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Vitiligo

Definition

Vitiligo is a disorder in which white patches develop on the skin. The patches may appear on any part of the body, including the hair, eyes, and mouth.

Causes

The white patches are due to the destruction of melanocytes cells. These cells in the skin make pigment. Loss of pigment causes the skin to become lighter. It looks especially lighter compared to normal skin nearby. This is why vitiligo is more visible in darker-skinned people.
The exact cause of the pigment loss is not known. Possible causes include:
  • The body’s immune system may destroy the melanocytes
  • Melanocytes may destroy themselves
  • Defective nerve cells may make toxic substances that harm the melanocytes
It is likely that a genetic defect makes the cells more vulnerable to damage.

Risk Factors

Vitiligo is more common in people between the ages of 10 and 30 years. Other factors that may increase your chance for vitiligo include:
  • Family members with vitiligo or hair turning gray early
  • Certain autoimmune diseases, such as thyroid disease

Symptoms

The main symptom is white patches on the skin. These patches may be clumped together or all over the body. Some common sites of pigment loss include:
  • Areas exposed to the sun such as the face, hands, arms, and upper part of the chest
  • Areas around body openings such as the eyes, nostrils, mouth, navel, and genitals
  • Body folds such as the groin and armpits
  • Sites of chronic minor injury such as knuckles and elbows
  • Sites of injury such as scrapes, cuts, and burns
  • The area around moles
White or prematurely graying hair and hair loss may also occur.
Vitiligo often begins with a rapid loss of skin color. This is followed by a long period without any change. Cycles of pigment loss and stability may occur again later. The cycle can continue throughout life.

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam and eye exam will be done. The diagnosis is usually made by the appearance of the skin. A skin biopsy may be done to confirm. Special UV lamps may be used during the skin exam. Blood tests are often taken to look for signs of autoimmune diseases.

Treatment

There is no known cure for vitiligo. Often, the longer the patches exist, the harder it is to repigment the area. Treatment is geared to decreasing the appearance of patches by:
  • Repigmentation—replace skin color in patches
  • Slowing loss of color
  • Decreasing the difference between affected and unaffected skin
This may be done by:

PUVA (Psoralen plus UVA) and Narrow Band UVB (nbUVB)

PUVA used to be the most common type of repigmentation. Now it is being largely replaced by narrow band UVB (nbUVB). You apply a psoralen cream or take psoralen medication orally. You then expose yourself to UV light A (UV-A) from the sun or an artificial source. The medicine is activated by UV-A. It may repigment white patches. This treatment takes months and can cause sunburn-type reactions. It may also cause nausea and an increased risk of skin cancer .

Excimer Laser

This is a special UV laser. It is shown to be effective in localized cases.

Skin Creams

  • Corticosteroid skin cream—can sometimes slow the loss of color. It may also help return color to small areas. It may cause thinning of the skin.
  • Tacrolimus or pimecrolimus skin creams—can sometimes slow the loss of color. They can help return color to small areas. They may also cause thinning of the skin.
  • Skin grafting —done if the condition is not widespread and stable. It may be possible to graft areas of normal pigmentation to the patches.
Skin Graft
Skin Graft
Copyright © Nucleus Medical Media, Inc.

Depigmentation

This involves removing the remaining pigment from your normal skin. This treatment makes your whole body the same white color. It is only done if you have already lost a large amount of your normal skin color and repigmentation has not been successful. The medicine used is called monobenzyl ether of hydroquinone 20%. This treatment takes about one year to complete. It can cause side effects, such as redness and swelling of your skin.

Cosmetics

You can make your white patches less noticeable. Makeup, dyes, stains, or self-tanning lotions can work as a cover. However, the color from dyes, stains, and lotions slowly wears off.

Sunscreen

The purpose of sunscreen is to:
  • Protect the depigmented area from the damaging effects of sun exposure
  • Prevent increased pigmentation of other areas
Depigmented areas are at much higher risk for skin cancer.

Counseling

For some, vitiligo can cause social distress, affecting quality of life. Cognitive-behavioral therapy can be used to:
  • Help you change your negative thought patterns and behaviors
  • Teach you techniques to help you control anxiety symptoms
  • Suggest changes to your social environment to minimize stress
  • Gradually expose you to feared situations in a controlled environment

Prevention

There is no known way to prevent vitiligo.
It is important to protect the depigmented areas from too much sun exposure. You can do so by wearing protective clothing and applying sunscreen.
Some other medical conditions occur more often in persons with vitiligo. Your doctor will likely ask about symptoms that might indicate a vitiligo-related disorder.

RESOURCES

American Academy of Dermatology http://www.aad.org

National Vitiligo Foundation, Inc. http://www.mynvfi.org

CANADIAN RESOURCES

Canadian Dermatology Association http://www.dermatology.ca

Dermatologists.ca http://www.dermatologists.ca

References

Gawkrodger DJ, Ormerod AD, Shaw L, Mauri-Sole I, Whitton ME, Watts MJ, Anstey AV, Ingham J, Young K; Therapy Guidelines and Audit Subcommittee, British Association of Dermatologists; Clinical Standards Department, Royal College of Physicians of London; Cochrane Skin Group; Vitiligo Society. Guideline for the diagnosis and management of vitiligo. Br J Dermatol. 2008 Nov;159(5):1051-1076.

Kanwar AJ, Dogra S, Parsad D, Kumar B. Narrow-band UVB for the treatment of vitiligo: an emerging effective and well-tolerated therapy. Int J Dermatol. 2005;44:57-60.

Nicolaidou E, Antoniou C, Stratigos A, Katsambas AD. Narrowband ultraviolet B phototherapy and 308-nm excimer laser in the treatment of vitiligo: A review. J Am Acad Dermatol. 2009;60(3):470-477.

Shah R, Hunt J, et al. Starting to develop self-help for social anxiety associated with vitiligo: using clinical significance to measure the potential effectiveness of enhanced psychological self-help. Br J Dermatol. 2014;171(2):332-337.

Taïeb A, Picardo M. Clinical practice. Vitiligo. N Engl J Med. 2009;360(2):160-169.

Vitiligo. American Academy of Dermatology website. Available at: http://www.aad.org/dermatology-a-to-z/diseases-and-treatments/u---w/vitiligo. Accessed Accessed August 27, 2014.

Vitiligo. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated May 7, 2014. Accessed August 27, 2014.

Vitiligo. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health%5FInfo/Vitiligo/default.asp. Updated June 2014. Accessed August 27, 2014.

Vitiligo basics. National Vitiligo Foundation website. Available at: http://www.mynvfi.org/about%5Fvitiligo. Accessed August 27, 2014.

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