Vitiligo is a disorder that results in the patch pattern loss of skin color. The degree and proportion of color loss from vitiligo is variable. It can involve the skin on any part of the body including hair and the inner part of your mouth.
Vitiligo image courtesy of Produnis
Vitiligo appears when the melanocytes that synthesize melanin become damaged or dysfunctional. Melanin is responsible for the color in your eyes, skin and hair. It can occur in people of any skin types. Although, Vitiligo is not fatal or communicable, it can be highly stressful for affected individuals.
Symptoms of Vitiligo
The principal symptom of vitiligo is irregular blotchy loss of skin color. In most cases, discoloration initially appears on areas frequently exposed to the sun. Vitiligo may be localized involving only some parts of skin or it can become extensive involving the entire body.
Signs Of Vitiligo are:
- Patchy discoloration
- Whitening or graying hair
- Discoloration of mucous membranes lining the lips
- Change in eye color
Onset of age is variable, but usually appears before age 20.
Causes Of Vitiligo
The exact mechanism of vitiligo is not well understood but it may be associated with an autoimmune disorder that attack the melanocytes. In some cases, it may be a hereditary condition triggered by sunburn or other chemical stress.
Complications
Vitiligo can also increase risk for skin cancer and sunburn. In addition to risks of deafness, it can have also serious psychological impact on patients.
Diagnosis
Vitiligo diagnosis is usually done by using a Woods lamp that shines ultraviolet light on the skin.
Treatment
As of now, medications to cure vitiligo have not been discovered. Treatment is primarily aimed at restoring skin color and tone. Most of these treatments take months for visible results. Furthermore, it does not prevent new patches of skin color loss from developing.
Treatments for vitiligo can help restore skin color but results are highly variable and can even have severe side effects. Due to this, many vitiligo patients are advised to use makeup or tanning products to even out skin tone. Many treatment options exist for Vitiligo that are directed at restoring lost skin color.
Using cosmetics to camouflage discoloration and opting for no medication
- Cosmetic camouflage can be done by using makeup, skin dyes, and self-tanners.
- This is a safe alternative to minimize vitiligo appearance without side effects.
- Recommended option for children in order to avoid treatment side effects
- The only disadvantage to this option is the need for repeated application.
Medicine applied to the skin
Numerous topical medicines can be helpful to add skin color.
Topical medication options are mostly for small areas of affected skin
Topical Steroids:
Daily application of topical corticosteroid cream to affected areas may gradually restore skin color. However, it may take several months before you notice an improvement. This is the most commonly prescribed potent topical treatment for vitiligo and is more effective in people of darker skin type. Chronic use of steroids for more than a year can have side effects such as skin atrophy.
Calcineurin inhibitors:
Creams made of tacrolimus or pimecrolimus can be used in combination with ultraviolet B light in individuals with localized Vitiligo. They are more effective on the face than in other parts of the body
Light treatment
Patient may sit in a light box to restore skin color in vitilgo affecting large body surface areas.
Excimer laser treatments can also be used but are applicable to treat only small areas.
Like topical treatments, lasers and light are most effective on the face and least effective on the skin over hands and feet.
Highly effective for several patients with nearly 70% patients reporting improvement with laser therapy.
Unfortunately, results are not permanent and can disappear with time if treatment is discontinued.
Darker skin patients may often acquire areas of hyperpigmentation after treatment with lasers. But these effects are temporary and treated skin gradually evens out resembling adjacent skin color.
Multiple treatments are needed with minimum 2 treatments per week to be continued for several weeks.
Combined treatment with topical steroids can enhance improvement
PUVA light therapy
This therapy combines UVA light with a medicine called psoralen to regain natural skin color.
Psoralen can be taken orally in the form of a pill or applied topically.
Effective treatment option for widespread vitiligo
Unlike other options, this therapy is effective even in other parts of the body except the hands and feet.
Requires time commitment as treatment should be repeated twice a week for at least one year.
Psoralen can have adverse effects on the eyes so regular eye checkup is essential prior to and after completion of treatment.
Requires careful monitoring due to the risk of serious side effects.
Surgery
- As a last resort, surgery is an option when topical medications and laser therapy are not effective. But this option is viable only for patients with stable, unchanged or non progressing vitiligo for at least 6 months.
- Not suitable for patients with tendency to scar or form raised scars such as keloids.
- Surgery for vitiligo is done by removing natural skin cells with normal skin tone and inserting them in areas with loss of skin color.
- High rate of efficacy
- Potential side effects of surgery are failure to work, infection and uneven skin tone.
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Alternative treatment
- Unconvential treatment options for vitiligo such as vitamins, minerals, amino acids, and enzymes are also available. But their efficacy is unknown due to lack of research and evidence to support their benefit.
- Currently, Ginkgo biloba is a herb being studied for treatment of vitiligo. Early clinical trial findings indicate it may restore skin color and prevent worsening of vitiligo.
Depigmentation
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- A less commonly used treatment is removal of the remaining pigment to even out the overall skin tone giving the entire skin a white appearance.
- This is achieved by daily application of skin lightening cream for 1 to 5 years steadily removing any remaining pigment.
Self-Care
- Protect your skin from the sun or other sources of UV light using water-resistant sunscreen with an SPF of at least 30. Avoid tanning beds and also use shades or clothing to cover the skin.
- Concealing affected skin using makeup can improve skin’s appearance specially if the discolored patches are located on visible skin.
- Connecting with others vitiligo patients: As the unnatural appearance of vititigo can result in an emotional toll on patients, many patients suffer from depression and lower quality of life. Emotional support by a therapist or by connecting with others vitiligo patients is essential for most people with vitiligo. Many famous people with Vitiligo such as Michael Jackson, Winnie Harlow, Graham Norton, Steve Martin have learned to deal with their condition. Seeking help to cope with the psychological effects can be extremely beneficial for vitiligo patients.
Reference:
https://www.mayoclinic.org/diseases-conditions/vitiligo/symptoms-causes/syc-20355912
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