What is Vitiligo?
Vitiligo is a skin disorder involving the appearance of white patches on skin due to a loss of pigmentation, skin may otherwise appear naturally healthy. This hypopigmentation occurs as a result of the destruction of the cells, called melanocytes, that make the skin’s brown pigment (melanin). The cause of vitiligo remains unknown, although there is speculation that it is an autoimmune condition involving the destruction of the melanocytes by the body’s own immune system cells. As well as the skin problems caused by vitiligo, the condition can also affect the mucous membranes in the mouth, nose and eye.
Damage from other skin diseases, such as psoriasis, and eczema may contribute to the causes of vitiligo, although some people appear to have a genetic predisposition to the dermatological condition. There are also some skin specialists that have put forward the hypothesis that the melanocytes destroy themselves, whilst other dermatologists believe that trauma from sunburn, and even emotional distress can be a cause of vitiligo. There is no clear evidence to support such theories however, which can make vitiligo very difficult to treat.
Who Gets Vitiligo?
In the US there are thought to be between one and two million people with vitiligo (about one in every hundred Americans), with most people developing it under the age of forty, and some cases of vitiligo in children. Although one of the most famous sufferers of vitiligo, Michael Jackson, had extensive loss of pigmentation, many more have smaller white patches. The incidence in men and women appears to be roughly equal and the condition affects people of different ethnic backgrounds equally, although those with darker skin may be more likely to notice the effects earlier than those with naturally pale skin. Patients with some autoimmune conditions such as hyperthyroidism, Addison’s Disease, and pernicious anaemia, are considered more likely to develop vitiligo, although it is unclear as to why. There may also be an hereditary component to the condition with discoloration of the skin often found in several members of the same family. However, vitiligo in children does not necessarily arise even if one or both parents have the condition although the risk of the skin condition developing is increased.
White Patches on Skin
Common areas for the development of the white skin spots include the hands, feet, arms, face, and lips. Areas of skin more frequently exposed to the sun appear more susceptible to vitiligo, possibly through trauma to the skin in the form of sunburn and free radical damage. Vitiligo disease may also lead to white patches on the skin around the groin and the armpits, around the mouth, eyes, nostrils, navel (belly button), and the genital region. The inside of a patient’s mouth may also undergo a loss of pigment and many sufferers notice that their hair turns grey earlier than their peers. The rate of skin discoloration varies widely between individuals with some experiencing no spread of the white skin patches and others undergoing a rapid loss of pigmentation across the body. Anecdotal evidence suggests that emotional stress and trauma can accelerate the progression of vitiligo although no research evidence is available to support this hypothesis due to the ethical constraints of such research.
Diagnosing vitiligo usually involves a medical history and physical examination. Family medical history will also form part of the diagnosis as a doctor will likely ask if others in the patient’s family suffer from skin diseases or autoimmune diseases. For patients with grey hair they may be asked if their hair lost pigment prior to their 40th birthday, and all patients are asked about skin trauma such as sunburn, rashes, and things such as eczema and psoriasis. Patients with other skin problems may be asked about their eczema treatment, or psoriasis treatment using topical steroid creams or other therapies as well as sensitivity to the sun, current and previous emotional stress and physical illness. Following a medical history and family history, the doctor may take a blood sample to test hormone levels and vitamin B12 status, and a small skin sample (biopsy), and conduct an eye examination. Treatments will usually not be prescribed until the test results have returned but the doctor will likely discuss possible vitiligo treatments with a patient first to determine any preference in how to approach the management of the skin condition.
The extent of the hypopigmentation will also determine the type of treatment a patient receives, as will any other medical conditions the patient suffers from. The treatment options for vitiligo include surgery, medications, and support although most aim to restore some degree of colour to the white patches of skin. A number of treatments for vitiligo can have harmful side-effects, which may lead patients to forego such therapy in favour of techniques such as vitiligo cover up using special vitiligo makeup instead. Where an immune system malfunction is thought to blame for vitiligo, a patient may be given a steroid cream to use. However, steroid creams may not be recommended for long-term use as they can thin the skin and make a patient more susceptible to other skin problems. Oral medications, plus UVA light therapy (PUVA), and depigmentation of other skin areas to match the white patches are all other treatment options for vitiligo sufferers. Other patients may decide to undergo surgery including skin grafts to cover small patches of vitiligo, or the use of tattoos to add colour to the white patches of skin.
All vitiligo patients are advised to use broad-spectrum sunscreen as the areas of hypopigmentation are at a higher risk of sun damage and can increase the possibility of skin cancer developing. Patients with vitiligo are encouraged to find a doctor experienced in treating skin disorders, with general practitioners often referring patients to a skin specialist (dermatologist) for further guidance. The alteration in appearance can be highly distressing for many patients and they may wish to find a local support group or online group to help them cope with the emotional effects of vitiligo. Family and friends are another great source of support for many patients and it is, therefore, important that they know what vitiligo is, that it is not contagious, and what they can do to help.