people who have vitiligo have a family member with the same condition (NIAMS).
Symptoms of Vitiligo
The main symptom of vitiligo is the absence of pigment on the skin. Three different patterns of depigmentation are possible:
- focal pattern: the loss of skin color appears in only a few small areas
- segmental pattern: depigmentation occurs on one side of the body
- generalized pattern: loss of melanin occurs on both sides of the body in a symmetrical pattern.
The generalized pattern is the most common type of vitiligo. Depigmentation in any of the three patterns can appear on the face, arms, underarms, legs, hands, feet, lips, and groin. The lining of the inside of your mouth may also lose color.
Premature graying of scalp and facial hair can also be a sign of vitiligo. This includes your eyebrows and eyelashes.
Your doctor will review your medical history and possibly test a skin sample to diagnose vitiligo. Family history of the condition and reports of sunburns or blistering are considered. According to the NIAMS, sun damage may trigger vitiligo symptoms in some patients (NIAMS). A skin biopsy can reveal the complete absence of pigment and may confirm the diagnosis.
Your doctor might also run blood tests to check your vitamin B12 levels and thyroid function. An overactive thyroid and a deficiency of B12 are often associated with vitiligo. Running these tests can help you get prompt treatment for related conditions, if needed.
Treatment and Management
Vitiligo is painless and benign from a health standpoint. The goal of treatment is purely cosmetic—to restore pigment to your skin. Treatment for vitiligo is a long-term commitment; most therapies do not show results for several months.
Topical medications can be effective ways to repigment the white patches of skin. Topical steroid medications are used in children and adults. Steroids must be applied to the skin daily for at least three months before you can expect to see results. Steroid creams can have some adverse effects, including a thinning of the skin or streaks of color on the skin.
Another group of drugs called immunomodulators may also treat vitiligo. These are ointments that contain the active ingredient tacrolimus or pimecrolimus. According to the Mayo Clinic, people who have small areas of pigment loss on the face and neck usually see results with immunomodulators (Mayo).
Ultraviolet light therapy can restore pigment in some people with vitiligo. Most often, you are required to take a medication called psoralen, which causes the skin to be more sensitive to the light treatment. Psoralen is available in both topical and oral forms. The combination of psoralen and UVA rays, PUVA treatment, darkens the light areas of skin.
Since you are more sensitive to sunlight when using psoralen and should protect the rest of your body with sunscreen. PUVA treatment can be given several times a week in a doctor’s office.
When repigmentation of the white patches fails, depigmenting the rest of your body is another treatment option. Depigmentation is reserved for people who suffer from vitiligo on more than half their body. The goal is to match the normal pigmented skin to the vitiligo-affected areas.
A medication called monobenzone is applied to the skin to lighten the pigmented areas. This topical medication can bleach the skin of other people who may come into direct contact with the patient; therefore skin-to-skin contact must be avoided for two hours after treatment.
Noninvasive management for vitiligo can include makeup and sunless tanners. Tanning does not help restore pigment loss from vitiligo, according to the NIAMS. As it turns out, tanning makes the difference between normal and depigmented skin tone more obvious (NIAMS). Sunscreen with UVA and UVB protection should be used to protect the skin.
In severe cases, you may elect to have surgery to try to restore normal skin tone. Skin grafting takes healthy skin and places it in an area that has been affected by vitiligo. Such surgical procedures are possibilities for people whose vitiligo has not improved despite several years of consistent treatment.However, the surgery is expensive, rarely covered by insurance, and can cause scarring.
Support for Vitiligo Patients
Vitiligo can be difficult to live with on a daily basis. Some people need help coping with the emotional repercussions of having a chronic skin condition. Ask your doctor for a referral to a support group or mental health professional. There, you can speak about your experiences without judgment. Counselors and your peers can also help you learn how to live with vitiligo and be happy.