Definition:

“Vitiligo or Leukoderma is a common skin disorder, which is characterized by white
spots or patches on the skin”

It may appear in various patterns of distribution.

This disease has been observed for thousands of years, all across the globe. It is a common abnormality and there is no significant difference in it incidence as regards gender, race or age of the individual. Approximately 1 out of every 100 people suffers from this disorder.

Main Types of vitiligo:

Vitiligo may be classified in various ways but following two categories are easily understandable.

a) Generalized form of Vitiligo

“This type of vitiligo often appears as symmetrical white patches on both sides of the body. This type of vitiligo is also known as bilateral vitiligo”.

b) Segmental form of Vitiligo

“Sometimes the white patches may affect only one area of the body. This is known as unilateral localized or segmental vitiligo.”

Unilateral vitiligo is less common than bilateral vitiligo. It occurs most commonly in children. More than half the patients with segmental vitiligo have patches of white hair.

Note:Following are some other common patterns of distribution of vitiligo.

  • Focal Vitiligo: If one or more skin areas lose their pigment in a localized place, it is referred to as Focal Vitiligo.
  • Mucosal Vitiligo: If vitiligo is limited only to mucosal membranes, it is called mucosal Vitiligo
  • Acro-facial Vitiligo: In such condition of vitiligo the Depigmentation occurs on body parts such as face, head, hands and feet.
  • Vitiligo Vulgaris: this name is given to a condition when white patches are widely distributed on the body.
  • Mixed Vitiligo: If more than one patterns of distribution are found in the same individual, like segmental and acrofacial, it is known as Mixed Vitiligo.
  • Universal or Complete, vitiligo: In some cases of vitiligo, there is complete or nearly complete depigmentation, when it is known as universal or complete vitiligo.
  • Occupational Vitiligo: If a person susceptible to vitiligo is exposed to certain chemicals (occupational or otherwise), it may lead to a skin reaction with appearance of white patches as an ultimate consequence. Such vitilgo is sometimes called Occupational or Contact vitiligo.

(Note: Vitiligo is also associated with certain diseases such as Hypothyroidism, Diabetes Mellitus, Addison’s disease, Pernicious Anemia, Alopecia Areata, and Halo Nevi).

Course of Vitiligo

Vitiligo usually appears in between the ages of 10 to 30, but that is not a rule. It can start at any age in any gender or ethnic group.
It is more common among colored races. It may disappear spontaneously in some individuals while it may show a slow progression others.

Areas Commonly Affected By Vitiligo

Vitiligo can affect any area of body, but most commonly it appears in the skin that is usually exposed to the sun, such as face, neck and hands. It is very common in people whose skin is dark or tanned. Sometimes, it can also develop on the scalp. A Patient’s hair may also turn white or grey due to lack of melanin in those areas.

Causes of Vitiligo:

Vitiligo is not contagious in any way. The cause of this disease is not clearly known but most of the experts believe it to be “an immune disease in which the body starts making antibodies against its own melanocytes”

Human skin contains two types of skin cell as its building blocks.

  1. Keratinocytes:(The skin cells which make up the bulk of the skin)
  2. Melanocytes: (The skin cells that make the skin color)

In people with vitiligo, the immune cells (cells which fight against infection) attack the melanocytes and kill them instead of killing germ cells. When the melanocytes die, the skin of that area turns white due to decline in melanin production, which colors the skin.

Vitiligo Challenge & Other Causes:

Vitiligo is now becoming a great challenge for Dermatologist and for the community, because we still do not know as to what derails the immune system. The research however continues and the mystery shall certainly be solved one day.

  • Vitiligo runs in families and some vitiligo experts believe, that genetics may have its own contribution in the causation of this disease.
  • Dr. Richard Spritz has spent several years in researching the genetics cause of vitiligo. He worked on isolated genes and through this work he came to discover a NALP1 gene that seems to have a connection with vitiligo and is closely related with autoimmune diseases.
  • Vitiligo is sometimes set off by severe stress as was diagnosed in Eddie Panlilio; a Philippine Province governor.
  • Vitiligo may sometimes also start at the site of an old injury.
  • Other researches are centered on vitamin deficiencies and internal pathogens. Vitamin deficiencies and psycho- social stresses can even affect the people with lighter skin complexions.

It is however important to know for people affected by vitiligo that it is not a contagious disease and it is not associated with cancer

Signs and Symptoms of Vitiligo

People with vitiligo may complain of the following symptoms.

  1. The most important and the basic symptom of vitiligo is appearance of skin patches that are either white or lighter in color than the adjacent skin. These patches may enlarge or more white with the passage of time. Such progression may be quick in some and very slow in other individuals.
  2. The first white patch usually develops where the skin has been exposed to the sun.
  3. About 12% vitiligo patients, experience intense itching at the area that had been exposed to sunlight, but normally it does not cause any physical discomfort.
  4. Less common signs include loss of color from the hair with graying of scalp hair, eyebrows, eyelashes or hair in other affected areas. The hair n the affected area may even fall off in cases of severe disease.
  5. The loss of pigment may also be experienced on the mucous membranes lining inside of the mouth and retina of the eye.
  6. The white spots are usually more common over bony prominences.
  7. Sometime, These white spots or patches may appear as mirror images on the opposite side of the body.

Diagnosis of vitiligo:

Medical Tests are not usually needed to diagnose vitiligo; a doctor may identify it JUST by its appearance. Typical lab work for vitiligo includes all or part of the following tests:

  • ANA Test: (Antinuclear Antibody) This test helps determine if the patient has other autoimmune diseases.
  • Thyroid peroxides antibody (TPOAb) -Thyroid antibody testing is primarily requested to help diagnose an autoimmune thyroid disease and to differentiate it from other forms of thyroiditis.
  • CBC with differential count.
  • Comprehensive metabolic panel.
  • Lupus panel
  • Lymphocyte panel.
  • 25-Hydroxy-Vitamin D.
  • Folate/B12

Note: The doctor may also use a Woods light to confirm vitiligo, as vitiligo will glow under this light.

Treatment of vitiligo:

Vitiligo is very difficult to treat; its Treatment often depends on its condition and the patient’s feelings of disfigurement. Following are some of the ways, which can help in to treating this disease for short term or prolonged remission. But there always remains a fear that, these white patches may return back and spread even more widely than before.

1. Make up and camouflage (including Self Tanning Lotions)

The affected skin may be covered with appropriate material to camouflage the discoloration. The creams and foundations can match the color of native skin. These creams includes cosmetics like; Derma blend, Chromelin Complexion Blender and Cover mark-up.

Self-tanning lotion (fake tan) may also help to cover vitiligo. Some types of these lotions can last for several days before you need to reapply them.

2. Treatment with Steroid Creams

The use of corticosteroid (steroid) creams for four to six weeks may helps to stop the spread of white patches, and may restore your original skin color. Steroid creams should only be used for a limited time because long-term use may cause unpleasant side effects.

3. Light therapy Or PUVA Treatment:

PUVA light treatment has a high success rate; about 50-70% of people affected by vitiligo show a very good response to this treatment. It is a very successful but time-consuming treatment. Roughly 50% of the people may respond satisfactorily.

In light therapy, a patient has to stand in a light box for 15-30 minutes, and then his skin is exposed to ultraviolet A (UVA) light from a special lamp. The subject is given a pill (psoralen) one hour prior light therapy. This therapy requires 2-4 sessions per week, and a total of 100-300 sessions may be required for effective treatment. The duration of treatment can hence span over more than a year.

Note: PUVA (psoralen and ultraviolet A light) treatment can cause skin cancer because of the extra exposure to UVA rays. Therefore, it is not recommended for children or pregnant women. Ultraviolet B (UVB) light is also sometimes used in light therapy.
4. Application Of SPF 50 Lotions:

Since people wit vitiligo may be more sensitive to sunlight, they may protect themselves by using appropriate sun screens or by keeping the affected areas otherwise covered while in sun.

5. Depigmentation:

“It is a medical process in which some area of normal skin color is removed in order to match white patchy area.”

Such depigmentation is usually achieved by chemical treatment and is opted only when vitiligo is widespread. It has its own hazards and should not be done without clear reasons. Intolerance to sunlight is usually the major nuisance. Different formulations of hydroquinone are used for this purpose, like monobenzyl ether of hydroquinone or the once commercially available cream benoquin. This treatment must be carried out under strict medical supervision.

6. Latest Treatment options in vitiligo

Melanocyte transplantation, in which melanocytes from healthy skin are surgically transplanted to the affected area, is a modern and very promising treatment option. It is however very expensive and still in its experimental stages, with inadequate evidence regarding long term outcomes.

Essential Nutrients For Vitiligo:

The followings are some important nutritional supplements, which may expedite recovery in vitiligo.

  • Daily intake of B-complex multivitamin.
  • Folic Acid 1 mg, Vitamin E 600 – 800 IU, and ascorbic acid 1000 mg a day.
  • The use of Vitamin D ointment on prescription can also prove helpful to some vitiligo patients.
  • The use of Tacrolimus ointment 1% for 6 months may help people with vitiligo. This medication should always be used on prescription.
  • Topical cortisone ointments on prescription can offer temporary remission in most cases of vitiligo.

Effect of Vitiligo On Life & Its Remedies

Vitiligo can have tremendous impact on the psychosocial well being of the affected individual and these people usually, experience a range of feelings and emotions including; shock, denial, anger, fear, embarrassment, shame, guilt, anxiety, isolation, depression and finally acceptance. They remain always worried about, how others people will react with them. A lot of people become overwhelmed and may develop poor self-esteem and confidence.

Some people with vitiligo, fail to demonstrate their full potential and may develop an introvert lifestyle. Children with vitiligo have been observed t have poor self-confidence with underachievement at school. People with dark skin when affected by vitiligo are often ostracized by their community.

Young people looking for partners or those in public professions may have special problems as it may compromise their chances of success. They may consider their life to be a life sentence, as its course is unpredictable.

Vitiligo however is only a cosmetic problem with virtually no risk to your physical health which may be taken as a source of inspiration. The unsightly patches may be camouflaged even if the treatment is inadequate. Vitiligo must not be an obstacle in the way of achieving your personal or professional goals.

Following are some useful ways, which can help in coping with vitiligo.

  • One’s should always be focusing on good attributes of his/her personality and should build up his/her self-esteem for coping with vitiligo.
  • Another important contribution may come from support by family and friends, who can help the affected person in coping with the altered state of mind.
  • Vitiligo patient should also talk with others people who have vitiligo.
  • A vitiligo patient should, find a doctor, whose knowledge about this disease and its current treatments is good and is also capable of providing an emotional support.
  • People suffering from vitiligo should not lose their Self-confidence.
  • Humor is another way of dealing with rude or insensitive remarks. Try to have a few funny remarks up your sleeve and use them when such occasion arises.
  • Vitiligo Guide provides current information about vitiligo treatment so people with vitiligo may consult it.
  • Counseling and support groups A vitiligo patient may find helpful opinion about his skin disorder to speak with a psychologist, or join a vitiligo support group. This may help him to understand more about this disease.
  • Having vitiligo is not a tragedy, although the loss of your skin color can threaten your racial identity if you have dark brown or black skin. Please remember, that your skin color is not the only thing, which makes you who you are! Family background, upbringing, personality, education, cultural, religious beliefs, and your nationality, are more important in defining you as a person. In short you can say that having a fair color is not a decree of judgment about the identity of a person. Those who condemn someone for having vitiligo are ignorant, and must be disregarded.