Of the thousands of things we may encounter throughout our lives that affect our health and even our physical appearance, vitiligo is one that brings the most questions.

What is Vitiligo?

Vitiligo is a long-term condition in which patches of skin lose their color. It can affect people of any age, gender, or ethnic group. The patches appear when melanocytes (the cells responsible for producing melanin) in the skin die. The area affected by vitiligo varies among individuals. It can include the eyes, inside the mouth, and hair. In most cases, these areas remain discolored for the rest of one’s life and affect between 0.5% and 2% of people worldwide.

Symptoms of Vitiligo

The only symptom of vitiligo is the appearance of white patches on the skin. The first noticeable patch is often in an area that tends to be exposed to the sun. It starts as a single spot, slightly lighter than the rest of the skin, but over time, it becomes lighter until it turns white. The patches have an irregular shape, and sometimes the edges can become slightly inflamed with a mild red tone, resulting in itchiness.

Increased Skin Sensitivity

However, it does not cause discomfort, irritation, pain, or dryness of the skin. Vitiligo is photosensitive. The affected areas will be more sensitive to sunlight than those that are not. It is difficult to predict if and how far they will spread. The spread can take weeks, or they may remain stable for months or years. The effects of vitiligo vary between people. Some may have just a few white spots that do not progress further, while others develop larger white patches that merge and affect bigger areas of skin. Vitiligo tends to be more visible in people with dark or tanned skin.

Causes of Vitiligo

The exact causes of vitiligo are not clear, but several factors may contribute. These include:

  • an autoimmune disorder, in which the immune system becomes overactive and destroys the melanocytes
  • an imbalance in oxidative stress genetics
  • a stressful event
  • damage to the skin due to a burn or critical cut
  • exposure to certain chemicals
  • a neural cause
  • heredity, as it can run in families

Important: Vitiligo is not contagious.

Types of Vitiligo

There are two types of vitiligo: Non-segmental vitiligo – Non-segmental vitiligo is the most common type, accounting for up to 90% of cases. The patches usually appear equally on both sides of the body, with some degree of symmetry. They usually appear on skin commonly exposed to the sun, such as the face, neck, and hands. Common areas include:

  • backs of the hands
  • arms
  • eyes
  • knees
  • elbows
  • feet
  • mouth
  • armpit and groin
  • nose
  • belly button
  • genitals and rectal area

However, they can also appear in other areas. Non-segmental vitiligo is divided into subcategories:

  • Generalized: no specific area or patch size. This is the most common type.
  • Acrofacial: mainly occurs on the fingers or toes.
  • Mucosal: mainly appears around the mucous membranes and lips.
  • Universal: Depigmentation covers most of the body. It is very rare.
  • Focal: One or a few scattered spots develop in a discrete area. Most often occurs in young children.

Segmental vitiligo – Segmental vitiligo spreads more quickly, but is considered more steady and stable than the non-segmental type. It is much less common and affects only about 10% of people with vitiligo. It is not symmetrical. It is more noticeable in younger groups, affecting about 30 percent of children diagnosed with vitiligo. Segmental vitiligo usually affects areas of the skin connected to nerves that emerge from the dorsal roots of the spinal cord. It responds well to topical treatments.

Treatment for Vitiligo

More than just a cosmetic problem, vitiligo is a health condition that needs medical attention. A number of remedies can help reduce the visibility of the condition.

Sunscreen

The use of sunscreen is recommended because the lighter patches of skin are especially sensitive to sunlight and can burn easily.

UVB Light Phototherapy

Exposure to ultraviolet B (UVB) lamps is a common treatment option. Home treatment requires a small lamp and allows for daily use, which is more effective.

UVA Light Phototherapy

UVA treatment is usually conducted in a healthcare setting. First, the patient takes a drug that increases the skin’s sensitivity to UV light. Then, in a series of treatments, the affected skin is exposed to high doses of UVA light.

Skin Camouflage

In mild cases of vitiligo, the patient can camouflage some of the spots with foundation. One should select the shade that best matches the skin.

Depigmentation

When the affected area is widespread, covering 50 percent of the body or more, depigmentation may be an option. This reduces the color of unaffected skin to match the whiter areas.

Topical Corticosteroids

Corticosteroid ointments are creams containing steroids. Some studies have concluded that applying topical corticosteroids to the patches can halt the spread of vitiligo. Others reported complete restoration of original skin color.

Calcipotriene

Calcipotriene is a form of vitamin D used as a topical ointment for vitiligo. It can be used with corticosteroids or light therapy. Side effects include rashes, dry skin, and itching.

Drugs Affecting the Immune System

Calcineurin inhibitor ointments may help with smaller vitiligo patches. However, there is a link between these drugs and skin cancer and lymphoma.

Psoralen

Psoralen can be used with UVA or UVB light therapy, as it makes the skin more susceptible to UV light. As the skin heals, more normal coloring sometimes returns. It is not recommended for children under 10 years old.

Skin Grafting

In a skin graft, a surgeon carefully removes healthy, pigmented parts of skin and uses them to cover areas with vitiligo. This procedure is not very common, as it takes time and can result in scarring at both the donor and recipient sites.

Tattooing

Surgery is used to implant pigment into the skin. It works best around the lips, especially in people with darker skin. Drawbacks can include difficulty matching skin color and the fact that tattoos fade but do not tan. Sometimes, skin damage from the tattoo can trigger another vitiligo patch.

Is there a cure for Vitiligo?

Unfortunately, there is still no cure for vitiligo, but there are several studies for a cure or treatment with promising results.

What complications can Vitiligo cause?

Vitiligo does not cause other diseases, but people with the condition are more likely to experience:

  • painful sunburn
  • hearing loss
  • changes in vision and tear production
  • thyroid problems,
  • Addison’s disease
  • Hashimoto’s thyroiditis
  • type 1 diabetes
  • pernicious anemia

Most people with vitiligo do not have these conditions, but tests can be done to rule them out.

Overcoming Social Challenges

If the skin patches are visible, the social stigma of vitiligo can be hard to deal with. Embarrassment can lead to self-esteem issues and, in some cases, to anxiety and depression. People with darker skin are more likely to face difficulties because the contrast is greater. In India, vitiligo is known as “white leprosy.” Raising awareness about vitiligo can help those with the condition overcome these challenges. See Also: Alopecia: Main Causes, Symptoms and Treatments Photos: James Heilman, Maria Sieglinda von Nudeldorf