Vitiligo is a continual and long term skin problem that produces white depigmentation patches that develop and enlarge only in certain sections of the skin. These white patches appear because the patient has very little or no skin cells - called melanocytes - which are the cells in charge of producing the skin pigmentation, called melanin, which gives the color of the skin and protects it from the sun´s UV rays.
It is impossible to predict how much of the skin can be affected. In the majority of cases, the affected areas remain affected for the rest of the person's life.
What are the causes of vitiligo? How common is vitiligo?
Surprisingly, the causes of vitiligo are yet to be precisely established, but most of the research so far points to the following:
- An autoimmune disorder - the patient's immune system becomes overactive, and destroys the melanocytes
- Genetic oxidative stress imbalance
- A stressful event
- Harm to the skin due to a critical sunburn or cut
- Exposure to certain chemicals
- A neural cause
- A viral cause
Vitiligo is not transmittable; people cannot catch it from each other. Less than 1% of the population is affected by the appearance of Vitiligo in their skin, meaning, it is not too common. It has no age, sex or ethnic discrimination, but studies have concluded that a larger percentage of the cases has been detected starting the age of 20.
Vitiligo signs and symptoms varies considerably from person-to-person. It is by far more perceptible in people with dark or tanned skinned. Some people may only acquire a handful of white dots which develops no further, while others develop larger white patches that join together affecting larger areas of the skin.
Types of Vitiligo
To easier explain this condition, scientists have separated vitiligo in basically two types which are called: non segmental, and segmental vitiligo.
Non Segmental Vitiligo
It is the most common type of vitiligo and occurs in up to 90% of the people who have this disorder.
In non-segmental vitiligo, the patches often become visible equally on both sides of the body, with some kind of symmetry. These unusual symmetrical patches most commonly appear on skin that is exposed daily to the sun, such as the face, neck, and hands, but it also appears on these other areas:
- backs of the hands
- arms
- eyes
- knees
- elbows
- feet
- mouth
Non-segmental vitiligo has sub-categories:
- Generalized Vitiligo: the most familiar pattern, it has no specific area or size when the white patches start occurring
- Acrofacial Vitiligo: This type of vitiligo is considered only when the appearance is mostly on the fingers or toes
- Mucosal Vitiligo: The appearance of the depigmentation generally around the mucous membranes and lips
- Universal Vitiligo: It is very rare since depigmentation has to cover most of the body
- Focal Vitiligo: one or a few scattered white patches in a small certain areas. It is often noticeable in young children
Segmental Vitiligo
Segmental Vitiligo has a different form of appearance. This condition spreads more rapidly, but is considered more constant and stable than non segmental. It is definitively much less common, and it affects only about 10% of people with this condition. But unpredictably, segmental vitiligo is more noticeable in the early ages affecting about 30% of the children that have been diagnosed with vitiligo.
It is non-symmetrical and usually tends to affect dorsal roots of the spine. It is more stable, less erratic, and responds well to topical treatments.
What Are The Signs and Symptoms of Vitiligo?
A symptom is felt by the patient, such as a headache dizziness or pain, and described to other people, including doctors and nurses. A sign can be spotted by everybody, including the patient, such as lighter patches of skin, a rash, or loss of hair.
The only sign of Vitiligo is the appearance of flat white spots or patches on the skin. Most of the times, the first white spot that becomes noticeable is usually on an area of the body that is exposed continuously to the sun.
At first, the vitiligo starts as a simple spot, a little paler than the rest of the skin. But gradually, as time passes, this spot will become much paler until reaching the white color.
The shape of these patches are completely irregular, and at times the edges can become a little inflamed with a slight red tone, and may sometimes result in itchiness. Other than the negative appearance and some itchiness of Vitiligo, it does not cause any discomfort, irritation, soreness or dryness in the skin.
Vitiligo is photosensitive; the patient should avoid prolonged skin exposure to direct sunlight.
To predict whether Vitiligo will spread, and by how much is particularly difficult. The spreading of the white patches to some might occur considerably in a matter of weeks, and to others it can rest without growing for months or even years.
If the first symptoms of the white patches are symetrical (non segmental vitiligo,) in other words, in the same areas of both parts of the body, the development is much slower than if the patches are in only one area of the body (segmental vitiligo).
What are the treatment options for vitiligo?
There are a number of remedies that can be performed in order to decrease the visibility of Vitiligo on the affected areas of the skin.
Phototerapy With UVB Light
Exposing the affected skin to UVB lamps is a very common practice and one of the simplest treatments, since it can easily be performed at home with a small lamp.
This home-alone treatment is recommended, and is highly effective since the person can do it daily. If these same treatments are done in clinics, the patient needs to go to the clinic 2-3 times per week, which slows down recuperation time.
If the white spots are located in large areas of the body, UVB phototherapy will have to be performed in a hospital with a full body treatment. It is important to mention the fact that even if evidence has suggested that UVB phototherapy, particularly when combined with other treatments, has a positive effect on vitiligo, it is still quite unpredictable and undependable.
There is still no real treatment that will totally re-pigment the skin to its full potential.
Phototerapy With UVA Light
This other Ultraviolet light (UVA) treatment is most commonly done in a hospital clinic. A drug that increases the skin´s sensitivity to ultra violet light, called psoralen, must be taken while the patient undergoes UVA light therapy. The affected skin goes through a series of UVA treatments, exposing the specific areas to high doses of UVA light.
In order to get any noticeable improvement, the patient will have to do several sessions. Progress will be evident usually after 6-12 month of twice-weekly sessions.
Possible Vitiligo Cure Breakthrough
Researchers from the Institute for Pigmentary Disorders in association with E.M. Arndt University of Greifswald, Germany, and the Centre for Skin Sciences, School of Life Sciences at the University of Bradford, United Kingdom, reported in The FASEB Journal that they have found a new compound that may provide a cure for the loss of skin color associated with Vitiligo.
The compound, a modified pseudocatalase (PC-KUS), also appears to restore original hair color among people with gray hair.
Karin U. Schallreuter, M.D. and colleagues analyzed 2,411 patients with vitiligo from several different countries. 2.4% (57) of them had strictly segmental vitiligo (SSV) while 3.2% (76) had mixed vitiligo, i.e. SSV plus non-segmental vitiligo (NSV).
They discovered that those treated with PC-KUS recovered pigmentation in their skin, as well as their eyelashes.
Skin Camouflage
In many cases, when vitiligo is still considered mild, some of the white patches can be camouflaged with cosmetic colored creams and makeup. The patient should select tones that best match his/her skin features.
Applying the creams is not too difficult, although some training will have to be done. If these creams and make up are correctly applied, they will last between 12-18 hours in the face, and up to 96 hours in the rest of the body. Most of the topical applications are water-proof.
Depigmenting
When the affected area is very widespread, in at least more than 50% of the body, de-pigmentation can be a viable solution. Depigmentation reduces the skin color in the areas that are not affected, in order to match the tone colors as much as possible.
Depigmentation is achieved by the use of several choices of strong topical lotions or oinments, like monobenzone, mequinol, or hydroquinone.
When the cream is applied to the areas with pigmentation, the pigmentation itself is eliminated.
Most of the times,l this treatment is considered permanent, and makes the skin more fragile. Special attention would have to be considered to avoid long exposures to the sun. The complete treatment of depigmentation will take between 12 to 14 months.
Topical Corticosteroids
Corticosteroids ointments or creams contain steroids. Some studies have concluded that topical corticosteroids when applied in the white patches can stop the spread. In other cases, experts have reported total restoration of the original skin color. Corticosteroids should never be used in the face.
If after one month of using any type of corticosteroid, the general practitioner sees that the vitiligo patches are not improving, or side effects are noticeable, treatment must stop.
If vitiligo, on the other hand, has shown some improvement, the treatment should be paused for a couple of weeks before starting it again.
Skin Grafts
A skin graft is a surgical procedure which entails carefully removing healthy patches of pigmented skin and using them to cover affected areas. This procedure is not very common because it is time consuming, and can result in scaring in two places - areas where the skin was taken out and also where it will be placed.
Skin graft procedure should never be performed in children. It should be performed in adults only if no new white patches have appeared or gotten worse in at least a year, and if the vitiligo was not originally triggered by damaging the skin due to a sever sunburn.
Are there any complications linked to vitiligo?
Although the vitiligo itself cannot develop into another condition, people with the condition are more likely to have some other autoimmune disorder, such as a thyroid problem, diabetes type 1, or pernicious anemia. The majority of vitiligo patients do not have these conditions, but a healthcare professional may recommend tests to rule them out.
If the vitiligo is noticeable by other people, embarrassment can lead to self-esteem problems, and in some cases depression.
Written by Christian Nordqvist
Copyright: Medical News Today
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