Vitiligo

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

What is vitiligo?

Vitiligo is a non-contagious, chronic skin condition that affects 0.5-2% 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  and are responsible for skin color. It manifests as pink or white, irregularly shaped macules or patches that frequently appear on the face and other visible areas of the body, such as the hands, feet, and arms,but can develop anywhere, including mucous membranes such as the nostrils, genitals, or the inner part of the mouth. When patches appear in hairy areas, hair may turn silver, gray or white.

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

Vitiligo is associated with systemic changes, including inflammation of the eyes and ears. People living with this disease are more likely to experiencesunburnt in affected areas due to the lack of melanin, which increases the risk of developing other dermatological conditions. In addition, people with  vitiligo have a higher risk of developing  other autoimmune diseases, such as thyroid disease.

Although vitiligo can appear at any age, almost 50% of patients begin  to show symptoms beforethe age of 20. The condition tends to progress over time, with larger areas of the skin losing pigment; however,  patches may  remain stable or even improveVitiligo affects both sexes equally and occurs across all skin types, but it is more noticeable in people with darker skin.

Types of vitiligo

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

  • Generalized vitiligo. Macules or patches appear in multiple areas of the body, often symmetrically .This is the most common type.

  • Segmental vitiligo. This type of vitiligo affects only  one area or one side of the body.

  • Focal vitiligo. An isolated, small depigmented patch that does not progress for at least 2 years.

  • Universal vitiligo. The skin is completely or  almost completely depigmented.

What causes vitiligo?

Vitiligo is an autoimmune disease in which the body’s immune cells mistakenly attack melanocytes, the cells responsible for producing melanin.  Although genetics strongly influence the risk of developing this disease,  certain  external factors may also contribute,  including  severe sunburn, pregnancy, major skin injuries, and significant stress.

How is vitiligo detected?

The appearance of white or pink macules or patches  on the skin is usually the most common symptom of vitiligo,  although some patients report itching beforenew patches appear . 
Diagnosis is usually made  through visual examination by healthcare professionals. In some cases, an  ultraviolet lamp may be used to confirm affected areas, particularly  in light-skinned patients. Blood tests may also be requested to rule out other autoimmune conditions.

How can vitiligo be prevented?

Currently, vitiligo cannot be prevented; however,  some treatments may help can prevent existing lesions from spreading .Protecting the skin from sun exposure, supporting the immune system through a healthy lifestyle,and taking care of mental health may also help patients manage the condition.

How is vitiligo treated?

Although there is currently no treatment that cures vitiligo,  several options are available to reduce existing vitiligo patches and/or prevent them from progressing, including :

  • Topical corticosteroids. Anti-inflammatory corticosteroid creams or ointments applied to  vitiligo lesions may help  restore  pigment,  particularlyin newly developed areas.Due to potential side effects, such as skin thinning ,  these treatments are usually prescribed for limted periods.

  • Phototherapy. This treatment involves exposing the skin to specific types of ultraviolet light that can help restore natural skin color.   Although it may be effective for some patients, treatment often needs to be prolonged and may requirehospital visits two to three times per week for several weeks or months. Phototherapy is sometimes combined with other treatments like  topical corticosteroids.

  • Surgical treatment. For patients who  do not respond to other therapies , surgery may be considered. Surgical options include skin grafting, in  whichhealthy skin is transferred to affected areas, and  cell transplant, in which  healthy cells  are placed into depigmented skin to promote  repigmentation. Surgery is generally not recommended  if  vitiligo patches have developed or progressed within the previous 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