Vitiligo |
What is Vitiligo?
Vitiligo is a common skin disorder in which patches of skin lose their color (pigmentation). Characterized by milk-white patches surrounded by the normal skin color, vitiligo occurs most commonly on the face, hands, armpits, and in the groin.
Vitiligo is thought to be an autoimmune disorder (where the body's defense system becomes defective, producing antibodies against normal parts of the body), which causes an absence of melanocytes. These are the specialized cells responsible for secreting melanin, the substance that gives skin its color. The color (pigmentation) of the skin helps protect the skin from the sun's harmful rays. Therefore, skin areas affected by vitiligo are particularly sensitive to sunlight.
Although vitiligo can occur at any age, it usually develops in early adulthood. It affects about one in every 200 people, and is most commonly found in blacks or those living in the tropics. About 30% of people with vitiligo will have a sudden reversal of symptoms (repigmentation).
How is it diagnosed?
History: Aside from loss of skin color, vitiligo has no other symptoms. If vitiligo affects the scalp (vitiligo capitis), the hairs growing out of the affected area will also lose their color.
Physical exam: Loss of pigment is the only skin change that occurs.
Tests include skin biopsy to rule out other skin diseases. In vitiligo, there is a complete lack of melanin production in the non-pigmented areas.
How is Vitiligo treated?
The usual remedy is to mask the white patches with cosmetics. In mild cases, this may be all the treatment that is necessary. PUVA (phototherapy) has caused the color to return (repigmentation) in more that 50% of cases, but it requires many treatments.
Anti-inflammatory creams (corticosteroids) may also help. If areas of vitiligo are extensive, certain chemicals may be used to bleach the pigment from remaining areas of normal skin so as not to be so noticeable.
Other treatments include the use of psoralens (certain plant substances applied to the skin before the area is exposed to sunlight or ultraviolet). Also, melanocytes (melanin-forming cells) are transplanted from pigmented areas to nonpigmented areas.
Therapy should take into account the individual's motivation, psychological impact of disease, and the visible extent of the disease. The risks and benefits of therapy must be weighed.
Medications (topical form)
Prograf (Tacrolimus)
What might complicate it?
Because the areas of vitiligo are particularly sensitive to sunlight, careful precautions must be taken to prevent sunburn. Only sunscreens that contain high sun protection factor (SPF) should be used.
Predicted outcome
About 30% of people affected with vitiligo undergo a spontaneous repigmentation. Intensive phototherapy has resulted in repigmentation in more that 50% of cases. Otherwise, mild cases are disguised with cosmetics, while extensive cases can be made less noticeable by chemically bleaching the surrounding skin.
Alternatives
Leukoderma has a similar presentation.
Appropriate specialists
Dermatologist.
Last updated 6 August 2011