Vitiligo

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at March 31, 2016
StartDiseasesVitiligo

Vitiligo causes blotches where the skin color has been lost. How much and how fast the skin color is lost is not something that can be predicted. Any part of the body can be affected by vitiligo. It can also affect the eyes, the inside of the mouth, and hair.

Contents

Definition & Facts

People with any type of skin color can be affected by vitiligo, but it is often more noticeable in those that have darker skin. It is not a contagious or life-threatening, but it can cause people emotional stress. People that have vitiligo also have an increased risk of:

Symptoms & Complaints

The main symptom that is seen with vitiligo is white or light patches on the skin due to a loss of color or pigment. These patches most commonly begin to show on parts of the skin that are most often exposed to the sun, such as arms, feet, hands, lips, and face. Other symptoms that may be seen include:

  • Hair on the head, beard, eyebrows, or eyelashes that begin to gray or turn white prematurely (often before the age of 35)
  • Losing color in the tissue that lines the inside of the nose or mouth (the mucous membranes)
  • Loss of color or change of color of the retina (the inner layer of the eyeball)
  • Patches around the navel, armpits, rectum, or genitals that are discolored

Vitiligo can begin to show at any age, but is most commonly seen after the age of 20. There are different types of vitiligo which will determine where the discoloration will appear. They are:

  • Generalized vitiligo - The patches will be on various parts of the body and will progress at about the same rate on all parts.
  • Segmental vitiligo - The patches will develop only on one side or one part of the body. This type of vitiligo often occurs at a younger age, will progress for about a year or two and will then stop.
  • Localized or focal vitiligo - The patches will develop on only a few or possibly one area of the body.

Causes

Typically melanin will determine the color of a person's eyes, hair, and skin. When vitiligo occurs, the cells that normally produce the melanin, called melanocytes, begin to die or do not function properly. The patches of skin where the cells die will become lighter in color or white. Doctors are not sure why the cells begin to die or fail to function, but it could be related to:

Diagnosis & Tests

If a doctor believes that a patient has vitiligo, he or she will likely ask the patient about his or her family and medical history. The physician will then complete a physical examination in order to rule out other medical problems such as psoriasis or dermatitis. The doctor may use a special ultraviolet light to shine on the skin that will help to determine if the patient has vitiligo.

The doctor may also take a biopsy, a small sample, of the skin that is affected. A sample of blood may also be taken so it can be tested in the lab. In order to further test for vitiligo, further exams may be recommended as well, including:

  • An eye examination that will be completed by an eye specialist. They will check for inflammation in the eye.
  • A hearing test that will be completed by a hearing specialist. They will complete a hearing evaluation because of the increased risk of hearing loss to those with vitiligo.

Treatment & Therapy

There are a great number of treatments that can be used to return color to the skin, but the results will vary from person to person. Some of the treatments have side effects that can be serious, so the doctor may advise their patients to first try using makeup to cover the patches or self-tanning products.

If the patient and doctor decide to treat the condition with drugs or other types of therapy, it could take months to determine whether or not the treatment is working. It is not guaranteed that the first type of treatment used will work, so it may take several attempts to find the right treatment.

There are no drugs available that can stop the loss the cells, but some drugs can help to improve the appearance of the skin. These are all medications that may be used:

  • Cream to control inflammation - A topical corticosteroid may begin to return the color to a person's skin. It could take several months to see any change in the color of the skin.
  • Cream form of vitamin D - Topical calcipotriene is often used with a corticosteroid or ultraviolet light.
  • Medications for the immune system - Ointments that contain tacrolimus or pimecrolimus may work for people that have smaller patches of light or white skin.
  • Combining medication and ultraviolet light - A drug called psoralen will be combined with ultraviolet light and can help to return color to the skin. Psoralen can be taken in an oral form or as an ointment then ultraviolet lights will be used.
  • Light therapy - Ultraviolet lights are used on the skin.
  • Removing the remaining color in the skin - Monobenzone is a medication that will work to remove the color from the rest of the skin so the patient's skin will all be the same color.

If medications do not work, there are surgical procedures that can be used as well.

  • Skin grafting - The doctor will remove small pieces of normal skin and attach it to the patches that have lost color.
  • Blister grafting - The doctor will create a blister on the normal skin, usually with suction, then the top of the blister will be removed and put onto the discolored skin.
  • Tattooing - The doctor will use a special instrument that will be put pigment into the discolored skin.

Prevention & Prophylaxis

Because doctors are not sure of why people get vitiligo, there are no real ways to prevent it. In order to reduce the risks, doctors will advise people to wear sunscreen or clothing when in the sun. This will help to protect people from getting sunburn. They will also advise to wear protective gear and use caution when dealing with industrial chemicals.

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