Vitiligo

Description

Vitiligo (vit-ih-LIE-go) is a disease that causes loss of skin color in patches. The discolored areas generally become larger with time. The condition can affect the skin on any part of the body. It may also affect hair and the inside of the mouth.

Normally, the color of the hair and skin is determined by melanin. Vitiligo occurs when the cells that produce melanin die or stop functioning. Vitiligo affects people of all skin types, but may be more noticeable in people with brown or Black skin. The condition is not life-threatening or contagious. It can be stressful or make you feel bad about yourself.

Treatment for vitiligo can restore the color to the affected skin. But not to prevent the loss of skin color or of a recurrence.

Symptoms

Vitiligo signs include:

  • Patches of color loss on the skin, which usually first appears in the hands, the face, and the areas around the holes of his body and genitals
  • Premature graying of the scalp hair, eyelashes, eyebrows or beard.
  • Loss of color in the tissues that line the inside of the mouth and nose (mucous membranes)

Vitiligo can start at any age, but usually appears before the age of 30 years.

Depending on the type of vitiligo you have, it can affect:

  • Almost all of the surfaces of the skin. With this type, called universal vitiligo, discoloration affects almost all the surfaces of the skin.
  • Many parts of the body. With this most common type, called generalized vitiligo, the discolored patches often progress similarly on corresponding body parts (symmetrically).
  • Only one of the sides or the part of the body. This type, called vitiligo segmental, tends to occur at a younger age, the progress of a year or two, then stops.
  • One or a few areas of the body. This type is called localized (focal) vitiligo.
  • The face and hands. With this type, called acrofacial vitiligo, the skin is affected in the face and hands, and around body openings such as the eyes, nose, and ears.

It is difficult to predict how this disease will progress. Sometimes the patches stop forming without treatment. In most cases, the loss of the pigmentation of the differential and, finally, it involves the majority of the skin. Sometimes, the skin gets its color.

When to see a doctor

Consult your health care provider if areas of your skin, the hair or the mucous membranes lose coloring. Vitiligo has no cure. But treatment can stop or slow the fading process and return a bit of color to your skin.

Causes

Vitiligo occurs when pigment-producing cells (melanocytes) die or stop producing melanin — the pigment that gives your skin, hair and eyes color. The patches of skin become lighter or white. It is not clear exactly what causes these pigment cells to fail or die. May be related to:

  • A disorder of the immune system (autoimmune disease)
  • Family history (heredity)
  • A trigger event, such as stress, severe sunburn or skin trauma, such as contact with a chemical

Risk factors

Anyone can develop vitiligo. But you may be more likely to develop if you:

  • Have a family history of the disease.
  • Have frequent direct contact with phenol-containing chemicals, such as those found in some detergents.

Complications

People with vitiligo may be at increased risk of:

  • Social or psychological distress
  • Sunburn
  • Eye problems
  • Hearing loss

Vitiligo

Diagnosis

Your health care provider will ask about your medical history and examine your skin, possibly with a special lamp. The assessment may also include a skin biopsy and blood tests.

Treatment

The choice of treatment depends on your age, the amount of skin, as well as, the rapidity with which the disease is progressing, and how it affects your life.

Drugs and light-based therapies are available to help restore the skin color or even skin tone, although results vary and are unpredictable. And some treatments have serious side effects. So the doctor may suggest that you first try to change the appearance of the skin by the application of a self-tanning or makeup product.

If you and your doctor decide to treat your condition with medications, surgery or therapy, the process can take many months to evaluate their effectiveness. And you may have to try more than one method or a combination of approaches before finding the treatment that works best for you.

Even if the treatment is successful for a time, the results may not last or new patches may appear. Your health care provider may recommend a medication applied to the skin as a maintenance therapy to help prevent a relapse.

Drugs

No drug can stop the process of vitiligo is the loss of pigment cells (melanocytes). But some drugs, used alone, in combination with light therapy, can help restore some color.

  • Drugs that control inflammation.The application of a corticosteroid cream to the affected skin can restore the color. This is most effective when the vitiligo is still in its early stages. This type of cream is effective and easy to use, but you can't see the changes in your skin color for several months. Possible side effects include thinning of the skin or the appearance of streaks or lines in the skin. Milder forms of the drug may be prescribed for children and for people who have large areas of discolored skin. Corticosteroid pills or injections may be an option for people whose condition is rapidly progressing.
  • Drugs that affect the immune system. Calcineurin inhibitor ointments, such as tacrolimus (Protopic) or pimecrolimus (Elidel) could be effective for people with small areas of depigmentation, especially on the face and neck. The Food and Drug Administration (FDA) has warned about a possible relationship between these drugs and the lymphoma and skin cancer.

Drugs that control inflammation. The application of a corticosteroid cream to the affected skin can restore the color. This is most effective when the vitiligo is still in its early stages. This type of cream is effective and easy to use, but you can't see the changes in your skin color for several months. Possible side effects include thinning of the skin or the appearance of streaks or lines in the skin.

Milder forms of the drug may be prescribed for children and for people who have large areas of discolored skin.

Corticosteroid pills or injections may be an option for people whose condition is rapidly progressing.

Therapies

  • The light therapy.Phototherapy with ultraviolet B narrow band (UVB) has been shown to stop or slow the progression of the assets of vitiligo. It may be more effective when used with corticosteroids or calcineurin inhibitors. You will need the treatment two to three times a week. It could take from 1 to 3 months before you notice any change, and that could take 6 months or more to get the full effect. Given that the Food and Drug Administration (FDA) warning about the possible risk of skin cancer with the use of calcineurin inhibitors, talk with your health care provider about the risks and benefits of the use of these drugs with phototherapy. For people who can't go to a clinic for treatment, rather small, portable or handheld devices for ultraviolet B narrow band of therapy are available for use in the home. Talk with your health care provider about this option if it is necessary. Possible side effects of ultraviolet B narrow band therapy include redness, itching, and burning. These side effects usually go away within a couple of hours after the treatment.
  • The combination of psoralen and light therapy. This treatment combines a plant-derived substance called psoralen with light therapy (photochemotherapy) to return the light color of the patches. After taking the psoralen by mouth or applied to the affected skin, you are exposed to ultraviolet a (UVA) light. This approach, while effective, is difficult to manage and has been replaced in many of the practices by ultraviolet B narrow band (UVB) therapy.
  • The removal of the remaining color (depigmentation).This therapy may be an option if the vitiligo is widespread and other treatments have not worked. A depigmentation agent is applied to the non-affected areas of the skin. This gradually lightens the skin so that it blends with the discolored areas. The therapy is done once or twice a day for nine months or more. Side effects can include redness, swelling, itching, and very dry skin. Depigmentation is permanent.

The light therapy. Phototherapy with ultraviolet B narrow band (UVB) has been shown to stop or slow the progression of the assets of vitiligo. It may be more effective when used with corticosteroids or calcineurin inhibitors. You will need the treatment two to three times a week. It could take from 1 to 3 months before you notice any change, and that could take 6 months or more to get the full effect.

Given that the Food and Drug Administration (FDA) warning about the possible risk of skin cancer with the use of calcineurin inhibitors, talk with your health care provider about the risks and benefits of the use of these drugs with phototherapy.

For people who can't go to a clinic for treatment, rather small, portable or handheld devices for ultraviolet B narrow band of therapy are available for use in the home. Talk with your health care provider about this option if it is necessary.

Possible side effects of ultraviolet B narrow band therapy include redness, itching, and burning. These side effects usually go away within a couple of hours after the treatment.

The removal of the remaining color (depigmentation). This therapy may be an option if the vitiligo is widespread and other treatments have not worked. A depigmentation agent is applied to the non-affected areas of the skin. This gradually lightens the skin so that it blends with the discolored areas. The therapy is done once or twice a day for nine months or more.

Side effects can include redness, swelling, itching, and very dry skin. Depigmentation is permanent.

Surgery

If the light of the therapy and medications have not worked, some people with stable disease may be candidates for surgery. The following techniques are intended to match the tone of the skin by restoring color:

  • A skin graft.In this procedure, the doctor transfers very small sections of your health, the pigmented skin areas that have lost pigment. This procedure is sometimes used if you have small patches of vitiligo. The possible risks include infection, scarring, a cobblestone appearance, color spots and the failure of the area to color.
  • The blister grafting.In this procedure, the doctor creates blisters on the pigmented skin, usually with the suction, and then transplant to the top of the blisters of the skin discolored. The possible risks include scarring, a cobblestone appearance, and the failure of the area to color. And the skin damage caused by the aspiration can trigger another patch of vitiligo.
  • Cell suspension transplantation.In this procedure, the doctor takes a little bit of fabric on your skin pigmented, put the cells in a solution, and then transplants them in the preparation of the affected area. The results of this re-pigmentation of start of the procedure, showing up within four weeks. The possible risks include scarring, infection, and uneven skin tone.

A skin graft. In this procedure, the doctor transfers very small sections of your health, the pigmented skin areas that have lost pigment. This procedure is sometimes used if you have small patches of vitiligo.

The possible risks include infection, scarring, a cobblestone appearance, color spots and the failure of the area to color.

The blister grafting. In this procedure, the doctor creates blisters on the pigmented skin, usually with the suction, and then transplant to the top of the blisters of the skin discolored.

The possible risks include scarring, a cobblestone appearance, and the failure of the area to color. And the skin damage caused by the aspiration can trigger another patch of vitiligo.

Cell suspension transplantation. In this procedure, the doctor takes a little bit of fabric on your skin pigmented, put the cells in a solution, and then transplants them in the preparation of the affected area. The results of this re-pigmentation of start of the procedure, showing up within four weeks.

The possible risks include scarring, infection, and uneven skin tone.

Potential future treatments

Treatments that are being studied 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 to control melanoctyes. Prostaglandin E2 is being tested as a way to restore the color of the skin in people with vitiligo, which is not very widespread, or the spread. Is applied to the skin as a gel.

Self-care

If you have vitiligo, the following self-care tactics can help you take care of your skin and improve its appearance:

  • Protect your skin from the sun and artificial sources of UV light.The use of a broad-spectrum, water resistant sunscreen with an SPF of at least 30. Apply sunscreen generously, and reapply every two hours or more often if you're swimming or perspiring. You can also seek shade and wear clothing that protects your skin from the sun. Do not use tanning beds, and sunlamps. Protect your skin from the sun helps to prevent sunburn of the skin coloration. The sunscreen also minimizes the tan, which accentuates the patches of vitiligo.
  • Hide the affected skin. Make-up and self-tanning products can help to minimize the differences in the color of the skin. You may have to try several brands of makeup and self-tanners to find one that will blend well with your normal skin tone. The coloring of self-tan products are not washed, but slowly fades over several days. If you use a self-tanner, select the one containing dihydroxyacetone, because that is approved by the Food and Drug Administration.
  • Do not get a tattoo. The damage to your skin, as that caused by a tattoo can cause a new patch of vitiligo to appear within two weeks.

Protect your skin from the sun and artificial sources of UV light. The use of a broad-spectrum, water resistant sunscreen with an SPF of at least 30. Apply sunscreen generously, and reapply every two hours or more often if you're swimming or perspiring.

You can also seek shade and wear clothing that protects your skin from the sun. Do not use tanning beds, and sunlamps.

Protect your skin from the sun helps to prevent sunburn of the skin coloration. The sunscreen also minimizes the tan, which accentuates the patches of vitiligo.

Alternative medicine

Limited number of studies that show that the herb Ginkgo biloba may return the color of the skin in people with vitiligo. Other small studies show that alpha-lipoic acid, folic acid, vitamin C, and vitamin B-12 plus phototherapy can restore the color of the skin in some people.

As with any prescription treatment, consult with your health care provider before trying the alternative medicine therapies to make sure that it does not interfere with other treatments that you are using.

Coping and support

The change in appearance caused by vitiligo can make you are feeling stressed, self-conscious or sad. These self-care approaches can help you cope with vitiligo:

  • Ensure a good connection. Find a doctor who knows a lot about the condition. A dermatologist is a doctor who specializes in the care of the skin.
  • Learn about your condition. Find out all you can about vitiligo and its treatment options so that you can help decide what steps to take.
  • Communicate your feelings. Let your doctor know if you are feeling depressed. You may benefit from a referral to a mental health provider who specializes in helping people with depression.
  • Talk with others. Ask your health care provider about psychotherapy or support groups in your area for people with vitiligo.
  • Confide in loved ones. To seek the understanding and support of your family and friends.

Preparing for your appointment

It is likely to start by seeing your primary care provider. Then, you may be referred to a specialist in skin disorders (dermatologist).

Here's some information to help you prepare for your appointment.

What you can do

  • Review your family medical history. Find out if someone in your family has vitiligo, a disease of the thyroid or a disease in which the immune system attacks the healthy tissues in the body (autoimmune disease).
  • List of relevant personal information, such as the recent major stressful events, life changes, burns, and rashes.
  • List of all the medicines, vitamins, and supplements you are taking, including dosage.
  • Take note of questions that you would like to ask your health care provider, that will help you make the most of your limited time together.

Some basic questions to consider include:

  • What is the most likely cause of my symptoms?
  • What are other possible causes?
  • Do I need any tests?
  • Is this condition temporary or long-term?
  • What treatments are available, and which do you recommend?
  • What side effects can I expect from treatment?
  • I can do something to help, such as avoiding the sun at certain times or use a sunscreen specifically?
  • Can you recommend a product to hide the discolored?
  • Do you have brochures or other printed material I can take home? What sites do you recommend?

What to expect from your doctor

Your health care provider will likely ask you some questions, such as:

  • When did you begin to notice bright spots in the skin?
  • Do you have a sunburn or rashes on the skin before you noticed the patches?
  • You are sensitive to the sun?
  • Make the discolored and cause itching or any other symptoms?
  • Have you ever had this kind of skin change before?
  • Does anyone in your family has vitiligo, a disease of the thyroid gland or an autoimmune disease?
  • What is your occupation, and what are your hobbies? They are exposed to harsh chemicals in any of the two?
  • How this condition affects your quality of life?
  • Are you taking any medication, or supplements?

What you can do in the meantime

While you are waiting to see their health care provider, limit sun exposure and use a broad-spectrum sunscreen with an SPF of at least 30. If you feel self-conscious about the changes in your skin, use makeup or a self-tanning product to cover the affected areas.

Symptoms and treatment of Vitiligo