Vitiligo or leukoderma is a chronic skin disease that causes loss of pigment, resulting in irregular pale patches of skin. The precise cause of vitiligo is complex and not fully understood. There is some evidence suggesting it is caused by a combination of auto-immune, genetic, and environmental factors. The population incidence worldwide is considered to be between 1% and 2%. According to Diseases Database, vitiligo is: “A disorder consisting of areas of macular depigmentation, commonly on extensor aspects of extremities, on the face or neck and in skin folds. Age of onset is often in young adulthood and the condition tends to progress gradually with lesions enlarging and extending until a quiescent state is reached.”
Causes of Vitiligo
The pigment that gives your skin its normal color is melanin: cells known as melanocytes make it. The cause of vitiligo is not yet fully known but many think that it is a disease in which the body makes antibodies to its own melanocytes and, in doing so, destroys them. After that, the skin cannot make melanin properly, and vitiligo is the result. In support of this idea is the way that people with vitiligo are more likely than others to have diseases—caused in much the same way—of other organs such as the thyroid. Sometimes vitiligo seems to be triggered by an episode of sunburn. It affects men and women of all races equally, but is most easy to see in people with dark skins. It is not “catching” or contagious.
About a third of people with vitiligo know of someone in their family who has it, but the exact type of inheritance has not yet been worked out. One problem here is that so many people have no idea if their relatives are hiding vitiligo under their clothing. If you have vitiligo, it does not follow that your children are sure to get it too.
Symptoms of Vitiligo
These fall into two groups:
- The sun burns the pale areas very easily. This is sore, and when the burn has settled down, the pale areas of vitiligo will stand out, more strikingly than before, against a background of tanned skin.
- Many people become embarrassed or depressed by the look of their vitiligo, and by the questions that other people ask them about it.
On the other hand, the most common sites for vitiligo are:
- The exposed areas—vitiligo often begins on the hands and face.
- Around body openings: the eyes, nostrils, mouth, umbilicus and genitals.
- In body folds: the armpits and groin.
- Anywhere your skin has been damaged; for example, by a cut or a burn.
- Areas around pigmented moles (as part of “halo naevi”).
- In one rare (segmental) type, vitiligo crops up on just one part of the body.
Treatment of Vitiligo
- Appearance Altering: There are a number of ways to alter the appearance of vitiligo without addressing its underlying cause. In mild cases, vitiligo patches can be hidden with makeup or other cosmetic camouflage solutions. If the affected person is pale-skinned, the patches can be made less visible by avoiding sunlight and the sun tanning of unaffected skin. However, exposure to sunlight may also cause the melanocytes to regenerate to allow the pigmentation to come back to its original color.
- Corticosteriod Cream:The traditional treatment given by most dermatologists is a strong corticosteroid cream. This gets some pigment back in new and early patches—but side effects, such as thinning of the skin, are a real risk. Your doctor can also prescribe you topical immunomodulators such as Protopic (tacrolimus). If those methods don’t work, then your doctor will probably give you oral immunosupressants such as cyclosporin, but be warned—these drugs have harsh side effects so it’s prescribed in a “risk versus benefit” fashion.
- Phototherapy: Phototherapy may also be beneficial. Using exposure to long-wave ultraviolet (UVA) light from the sun or from UVA, together with Psoralen, called “PUVA”, Or with UVB Narrowband lamps (without Psoralen), can help in many cases. Psoralen can be taken in a pill 1-2 hours before the exposure or as a Psoralen soaking of the area a half hour before the exposure. With this method, you will be given a Psoralen tablet to take by mouth, and then be exposed to ultraviolet light of type A—hence the acronym, ‘PUVA”.You will have to attend a skin department regularly and frequently, and probably for at least a year. Even then, the chance of getting a reasonable amount of pigment back may only be about 50%. Localized small patches of vitiligo may be treated with a psoralen gel, paint or cream in combination with ultraviolet light of type A. Narrow band ultraviolet light of type B is also sometimes used for vitiligo.
Lately, PUVA is being more and more replaced with exposure UVB Narrowband light at a wavelength of 311-313 nanometers. This treatment does not involve Psoralen, since the effect of the lamp is strong enough. The source for the UVB Narrowband UVB light can be special fluorescent lamps that treat large areas in a few minutes, or high power fiber-optic devices in a fraction of a second.
- Depigmentation: Alternatively, some people with vitiligo opt for chemical depigmentation, which uses 20% monobenzone (monobenzylether of hydroquinone). This process is irreversible and generally ends up with complete or mostly complete depigmentation.
- The use of a sunscreen with a sun protection factor of 25 or higher helps to prevent burning of the white patches of vitiligo. In light-skinned individuals, it also minimizes pigmentation of the skin around the patches of vitiligo. Remember that the sun is no longer your friend. The pale areas on your skin will burn easily in the sun and may even spread as a result, and tanning will make the contrast between the white and normal skin more obvious. Avoid the sun; use sunscreens and protective clothing.
- Melanocytes: In late October of 2004, doctors successfully transplanted melanocytes to vitiligo affected areas, effectively repigmenting the region. The procedure involved taking a thin layer of pigmented skin from the patient’s gluteal region. Melanocytes were then separated out and used to make a cellular suspension. The area to be treated was then ablated with a medical laser, and the melanocyte graft applied. Three weeks later, the area was exposed to UV light repeatedly for two months. Between 73 and 84 percent of patients experienced nearly complete repigmentation of their skin. The longevity of the repigmentation differed from person to person.
- Piperine: In early 2008, scientists at King’s College London discovered that Piperine, a chemical derived from black pepper, can aid repigmentation in skin, especially when combined with PUVA therapy. The dual methods of Piperine and PUVA produced a longer lasting and more even pigmentation than previous treatments.
- Ginkgo Biloba: A study has shown that orally taken Ginkgo biloba can be effective in arresting the progression of slowly spreading vitiligo.
- Surgery: Surgical procedures are still being developed and are not yet in general use.
- Bleaching: Finally, if the vitiligo has spread very widely, it may be easier to get rid of the small amounts of pigment left using a bleaching chemical (a hydroquinone) than to get the lost pigment back. The even white color gained in this way may be less ugly than a mixture of dark and pale areas, but the social implications of becoming white all over must be discussed before this treatment is used.
Vitiligo has many, many varied treatments that range from chemical depigmentation to phototherapy. As such, it should be the sufferer’s prerogative to learn more about the techniques outlined in this article and other methods not included in this piece. Knowledge isn’t only power, it can mean the difference between an effective and ineffective treatment. Moreover, consult your dermatologist for any potential side effects that the treatments can cause to your already sensitive skin.
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