Vitiligo

Vitiligo is a chronic skin disease associated with a loss of pigmentation of certain body parts

What is vitiligo?

Vitiligo is a non-contagious chronic skin condition that affects 0.5 to 2% of the worldwide population and is associated with a loss of pigmentation due to the progressive destruction of melanocytes, the skin cells that produce melanin, responsible for skin color. It manifests as pink or white irregularly shaped macules or patches that frequently appear in the face and other visible areas of the body such as hands, feet, arms, and face, but can develop anywhere, including mucous membranes like nostrils, genitals, or the inner part of the mouth. When the patch is placed in a hairy place, hair can turn silver, gray or white.

For patients, the disease is perceived as disfiguring and burdensome, and in consequence it can be psychologically devastating, with an impact on quality of life similar to other dermatologic conditions such as psoriasis or atopic dermatitis.

Besides, vitiligo is associated with systemic changes, including inflammation of the eyes and ears, and people living with this disease are more likely to get sunburnt in affected areas due to the lack of melanin, which increments the risk of suffering other dermatological conditions. Also, people who have vitiligo have a higher risk of developing some other autoimmune diseases like thyroid disease.

Even though vitiligo can appear at any age, almost 50% of patients start exhibiting symptoms before they are 20 years old. The condition tends to progress over time, with larger areas of the skin losing pigment, but the patches can remain stable or even improve. It is equally present among both sexes and among people of different skin types, but it is more visible in people with darker skin.

Types of vitiligo

There are different types of vitiligo. Some of the most common ones are:

  • Generalized. Macules or patches appear in various places of the body, often in a symmetrical way. It is the most common type.

  • Segmental. This kind of vitiligo only affects an area or side of the body.

  • Focal. There is an isolated, small, and depigmented patch that does not progress for at least 2 years.

  • Universal. The skin is completely or nearly-completely depigmented.

What causes vitiligo?

Vitiligo is an autoimmune disease in which immune cells of the body mistakenly attack melanocytes, the cells responsible for producing melanin. Even though genetics strongly influence the risk of developing this disease, some external factors can also contribute, among them severe sunburn, pregnancy, major skin injuries, and significant stress.

How to detect vitiligo?

The appearance of white or pink macules or patches in the skin are usually the most prevalent symptom of vitiligo, even though some patients report itch before a new patch arises. Diagnosis is usually easily made by healthcare providers through visual examination, but sometimes they will use an ultraviolet lamp to confirm affected areas, especially when patients are light-skinned. Healthcare providers might also request blood tests to discard other autoimmune conditions.

How to prevent vitiligo?

Currently, vitiligo cannot be prevented, but there are some treatments that can prevent existing vitiligo lesions from growing. If you suffer from vitiligo, protecting your skin from the sun, supporting your immune system with a healthy lifestyle or taking care of your mental health can also help you control the disease.

How to treat vitiligo?

Even though it does not currently exist any treatment that cures vitiligo, there are several options available to clear existing vitiligo patches and/or prevent them from growing, among them:

  • Topical corticosteroids. The use of a corticosteroid anti-inflammatory cream or ointment in vitiligo lesions can be effective to restore some pigment, especially in cases where vitiligo has recently developed. However, because of possible secondary effects such as thinning of the skin, healthcare providers often prescribe these treatments for a limited time.

  • Phototherapy. This treatment involves exposing the skin to a type of ultraviolet light that can restore natural skin color. Even though it can be helpful for some patients, treatment often needs to be prolonged, implying hospital visits two to three times a week for several weeks or months. Sometimes it is used in combination with other treatments such as topical corticosteroids.

  • Surgical treatment. In cases in which patients do not respond to other treatments, surgery can be an option. Two kinds of surgery are used to treat vitiligo: skin graft, in which a surgeon removes healthy skin to place it in areas affected by vitiligo, and cell transplant, in which a surgeon removes healthy cells and places them into skin with vitiligo so that they reproduce and cause a skin re-pigmentation. Surgery is not recommended in cases in which vitiligo patches have developed or grown within last 12 months.

References

1. Rodrigues M, Ezzedine K, Hamzavi I, Pandya AG, Harris JE; Vitiligo Working Group. New discoveries in the pathogenesis and classification of vitiligo.J Am Acad Dermatol. 2017;77(1):1–13. doi:10.1016/j.jaad.2016.10.048.

2. Hann, S. K., & Nordlund, J. J. (2000).Vitiligo: A monograph on the basic and clinical science. In Vitiligo: A monograph on the basic and clinical science (pp. xiv-306).

3. Elbuluk N, Ezzedine K. Quality of life, burden of disease, co-morbidities, and systemic effects in vitiligo patients.Dermatol Clin. 2017;35(2):117–128. doi:10.1016/j.det.2016.11.002.

4. Morrison B, Burden-Teh E, Batchelor JM, Mead E, Grindlay D, Ratib S. Quality of life in people with vitiligo: a systematic review and meta-analysis. Br J Dermatol. 2017;177(6):e338–e339. doi:10.1111/bjd.15933.

5. Radtke MA, Schäfer I, Gajur A, Langenbruch A, Augustin M. Willingness-to-pay and quality of life in patients with vitiligo. Br J Dermatol. 2009;161(1):134–139. doi:10.1111/j.1365-2133.2009.09091.x

6. British Skin Foundation. Vitiligo. Available at: https://knowyourskin.britishskinfoundation.org.uk/condition/vitiligo/

7. American Academy of Dermatology. Vitiligo. Available at:https://www.aad.org/public/diseases/a-z/vitiligo-overview