Vitiligo
Vitiligo
is a condition in which white patches develop on the skin. Any location on the
body can be affected, and most people with vitiligo have white patches on many
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Vitiligo is a loss of melanocytes that causes patches of skin to turn white.
- Patches of whitened skin are present on various parts of the body.
- Doctors usually base the diagnosis on the appearance of the skin.
- Corticosteroid creams, other drugs, or phototherapy plus light-sensitizing drugs may help repigment the skin, or, if needed, skin grafts may be used.
Vitiligo Causes and Risk Factors
The skin
doesn't have its characteristic color because it has lost its melanin. For some
reason, the pigment-forming cells known as melanocytes have been destroyed.
We don't
know why this happens. It might be an autoimmune condition, where your body's
defenses turn on your own cells instead of attacking invading germs.
Although
vitiligo affects all races equally, it's more noticeable in dark-skinned
people.
Vitiligo affects up to 2% of people
all over the world
The cause of vitiligo is unknown, but it is a disorder of skin pigmentation that may involve an attack by the immune system on the cells that produce the skin pigment melanin (melanocytes). Vitiligo tends to run in families, or people may spontaneously develop it. Vitiligo may occur with certain other diseases. Vitiligo is associated with autoimmune disorders (when the body attacks its own tissues), and thyroid disease is the most common one. It is most strongly associated with an overactive thyroid ( hyperthyroidism, particularly when caused by Graves disease) and an underactive thyroid ( hypothyroidism, particularly when caused by Hashimoto thyroiditis). People with diabetes, Addison disease, and pernicious anemia also are somewhat more likely to develop vitiligo. However, the relationship between these disorders and vitiligo is unclear.
Vitiligo Types
Vitiligo
is an autoimmune condition in which the pigment forming cells known as
melanocytes are injured, resulting in white patches. The condition tends to
progress and may even become universal. Vitiligo appears to affect all races
equally but is more noticeable on those with darker skin.
There are five types of vitiligo. Which type you have depends on where you have it.
Generalized is the most common type. This is
when discolored patches show up all over your body.
Segmental is when your vitiligo is confined
to one area of your body, like your face or your hands.
Focal happens when the discoloration
stays in one spot and doesn't spread.
Trichrome is when there is an area of heavy
discoloration, followed by an area of lighter discoloration, followed by
regular-color skin.
Universal is a rare type. If you have this,
at least 80% of your skin is discolored.
Melanocyte
Specialized
cells called melanocytes produce the pigment melanin. Melanocytes originate
from cells in the deepest layer of the epidermis called the basal layer.
Occasionally,
vitiligo occurs after physical injury to the skin, for example, as a response
to a chemical burn or sunburn. People may also notice vitiligo is triggered by an
episode of emotional stress.
Vitiligo
may cause considerable psychologic distress, especially in dark-skinned people.topics for health
Symptoms of Vitiligo
In some people, one or two well-defined patches of vitiligo appear. In other people, patches appear over a large part of the body. Rarely, vitiligo occurs over most of the skin surface. The changes are most striking in people with darker skin. Commonly affected areas are the face, fingers and toes, wrists, elbows, knees, hands, shins, ankles, armpits, anus and genital area, navel, and nipples. The affected skin is extremely prone to sunburn. The areas of skin affected by vitiligo also produce white hair because melanocytes are lost from the hair follicles.
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Vitiligo
The white
spots on the ankle are vitiligo, which is caused by loss of skin
pigment–producing cells (melanocytes).
Diagnosis of Vitiligo
- A doctor's evaluation
Vitiligo
is recognized by its typical appearance. A Wood light examination is often done
to help distinguish vitiligo from other causes of lightened skin. Other tests,
including skin biopsies, are rarely necessary.
Treatment
of Vitiligo
- Sun protection
- Cream containing a
corticosteroid and calcipotriene or sometimes other
substances applied to the skin (topical therapy)
- Phototherapy and psoralens
- Surgery
- Bleaching unaffected skin
No cure is
known for vitiligo, and the disorder can be challenging to manage. However,
skin color may return spontaneously. Treatment may be helpful. All affected
areas of skin are at risk of severe sunburn and should be protected from the
sun with clothing and sunscreen.
Topical
therapy
Small patches sometimes darken (repigment) when treated with strong corticosteroid creams. Drugs may be applied to patches on the face or groin, where strong corticosteroid creams may cause side effects. Calcipotriene (also called calcipotriol), which is a form of vitamin D, blended with betamethasone (a corticosteroid cream), can be effective and is more effective than either cream used alone. Some people simply use bronzers, skin stains, or makeup to darken the area.
Phototherapy
and psoralens
Because
many people still have a few melanocytes in the patches of vitiligo, exposure
to ultraviolet (UV) light in a doctor’s office (phototherapy) restimulates
pigment production in more than half of them ( see Phototherapy). In particular, psoralens (drugs that make
the skin more sensitive to light) combined with UVA light (PUVA) or narrowband
UVB light treatment without psoralens can be given. However, phototherapy takes
months to years to be effective and may need to be continued indefinitely. It
can also lead to skin cancer. Doctors also use lasers on
some people who have small patches that do not respond to corticosteroid
creams.
A new
class of drugs called Janus kinase inhibitors (or JAK inhibitors) are emerging
as possible treatment options for vitiligo. However, depigmentation can recur
after use of these drugs is stopped.
Surgery
Areas that
do not respond to phototherapy may be treated with various skin-grafting
techniques and even transplantation of melanocytes grown from unaffected areas
of the person’s skin. Tattooing is especially useful for areas where it is
difficult to restimulate pigment production (such as the nipples, lips, and
fingertips).
Bleaching
Some
people who have very large areas of vitiligo sometimes prefer to bleach the
pigment out of the unaffected skin to achieve an even color. Bleaching is done
with repeated applications of a strong hydroquinone cream to
the skin for weeks to 1 year or more. The cream can be extremely irritating.
The effects of bleaching (such as permanent loss of pigment) are irreversible.