Vitiligo is a skin disease resulting in white patches all over the body. This skin condition can also affect hair and even the internal wall of the mouth. In most cases, these patches grow bigger with time. Though it is not contagious or life-threatening, the loss of pigment from prominent body parts can cause stress among the people affected.
What happens in vitiligo?
Human beings get the characteristic color in the skin and hair due to a pigment called melanin. However, in vitiligo, melanocytes (cells responsible for the formation of melanin) get damaged. It results in loss of color in patches in various organs like hands, feet, and face. Until now, there is no cure for this skin condition. However, regular treatment helps in restoring some color on affected areas.
Types of vitiligo
Depending on the body parts affected, vitiligo can be of following types:
- Generalized vitiligo- This type of skin discoloration appears all over the body. It is the most prevalent type of vitiligo.
- Segmental vitiligo- The segmental vitiligo appears and remains restricted to only one side of the body, like the face or hands. It usually occurs at a young age, and then increases its effect for a year or two and finally stops progressing further.
- Focal vitiligo- In focal vitiligo, the depigmentation does not progress to other parts . It remains confined to a single spot.
- Trichome vitiligo- The trichome vitiligo is a unique type of vitiligo where you can find a combination of various degrees of discoloration. Patients demonstrate an area of robust depigmentation, succeeded by a lighter zone, which is again followed by a natural skin tone.
- Universal vitiligo- The universal vitiligo is a rare form of skin discoloration where at least 80% of the victim’s body surface gets affected.
- The face and hands- With this type, known as acrofacial vitiligo, the affected skin is on the hands and face, and around the body openings, like the eyes, nose and ears.
What are the symptoms of vitiligo?
Symptoms of vitiligo include:
- Loss of skin color in patches. Vitiligo initially appears on the face, hands, genitals, and skin near the body openings and then progresses further.
- Premature graying of scalp hair, eyebrows, eyelashes, and beard.
- Loss of color on the inner lining of the mouth and nose. Here melanocytes in the mucous membrane get affected.
When to see a doctor in vitiligo?
It is challenging to determine how vitiligo is going to impact a patient. In most cases, the white patches spread to other organs with time, and sometimes, almost your entire body gets affected. Sometimes, the discoloration can stop progression and, in rare cases, patients gain their original skin tone.
So, it is best to seek the consultation of a dermatologist at the first appearance of vitiligo.
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What causes vitiligo?
Patients develop vitiligo when their melanocytes stop producing melanin pigment or start dying prematurely. The melanocytes become non-functional causing the loss of normal skin tone , that turns pale and white. Though doctors are still unsure about vitiligo’s exact cause, scientists speculate that it can be an autoimmune (immune system start malfunctioning) or hereditary condition. In some cases, triggers like stress, contact with harsh chemicals, and severe sunburn may also play a role in developing this skin disease.
What are the risk factors of vitiligo?
Though vitiligo can occur in individuals of all ages and race, risk factors include
- family history of vitiligo
- members in the family show premature graying of hairs
- people suffering from autoimmune diseases like type 1 diabetes and Hashimoto’s thyroiditis (a thyroid disorder)
What are the complications of vitiligo?
Vitiligo patients have an increased risk of
- hearing impairment
- vision issues
- social and psychological distress
- skin cancer
Treatment options for vitiligo
Dermatologists usually prescribe medications, light-based therapies, and surgeries for treating this skin disorder. The choice of treatment depends on the amount of skin involved, speed of progression, and patients’ age. Have a look at the various treatment options for vitiligo-
UV treatment for vitiligo
The ultraviolet ray therapy for vitiligo is a popular choice for arresting the depigmentation.
- Narrowband ultraviolet B (UVB)
Dermatologists advocate the use of narrowband ultraviolet B (UVB) for active vitiligo patients. Results show that they are more effective in controlling the progression of white patches when administered in combination with corticosteroids or calcineurin inhibitors. There are chances of a few side effects, including burning sensation, redness, and itching. However, these subside within a few hours of treatment.
Patients often require UV treatment for vitiligo twice or thrice a week for satisfactory results. You start experiencing the beneficial effects within one to three months. However, you need to wait for six months or even longer to feel this therapy’s final impact. These days, small portable or handheld devices are also available for implementing narrowband ultraviolet B therapy. Patients can even use these gadgets in the comfort of their house under expert guidance.
- Combination of psoralen and UVA therapy
There is also an option of combining psoralen with phototherapy for inducing color to light patches. Here doctors use a plant-derived compound- psoralen is the association with ultraviolet A rays. Patients either ingest psoralen through the mouth or apply it to the depigmented surface directly. After this, the therapist exposes the patient to UVA rays. If facilities are not available for UVA, Patient can also expose to natural sunrays in a graded manner. Though this phototherapy has shown satisfactory results, it is challenging for the candidate to undergo the process. It is the reason most skin clinics now resort to narrow-band UVB therapy.
Medications for vitiligo
Though it is not possible to reverse the loss of pigmentation in vitiligo completely, doctors often advise a combination of drugs and light therapy to manage the symptoms.
- Medications for controlling depigmentation
Corticosteroid creams help return some color to depigmented skin. However, it is crucial to start with this treatment at the early stages of the disease for the best results.
These medicines may take months before showing some visible change to the discoloration and prove their effectiveness.
- Medications affecting the immune system
In rare cases, dermatologists also prescribe calcineurin inhibitor ointments like tacrolimus or pimecrolimus which might be effective for individual with small regions of depigmentation, especially on the face and neck
- Medications to promote repigmentation
Recently a new molecule decapeptide or basic fibroblast growth factor is used as application at night followed by sun exposure next morning to promote melanocytes to produce color and spread it to the overlying skin.
Surgery for vitiligo
If you do not experience noticeable changes in the depigmentation even after undergoing phototherapy or pigmentation, doctors may suggest the following surgical procedures to control vitiligo.
- Skin grafting
Here the surgeon transfers a tiny pigmented section of the epidermis to the discolored area. It is successful, especially if you have a small localized vitiligo patch. However, there are risks of postoperative infection, scarring, spotty color, and failure in the reappearance of skin pigment.
- Blister grafting
Here the surgeon generates blisters on a pigmented area of the skin through the suction procedure. After that, he transplants the upper layer of blisters to the depigmented site.
- Cellular suspension transplant
In this procedure, surgeons collect a section of your tissue from the pigmented area and introduce it to a solution. After this, he transplants the tissue on the prepared discolored location. Patients can experience the initiation of the repigmentation procedure within four weeks.
Lasers for vitiligo
In vitiligo, an Exciter laser with a wavelength of 308nm given twice a week for three to four months gives good results. Availability of the machine is the only constraint
Though vitiligo is non-curable, timely treatment can slow down the progression of the depigmentation. It may even succeed in bringing back some color to white patches. UV treatment is the preferred treatment mode for the treatment of vitiligo.
Frequently asked questions (FAQs)
- How do dermatologists diagnose the occurrence of vitiligo?
Dermatologists can diagnose the occurrence of vitiligo by your medical history and physically examine the skin. They may also prescribe blood tests and skin biopsy to confirm the skin disorder.
- What are the potential future treatments for vitiligo?
Currently, doctors are working on medications that would trigger the production of melanocytes in the vitiligo patches. Called afamelanotide, this will be implanted below the epidermis for the best results. Additionally, they are also researching the Prostaglandin E2 group of compounds for generating melanocytes in vitiligo patients.
- What is depigmentation therapy for vitiligo?
Doctors also advise the depigmentation technique for patients with widespread vitiligo. Here they introduce a depigmenting agent on the colored area of the skin to gradually lighten it and match it with the vitiligo patches.