What is vitiligo?
Vitiligo is a condition in which areas of skin lose their normal colour and so become lighter coloured and ultimately become white. It is common, and affects about 1% of the world’s population.
What causes vitiligo?
Skin colour is determined by the presence of a pigment called melanin. Our skin contains cells called melanocytes which produce this pigment. When melanin is destroyed in certain areas of skin, vitiligo results. The exact cause as to why cells suddenly lose pigment 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.
Who can get Vitiligo ? Is it hereditary?
It affects men and women of all races equally, but is most easy to see in people with dark skins. It can start at any age but usually occurs before the age of 20. It is not a disease which can be transmitted.
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.
What are the symptoms of vitiligo?
There are no symptoms as such like itching or burning. But affected people may become depressed or embarrassed by the look of their skin.
Melanin protects against the sun and because of the lack of melanin in the vitiligo patches , they are prone for sun damage. Sun burns and photosensitive reactions occur more easily on vitiligo patches which are exposed to the sun.
What does vitiligo look like?
Spots or patches in the skin which are lighter coloured or have lost colour should make one suspect vitiligo.
There are other conditions which can present with lighter coloured patches like Pitrasis Versicolor which is a fungal infection, or Leprosy, which is a bacterial infection .Therefore it is better to get an evaluation done.
Commonly vitiligo is seen in the exposed areas like the hands and face. Mucosal surfaces can also be affected like oral mucosa and genital mucosa. Vitiligo can also occur over areas of skin trauma, like cuts or burns. It is more prominent in people with dark skin because of the contrast .
How will vitiligo be diagnosed?
Clinical diagnosis is usually easy and is made on the basis of the appearance of the patches (white with a normal skin texture). A Wood’s (ultraviolet) light can help to show up white areas that could have been missed in a pale-skinned person. Once the diagnosis of vitiligo has been made, your doctor may want to check you for thyroid disease, and for other autoimmune conditions that are more common than usual in people with vitiligo.
What is the course and prognosis ?
It is difficult to predict with certainity the behaviour of the disease.
Patches can be stable without enlarging or spreading and if they remain so for a period of two years it is called as stable vitiligo. This is more amenable to treatment. Localised vitiligo also responds favourably to treatment
Unstable vitiligo is more active with emergence of new patches and the disease becomes more generalized. Vitiligo of the mucosal areas is more resistant to treatment.
Can vitiligo be cured?
Vitiligo occasionally goes away by itself, and some treatments may slow its progress, but a cure cannot be guaranteed.
How can vitiligo be treated?
The treatment of vitiligo is both medical and surgical. Treatment options are many and you should discuss the options in detail with your Dermatologist.
If Vitiligo is within 10% of the body surface area , topical treatments are preferred. There are many options like topical steroids , Tacrolimus and psoralens.
If Vitiligo is more than 10% of the body surface area , it is better to consider systemic steroids, phototherapy or photochemotherapy.
For localized stable Vitiligo , surgical options like punch grafts and split skin grafts could be considered.
The use of a sunscreen with a sun protection factor of 25 or higher helps to prevent burning of the white patches of vitiligo.
Keep your self-confidence high by making your skin look as normal as possible. Learn about the right way to hide the white areas with cosmetics. Good modern ones come in a range of colours, are hard to rub off, and can be waterproof.
Don’t waste time changing your diet – this never does much good.
Resources: British Association of Dermatologists, IADVL Therapeutic guidelines.
Dr. Irene Nirmala Thomas
Associate Professor of Dermatology
Gulf Medical College Hospital and Research Centre Ajman
