Vitiligo

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Vitiligo

What is vitiligo?

Vitiligo (vit-ih-LIE-go) is a skin disease that causes loss of skin color in patches or blotches on multiple places on the body. It’s due to the death, or malfunction, of skin cells that produce skin color. It can affect skin on any part of the body and the affected areas get bigger over time. While it’s not contagious or harmful to overall health, there is no cure. It can be stressful if the patient is self-conscious about it. Treatment can restore color to the affected skin, but vitiligo can recur and cause more loss of skin color. Vitiligo affects men and women equally, and occurs in people of all races and skin colors. It’s more noticeable in people with darker skin. An estimated five million Americans have vitiligo.

Is vitiligo a medical or cosmetic condition?

Vitiligo is more than just a cosmetic problem, it’s a medical condition. It may be the result of an autoimmune disease, when the body attacks its own cells, or it may be genetic. You’re more likely to develop it if a close family member is affected by vitiligo. It can cause long-term eye problems, or hearing loss if the ears are affected. While vitiligo is not life-threatening, it can be life-altering because of the skin’s unusual appearance. People with vitiligo are more likely to easily sunburn because there’s no melanin to protect against ultraviolet radiation.

Causes

What causes vitiligo?

Vitiligo is caused when the body’s pigment-producing cells (melanocytes) either die or stop producing skin color (melanin). These cells give color to skin, hair and eyes. The exact cause of vitiligo is not known, but probable causes include:

  • Autoimmune disorder that’s caused when the immune system mistakes a part of the body as foreign, and attacks and kills it.
  • Hereditary - you’re more likely to develop it if family members are affected, especially if they have prematurely graying hair.
  • Triggers such as stress, severe sunburn, skin injury, or contact with a chemical.
  • Nervous system dysfunction is believed to be the cause of segmental vitiligo.

The chances of getting vitiligo increase if you have another autoimmune disease: thyroid disease, Hashimoto’s thyroiditis, or type 1 diabetes.

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Symptoms

What are the symptoms of vitiligo?

  • The main symptom, and the most common one, is loss of color in blotches or patches of skin. Once the color is lost, it very rarely returns. Skin can become lighter or white. It usually begins on the hands, face, genitals, and areas around body openings. 
  • The loss of skin color can happen quickly, followed by the color stabilizing for a while. Over time, the lighter patches become larger. The cycle of pigment loss, followed by stability, can occur many times during a lifetime. 
  • Vitiligo can affect the scalp and hair, causing a section of hair to turn white or prematurely gray. It can also affect eyebrows, eyelashes or beard. 
  • The eyes can lose some color. 
  • Some people lose color inside their mouths, on their lips, nose, genitals or rectum. If vitiligo affects the inner ear, the person may develop hearing loss. 
  • Some people have itching or pain with vitiligo, or tingling when bare skin is exposed to sunlight. However, most people don’t have any other symptoms and feel completely healthy.
  • Some people are embarrassed about their appearance, which can damage their self-confidence and cause isolation and depression. 
  • In most cases, vitiligo develops between the ages of 10 and 30, rarely developing after age 40.

The most common locations for vitiligo include:

  • Skin folds like armpits
  • Places that have been injured
  • Sun-exposed areas
  • Around moles
  • Around body openings
  • Mucous membranes such as mouth, nose or genitals

Are there different types of vitiligo?

Yes, there are two main types of vitiligo: segmental and non-segmental.

  • Segmental or unilateral vitiligo develops on one part of the body such as the face or leg. About half of patients also lose some hair color. Vitiligo usually progresses for a year or so and then stops. It can return and cause the lighter patches to grow larger.
  • Non-segmental or generalized vitiligo is also called bilateral or vitiligo vulgaris. It’s more common than segmental vitiligo and develops in large areas on both sides of the body. It usually begins on the hands, fingertips, wrists, around the eyes, mouth or feet. Color loss begins with a rapid loss of color, stabilizes for a while, only to return with more color loss. This active/inactive cycle continues throughout the person’s life.

Vitiligo is also divided into subtypes to indicate the amount of skin color that has been lost. 

  • Localized or focal vitiligo causes one or a few spots of vitiligo, and it’s limited to one or a few areas of the body without spreading.
  • Generalized vitiligo is most common, and causes scattered patches of lost pigment on corresponding sides of the body or symmetrically. 
  • Trichrome vitiligo causes an area of heavy discoloration and an area of lighter discoloration next to normal skin.
  • Universal means most pigment (at least 80%) is gone; this subtype is rare.

Diagnosis

How is vitiligo diagnosed?

Your dermatologist can usually diagnose vitiligo by examining your skin. A Wood’s lamp may be used to examine your skin under an ultraviolet light. You may also have a skin biopsy or a blood test. The blood test may be needed to check the thyroid gland. Vitiligo patients often have thyroid disease, too.

Treatment

What are the treatment options for vitiligo?

The overall goal of treatment is to return the skin to its normal color or to even out your skin tone. Treatment depends on your age, the amount of skin involved, location of the affected areas, how quickly the disease is progressing, and how vitiligo is affecting your life. 

Treatment is important because it can stop or slow the discoloration and return some of your normal color. Treatment results can vary and it’s hard to predict which treatments will work best for each case. Treatment can take many months to determine if it is going to work on your skin. Several treatments or a combination of treatments may be used until your dermatologist finds what works best for you. And, even if treatment is successful, it may not last, or new vitiligo may develop. 

Some treatments carry serious side effects. A frank discussion with your dermatologist is essential to understand what may or may not happen with treatment. 

Treatment options can include:

  • No treatment except for makeup to even skin tone.
  • Self-tanning products may be the first recommendation. Self-tanning can be time consuming and the result may not look natural.
  • Corticosteroid creams can help control inflammation and restore color. They are most effective if used when vitiligo starts. Treatment may take several months. Side effects include skin thinning or streaks/lines on the skin. Skin also becomes very dry, fragile and easily damaged. 
  • Corticosteroid injections or pills may be used if vitiligo is progressing quickly.
  • Medications that affect your immune system can be effective for cases with small areas of lighter skin. Side effects are a possible link to lymphoma and skin cancer.
  • Light-based therapy (phototherapy) can stop or slow the development of active vitiligo. Often used with corticosteroids or immune system medications. It takes months to see an improvement and about six months to see the full effect. Most people require two to three treatments a week. Phototherapy can cause skin redness, itching and burning for a few hours after each treatment.
  • Phototherapy with ultraviolet-A light plus psoralen that is taken internally or applied to the skin. Lasers can be used on small areas.
  • Depigmentation involves removing any remaining color. It’s used if vitiligo is widespread and/or if other treatments were unsuccessful. Depigmenting medication is applied to the affected skin to gradually lighten it so it blends with discolored areas. This method requires once- or twice-a-day applications for nine months to up to four years. It can cause redness, swelling, itching and very dry skin. This treatment causes permanently white skin.
  • Surgery may be used if phototherapy and medications were unsuccessful. Surgery can even out skin tone by restoring color. However, it can also cause an infection, scarring, bumpy skin, spotty color, skin damage that causes more vitiligo patches, or the area may not recolor. Surgical options include:
    • skin grafting takes small sections of normal skin and grafts them onto lighter patches
    • blister grafting creates skin blisters using suction and transplants the tops of the blisters to lighter skin
    • cellular suspension transplant takes normal skin tissue, removes the cells and places them in a solution that is transplanted to the affected areas. 
  • Developing a coping strategy is an important part of treatment because most people have vitiligo for life. The condition brings unwanted attention or embarrassment that can affect patients’ mental and social health. Support groups and/or counseling therapy can be very helpful in maintaining a positive outlook.
  • Lifestyle remedies can help protect skin and improve its appearance. These include wearing sunscreen every day, avoiding tanning beds and sun lamps, avoiding tattoos because they can cause more patches of vitiligo.

References

Mayo Clinic. (April 2020). Vitiligo. Retrieved 10-9-21, {https://www.mayoclinic.org/diseases-conditions/vitiligo/symptoms-causes/syc-20355912#:~:text=Vitiligo%20is%20a%20condition%20in,of%20skin%20color%20in%20patches}
Mayo Clinic. (April 2020). Vitiligo: Diagnosis and Treatment. Retrieved 10-9-21, {https://www.mayoclinic.org/diseases-conditions/vitiligo/diagnosis-treatment/drc-20355916}
WebMD. (2020). Vitiligo and Loss of Skin Color. Retrieved 10-11-21, {https://www.webmd.com/skin-problems-and-treatments/guide/vitiligo-common-cause-loss-skin-pigment}
American Academy of Dermatology Association. (n.d.)  Vitiligo: Signs and Symptoms. Retrieved 10-11-21,(https://www.aad.org/public/diseases/a-z/vitiligo-symptoms}
American Academy of Dermatology Association. (n.d.)  Vitiligo: Diagnosis and Treatment.  Retrieved 10-11-21, {https://www.aad.org/public/diseases/a-z/vitiligo-treatment}
American Academy of Dermatology Association. (n.d.)  Is Vitiligo a Medical Condition?  Retrieved 10-11-21, {https://www.aad.org/public/diseases/a-z/vitiligo-medical-condition}

Information

Medically reviewed by:

Dr. Javeed Siddiqui, MD, MPH

Dr. Siddiqui is the Chief Medical Officer at TeleMed2U responsible for clinical and technical program development as well as maintaining a thriving telemedicine practice in infectious diseases which includes specialized care of Hepatitis and HIV.

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