- “Speaking of Vitiligo…”
- What Is Vitiligo?
- Overview – Vitiligo
- What causes vitiligo?
- What Is It?
- Early Signs of Vitiligo
- Types of Vitiligo
- What can vitiligo be confused with?
“Speaking of Vitiligo…”
I was driving into Boston on Friday to meet with a pharmaceutical company and discuss developing new treatments for vitiligo. While I was listening to National Public Radio (NPR), I heard a human-interest piece titled, “Inheriting A Rare Skin Condition, And The Ability To Laugh About It”. It was an entry for StoryCorps, where they record stories from people in America that they archive into the Library of Congress for posterity. It’s about a father and daughter who both have vitiligo, and how that affected their relationship.
First, I had to get past the fact that they called vitiligo a “rare skin condition” – it is not. In fact, it’s one of the most common autoimmune diseases of the skin or any organ. But after that, the story reminded me of a question I’m asked in clinic by patients all the time. “What are the chances my kids are going to get vitiligo?” They know the emotional and other struggles that go along with having vitiligo, and are afraid for their children.
The risk of developing vitiligo in the general population is about 1%, or 1 in 100 people. That is really common. In comparison, the risk for juvenile diabetes is about 0.2%, or 1/500, and multiple sclerosis is 0.1%, or 1/1000. Because vitiligo is so common and visible, I see multiple people with it when I’m in large crowds, like at town fairs (a favorite past time in the fall). I often catch myself staring, and then feel terrible because that’s one of the main complaints of patients with vitiligo, and one that’s discussed in the NPR story (the daughter jokingly tells a child she caught it by staring at someone else). Both men and women are at similar risk for getting vitiligo, and over half of patients who have vitiligo got their first spots before the age of 20. We think the risk is the same all over the world, but we don’t know for sure. In fact, it’s likely even more common than 1%, because unlike patients with juvenile diabetes who must go to the doctor for treatment to survive, vitiligo patients may or may not choose to go to the doctor, and therefore may not be “counted”.
Ok, now for the risk to family members. This is particularly interesting to me, because my grandmother (on my mother’s side) and her brother both had vitiligo, but I don’t have it (yet). If a person has vitiligo, the risk that a first-degree family member (parent, child, or sibling) is 5%, or 5 times higher than the general population. That seems like a big increase, but even so, that means only about 1 in 20 first-degree relatives of vitiligo patients get vitiligo as well. That brings me back to the NPR story – the father in the story says, “I was shocked, because I had asked doctors if any of my kids would have vitiligo, and they said, ‘Probably not, it usually skips a generation.’ So when I found out that you had it, I was scared for you.” It’s not true that vitiligo “usually skips a generation”. It may seem that way though, since later generations have more people (you typically have more grandchildren than children, and so on), and therefore it’s more likely that someone will get the disease in later generations because there are just more people.
The fact that vitiligo is more common in family members of people with vitiligo means that genetics play a role in the disease. That’s not too surprising, since genetics plays a role in most diseases, as well as normal traits (like hair color, height, etc). Dr. Richard Spritz has done some amazing work in the past 10 years discovering some of the genes that affect vitiligo risk, and I’ll ask him to comment on his work in a future blog entry.
Finally, it’s important to mention that genetics aren’t the entire story for vitiligo. Environmental factors, and probably chance, each play a role as well. We know this because an identical twin of a person with vitiligo has a 23% risk of developing the disease as well, even though almost all of their DNA is identical. If genes were the whole story, that risk would be 100% (as with cystic fibrosis, for example). I’ll blog about these environmental and other factors in the future as well, but in the meantime, you can read about environmental factors here.
The main sign of vitiligo is pigment loss that produces milky-white patches (depigmentation) on your skin. Other less common signs may include:
- Premature whitening or graying of the hair on your scalp, eyelashes, eyebrows or beard
- Loss of color in the tissues that line the inside of your mouth (mucous membranes)
- Loss or change in color of the inner layer of your eye (retina)
Although any part of your body may be affected by vitiligo, depigmentation usually first develops on sun-exposed areas of your skin, such as your hands, feet, arms, face and lips. Vitiligo generally appears in one of three patterns:
- Focal. Depigmentation is limited to one or a few areas of your body.
- Segmental. Loss of skin color occurs on only one side of your body.
- Generalized. Pigment loss is widespread across many parts your body.
Although it can start at any age, vitiligo often first appears between the ages of 20 and 30. The white patches may begin on your face above your eyes or on your neck, armpits, elbows, genitalia, hands or knees. They’re often symmetrical and can spread over your entire body. The disorder affects both sexes and all races equally.
Most people with vitiligo are otherwise healthy and have normal skin texture and sensation. However, the condition may be more common in people with certain autoimmune diseases – diseases in which your immune system reacts against your body’s own organs or tissues – such as Addison’s disease, vitamin B-12 deficiency anemia (pernicious anemia), or thyroid disorders, including hyperthyroidism and hypothyroidism.
The natural course of vitiligo is difficult to predict. Sometimes the patches stop forming without treatment. In other cases, pigment loss can involve most of the surface of your skin.
What Is Vitiligo?
Treatments for vitiligo aim to restore color balance to your skin. Some treatments aim to add pigment while others remove it. Your options will vary according to:
- the severity of your condition
- the location and size of your patches
- how many patches you have
- how widespread the patches are
- how you respond to treatment
The types of treatments include medical, surgical, or a combination of both. But not all treatments work for everyone and some may cause unwanted side effects.
Always contact your doctor if you start experiencing side effects due to a treatment. They may readjust your dosage or provide alternatives.
You’ll usually need at least three months of treatment before you can see its effects. Medical treatments include:
Topical creams: Some creams, including corticosteroids, can help return color to white patches in the initial stages. Others help slow the growth. You’ll need a prescription for creams that are strong enough, but they can also cause side effects when used for a long time. Side effects can include:
- skin shrinkage
- excess hair growth
- skin irritation
Oral medications: Some medications like steroids and certain antibiotics may be effective in treating vitiligo. These are only available by prescription.
Psoralen and ultraviolet A (PUVA) therapy: This treatment combination requires you to take psoralen as a pill or apply it to your skin as a cream. Then your doctor exposes you to UVA light to activate the drugs which help restore color to your skin. Afterwards, you’ll need to minimize sun exposure and wear protective sunglasses. PUVA does have side effects that can include:
Narrow band UVB light: This is an alternative to traditional PUVA therapy. This treatment provides a more focused type of light therapy often leading to fewer side effects. It can also be used as part of a home treatment program under a doctor’s supervision.
Excimer laser treatment: This treatment helps with small areas of patches and takes less than four months, two to three times per week.
Depigmentation: Your doctor may recommend depigmentation if more than 50 percent of your body is affected and you want to balance your skin. This often is a solution when treatments to return pigment to your skin have failed. Depigmentation focuses on fading the rest of the skin to match the areas that have lost color. It can take up to two years for treatment to be effective. You’ll apply a medication like monobenzone as directed by your doctor. The biggest side effect of depigmentation is inflammation. This treatment tends to be permanent and you’ll be extra sensitive to sunlight.
Surgical options are available when medications and light therapy don’t work. Your doctor can recommend surgical options if you have had no new or worsening white patches in the last 12 months, and your vitiligo wasn’t caused by sun damage.
The types of surgery include:
Skin grafting: Your surgeon removes healthy, pigmented skin and transfers it to depigmented areas. Risks of skin grafting include infection, scarring, or failure to re-pigment. Skin grafting using blisters is another option that has less risks. For this procedure, your doctor will create blisters on your unaffected skin and transfer the top of the blister to another area.
Melanocyte transplants: Your doctor removes melanocytes and lets them grow in a lab. Then, the cells are transplanted to the depigmented areas of skin.
Micropigmentation: Your doctor will tattoo pigment into your skin. This is best for the lip area, but it may be hard to match your skin’s color.
Other therapies and management options
Even if you are undergoing medical treatment for vitiligo, the results can be slow. So, you may want to incorporate the following:
Sunscreen: Reducing sun expose can help keep your skin even. Tanning will add contrast to your skin, making affected areas more visible. The higher the SPF, the more protection you receive. It is important to use sunscreen as areas without pigmentation are susceptible to sunburns and sun damage.
Cosmetics: Makeup or self-tanning lotions can help even out your skin tone. You may prefer self-tanning lotions because the effect lasts longer, even with washing.
Managing mental health: One study suggests that medication and psychotherapy can improve your quality of life. Talk to your doctor if you are experiencing negative mental health effects.
What causes vitiligo?
Vitiligo is caused by the lack of a pigment called melanin in the skin. Melanin is produced by skin cells called melanocytes, and it gives your skin its colour.
In vitiligo, there are not enough working melanocytes to produce enough melanin in your skin. This causes white patches to develop on your skin or hair. It’s not clear exactly why the melanocytes disappear from the affected areas of skin.
Non-segmental vitiligo (the most common type) is thought to be an autoimmune condition.
In autoimmune conditions, the immune system does not work properly. Instead of attacking foreign cells, such as viruses, your immune system attacks your body’s healthy cells and tissue.
If you have non-segmental vitiligo, your immune system destroys the melanocyte skin cells that make melanin.
Vitiligo is also associated with other autoimmune conditions, such as hyperthyroidism (an overactive thyroid gland), but not everyone with vitiligo will develop these conditions.
You may be at increased risk of developing non-segmental vitiligo if:
- other members of your family have it
- there’s a family history of other autoimmune conditions – for example, if one of your parents has pernicious anaemia (an autoimmune condition that affects the stomach)
- you have another autoimmune condition
- you have melanoma (a type of skin cancer) or non-Hodgkin lymphoma (cancer of the lymphatic system)
- you have particular changes in your genes that are known to be linked to non-segmental vitiligo
Segmental vitiligo (the less common type) is thought to be caused by chemicals released from the nerve endings in your skin. These chemicals are poisonous to the melanocyte skin cells.
It’s possible that vitiligo may be triggered by particular events, such as:
- stressful events, such as childbirth
- skin damage, such as severe sunburn or cuts (this is known as the Koebner response)
- exposure to certain chemicals – for example, at work
Vitiligo is not caused by an infection and you cannot catch it from someone else who has it.
What Is It?
Published: May, 2019
Vitiligo consists of white patches of skin that are caused by the loss of melanin, the pigment that is a major contributor to skin. Melanin is produced by special cells called melanocytes, which are destroyed in people who have vitiligo. The cause of vitiligo is not known but evidence strongly suggests that vitiligo is an autoimmune disorder, in which the body’s immune system mistakenly targets and injures these specific cells.
Vitiligo can cause minor changes or extensive changes in the skin. In some people, it may be hardly noticeable, while in others it is obvious. In dark-skinned people the vitiligo patches are obvious since they contrast with normal skin. Light-skinned people may have fewer cosmetic concerns, but patches without pigment can become obvious in the summer because unaffected skin tans while vitiligo skin does not tan.
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Early Signs of Vitiligo
Types of Vitiligo
The disease can take on different forms, which depend on certain conditions:
- Stationary type, which is characterized by a single symptom of white spots without spreading or increasing in volume.
- Progressive form, acute course with growing foci spreading throughout the body.
- Repigmentation develops under the influence of certain drugs or chemical agents, which leads to the violation of skin pigmentation.
The disease is chronic and accompanies the patient all his life. However, there are cases of spontaneous recovery without any particular therapy.
What can vitiligo be confused with?
Diagnosis of vitiligo is not a complicated process, but some diseases have the same skin defects. Such pathological conditions include:
- Leukoderma of syphilitic origin. In contrast to vitiligo, it affects the mucous membranes.
- Leprosy. With this conditions, spots are deprived of sensitivity or vice versa, causing painful sensations due to damage to nerve endings.
- Multi-colored lichen. Spots appear in the period of remission and disappear when exposed to sunlight, which is not possible with vitiligo.
It is impossible to cure vitiligo completely. However, you can stop the spreading of foci. There are several types of vitiligo treatment:
- symptomatic treatment;
- psychotherapy – of stress is the cause;
- local therapy.
Recent studies have shown that the affected skin is sensitive to ultraviolet rays. Today, UVB lamps are used successfully to remove local symptoms and prolong periods of remission. Positive results are already visible after the first or second week of use.
Posted: March 8, 2018 by UVB-lamps Team23,637(6 votes, average: 1.33 out of 5)