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.
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 (autoimmune)
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.
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
those that affect the thyroid gland
The main symptom is white patches on the skin. These patches may be any size or location.
The patches may be focal (only a few areas) or be more widely spread (generalized)
Nonsegmental (most common):
Present on both sides of the body
More likely to be generalized and spread
May involve the hair
Usually autoimmune, with flare-ups
Present on one side of the body
May develop quickly, but then stop spreading
Not usually autoimmune
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
Areas where clothing or jewerly rub, such as the neck
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.
Cycles of pigment loss and stability may occur, most common with nonsegmental type. The cycle can continue throughout life.
You will be asked 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 it. Special UV lamps may be used during the skin exam.
You may also be tested for other autoimmune diseases, such as
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). A psoralen cream is applied or a psoralen medication is taken orally. Your body is exposed to UV light A (UV-A) from the sun or an artificial source. The medication 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
This is a special UV laser. It is shown to be effective in localized cases.
Skin creams may be used to treat the affected areas:
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.
—Done if the condition is not widespread and stable. It may be possible to graft areas of normal pigmentation to the patches.
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 medication used is called monobenzyl ether of hydroquinone 20%. This treatment takes about 1 year to complete. It can cause side effects, such as redness and swelling of your skin.
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. Tattooing may also be and option.
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.
For some, vitiligo can cause social distress or anxiety, which affects quality of life. Counseling or
or 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
There are no current guidelines to prevent vitiligo.
Vitiligo. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health_Info/Vitiligo/default.asp. Updated June 2014. Accessed May 16, 2016.
Vitiligo basics. National Vitiligo Foundation website. Available at: http://www.mynvfi.org/about_vitiligo. Accessed May 16, 2016.
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(1):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, Thompson AR. 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.
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