Vitiligo: Symptoms, Causes, Complications, Diagnosis and Treatment

Vitiligo, also known as Leucoderma is a disease in which the pigment cells of the skin called melanocytes, are destroyed in certain areas.

Updated: November 3, 2019


Vitiligo, also known as Leucoderma is a disease in which the pigment cells of the skin called melanocytes, are destroyed in certain areas.The word literally means white skin. The color of hair and skin is determined by melanin. When the cells that produces melanin die or stop functioning, there will be a gradual loss of the pigment melanin from the skin layers which results in white patches.
It can start from any part of your body including hair and the inside of the mouth. It can be focal and localized to one area, or it may affect several different areas on the body.
It can affects all skin types and these patches look ugly. However,it may be more noticeable in persons with a dark complexion. The condition does not cause any organic harm. This disease is caused neither by any germs, nor is it due to any infection. It is considered to be neither not life-threatening nor contagious. Symptoms and signs of vitiligo include loss of skin color in the form of depigmented, or white, patches of skin in any location on the body.
It may have a genetic component, as the condition tends to run in families. Sometimes it is associated with other medical conditions, including thyroid dysfunction.
Vitiligo is not painful and does not have significant health consequences. But it can have emotional and psychological consequences which could be stressful or make you feel bad about yourself. Currently there is no cure for vitiligo. Treatment for vitiligo may restore color to the affected skin. But it does not prevent continued loss of skin color or a recurrence.
An early diagnosis will help treating the symptoms. Spread of vitiligo is unpredictable. There is no way to determine if vitiligo will spread or remain confined to one location.
The white patches do not spread for some people. But often the white patches will spread to other areas of the body. Vitiligo spreads slowly, over many years for some people where as for others spreading may occur quickly. Some people have reported more white patches after physical or emotional stress. Medical treatments can reduce the severity of the condition, but it can be difficult to cure and there is no known way to prevent vitiligo.

Symptoms of Vitiligo:

Usually it starts with a small white spot which later develops into patches. These patches are pale in the beginning, but over time it become whiter and whiter due to loss of pigment. As the spots enlarge, they merge into each other and, in course of time, form a very broad patch. In some cases, most of the skin of the body may be covered with white patches.These patches are more common in areas where the skin is exposed to the sun. The patches may be on the hands, feet, arms, face, and lips.
The patches can be seen in the armpits and groin where the leg meets the body. It can aslo be seen around the mouth, eyes, nostrils, navel, genitals and rectal areas.
People with vitiligo often have premature whitening or graying of the hair on your scalp, eyelashes, eyebrows or beard. Those with dark skin may notice a loss of color in the tissues that line the inside of your mouth and nose. Loss of or change in color of ratina may occur in few cases. Vitiligo often appears before age 20, but can start at any age.
The discolored patches may cover many parts of your body, only one side or part of your body or one or only a few areas of your body depending on the type of vitiligo you have.The discolored patches often progress symmetrically and may cover many parts of your body in generalized vitiligo  which is the most common type. When the patches are seen in only one side or part of your body, it is called segmental vitiligo. Usually this type occur at a younger age, progress for a year or two, then stop. In localized or focal vitiligo, the patches are seen one or only a few areas of your body. The progress of disease is unpredictable. Sometimes the patches stop forming without treatment. But in most cases, pigment loss spreads and eventually involves most of your skin. Rarely, the skin gets its color back.
If areas of your skin, hair or eyes lose coloring, visit your doctor immediately. There is no cure for vitiligo. But treatment may help to stop or slow the discoloring process and return some color to your skin.

Causes of Vitiligo:

Melanin is the pigment that gives your skin, hair and eyes color. Vitiligo  occurs when pigment producing cells called melanocytes die or stop producing melanin. As a result the affected areas will have lighter or white patches. The exact cause of failure of cells is unknown. However it may be related to:

  • A disorder in which your immune system attacks and destroys the melanocytes in the skin
  • Family history or heredity
  • A trigger event, such as sunburn, stress or exposure to industrial chemicals

Other causes may be chronic or acute gastric disorders, impaired hepatic function such as jaundice, worms or other parasites in the alimentary canal, typhoid, a defective perspiratory mechanism, and burn injuries.
People with certain autoimmune diseases such as hyperthyroidism are more likely to get vitiligo.

Complications of Vitiligo:

People with vitiligo may be at increased risk of:

  • Social or psychological distress
  • Sunburn and skin cancer
  • Eye problems, such as inflammation of the iris known as iritis
  • Hearing loss

Diagnosis of Vitiligo:

Vitiligo can be diagnosed based on your medical history, physical exam, and some tests. Your doctor will examine you and try to rule out other medical problems, such as dermatitis or psoriasis. He or she may use a special lamp to shine ultraviolet light onto the skin to determine whether you have vitiligo.
Tests might include:

  • Biopsy is done by taking a small sample of the affected skin.
  • Blood tests can be done to look for underlying autoimmune conditions, such as anemia or diabetes
  • An eye examination is done to look for iritis.

Treatment of Vitiligo:

Treatments are available to help restore skin color or even out skin tone. Results may vary person to person and are unpredictable. Treatments can take a long time, and sometimes they don't work. As some treatments have serious side effects, improving the appearance of your skin by applying self tanning products or makeup are recommended as first option of treatment.
The effectiveness of a drug, surgery or therapy may take many months to judge. Most of the time you may have to try more than one approach or a combination of approaches before you find the treatment that works best for you. The results may not last or new patches may appear even if treatment is successful for a while.

Medications:

The process of vitiligo that is the loss of pigment cells (melanocytes) can not be stoped by any medication. However, some medicines, used alone or with light therapy, can help restore some skin tone. These include:

Creams that control inflammation:

Applying a corticosteroid cream to affected skin may help return color. This will be more effective if you start using it early in the disease. A change in the color of your skin will not be noticed for several months. This type of cream is effective and easy to use. But it can cause side effects, such as skin thinning or the appearance of streaks or lines on your skin.
For children and for people who have large areas of discolored skin, milder forms of the drug may be prescribed.

Medications that affect the immune system:

Ointments containing tacrolimus or pimecrolimus or calcineurin inhibitors may be effective for people with small areas of depigmentation, especially on the face and neck. This treatment can be used with ultraviolet B (UVB) light which may have fewer side effects than corticosteroids. However, there is a possibility of developing lymphoma and skin cancer using these drugs.

Therapies:

Combining psoralen and light therapy:

A plant derived substance called psoralen can be combined with light therapy or photochemotherapy to return color to the light patches. During the treatment psoralen can be taken by mouth or applied to the affected skin. After this, you will be exposed to ultraviolet A (UVA), UVB light or excimer light. These combinational approaches tend to have better results than using medication alone or light therapy. The treatment should be done up to three times a week for 6 to 12 months.

Depigmentation or Removing the remaining color:

If your vitiligo is widespread and other treatments haven't worked, this therapy may be an option. In this therapy a depigmenting agent is applied to unaffected areas of skin so that it will gradually lightens it to blends with the discolored areas. The therapy is done once or twice a day for nine months or longer. Redness, swelling, itching and dry skin are some of the side effects from this therapy. Depigmentation is permanent, and you will always be extremely sensitive to sunlight.

Surgery:

If light therapy doesn't work, surgery may be an option for you. Surgery can also be used with those therapies. The goal of the treatment is to even out your skin tone by restoring color.

Skin grafting:

This procedure is sometimes used if you have small patches of vitiligo. A very small portion of your normal, pigmented skin will be removed by your doctor and will be attached to areas that have lost pigment. Infection, scarring, a cobblestone appearance, spotty color and failure of the area to recolor are some of the possible risks of this procedure.

Blister grafting:

Blisters on your pigmented skin are created by your doctor. Usually this is done with suction. The tops of the blisters are then removed and transplanted to an area of discolored skin. Possible risks include scarring, a cobblestone appearance and failure of the area to recolor. The skin damage caused by suctioning may trigger another patch of vitiligo.

Tattooing or micropigmentation:

Your doctor uses a special surgical instrument to implant pigment into your skin in this procedure. If the patches are in and around the lips in people with darker complexions, micropigmentation is most effective. Difficulty matching the skin color and potential for the tattooing to trigger another patch of vitiligo are few drawbacks.
Some research are going on some medication for potential future treatments. These include:

  • A drug to stimulate color producing cells melanocytes called afamelanotide. This potential treatment is implanted under the skin to promote the growth of melanocytes.
  • A drug that helps control melanoctyes. Prostaglandin E2 is being tested as a way to restore skin color in people with localized vitiligo that isn't spreading. It is applied as a gel to the skin.
  • A drug that reverses loss of color. Tofacitinib, an oral drug typically used to treat rheumatoid arthritis, has shown some potential as a treatment for vitiligo.

Other treatments include:

  • Sunscreens
  • Cosmetics, such as makeup or dye, to cover the white patches
  • Counseling and support


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