What is Vitiligo?

Vitiligo is an autoimmune condition that causes the loss of skin color in blotches. With vitiligo, the immune system attacks and destroys melanocytes, which are the cells responsible for skin pigmentation. When melanocytes are destroyed, the skin loses its color and white patches appear. These patches can occur anywhere on the body, but commonly affect areas like the face, hands, arms, feet, and lips.

The appearance of vitiligo is different for each person. For some, it starts as a small white spot that slowly spreads. Others may experience a more rapid loss of skin pigment resulting in larger patches. The patches may be localized to one part of the body or spread across large areas. The condition is not life-threatening or contagious, but can have emotional and psychological effects due to its visible symptoms affecting appearance. There is no cure for vitiligo, but several treatment options are available to help manage it. The goal of treatment is to stop progression and restore some of the lost skin color.

Symptoms of Vitiligo

The main symptom of vitiligo is the appearance of patchy loss of skin color. The patches of de-pigmented skin are initially small, but often grow and change shape over time. The patches can appear anywhere on the body, but are most commonly seen on sun-exposed areas like the face, neck, hands, arms and lips.

The loss of skin pigment is particularly noticeable on darker skin. The affected skin patches start off as pale white at first. Over time, the white patches may become larger and spread to other areas. The borders of the white patches are often sharply defined at first, but may become irregular over time. The white patches may also appear on hair, the inside of the mouth or nose, and even the eyes.

In addition to white patches on the skin, people with vitiligo may experience premature graying of scalp hair, eyelashes, eyebrows and beard. Loss of color in the tissues lining the inside of the mouth and nose, and the retina of the eyes is also possible.

What Causes Vitiligo?

Vitiligo is caused by the loss of melanin, the pigment that gives skin its color. Melanin is produced by melanocytes, specialized cells found in the epidermis (outer layer of the skin). In vitiligo, the melanocytes are destroyed, leading to depigmented patches on the skin.

The exact cause of melanocyte destruction is unknown, but research suggests it’s an autoimmune disorder. This means the body’s immune system mistakenly attacks the melanocytes. Antibodies directed against pigment cells have been found in the blood of people with vitiligo.

Other theories include oxidative stress damaging the melanocytes, and a genetic predisposition to vitiligo. Triggers like sunburn, stress, or exposure to industrial chemicals may also set off the condition in susceptible individuals. Overall, vitiligo is considered a multifactorial disease with genetic, immune, and environmental factors involved.

Diagnosing Vitiligo

Diagnosing vitiligo involves a physical exam, medical history, and blood tests.

Physical Exam

During a physical exam, a dermatologist will examine the skin, looking for depigmented patches. They will note the location, size, shape and extent of the discoloration. The doctor will also check for signs of inflammation or if the skin feels different in the discolored patches. They will look for poliosis, which is the loss of color of the hair in those areas.

Medical History

The dermatologist will take a full medical history, asking about:

• When the discoloration first appeared and how quickly it spread
• If the patches appeared after sun exposure or skin trauma
• If the patient has a family history of vitiligo
• If the patient has any other autoimmune disorders like hyperthyroidism, rheumatoid arthritis or Addison’s disease.

Blood Tests

The dermatologist may order blood tests to check for thyroid issues, diabetes, and other autoimmune disorders. This can help confirm the diagnosis. They may also do a biopsy of the skin.

Conventional Vitiligo Treatment

Conventional medical treatments for vitiligo aim to stop the spread of depigmentation and possibly restore some of the lost skin color. Common approaches include:

Corticosteroid Creams

Corticosteroid creams are often the first line of treatment for vitiligo. These creams help reduce inflammation and may suppress the immune response that destroys melanocytes. Corticosteroids come in varying strengths and are applied directly to depigmented patches once or twice daily. Results can take weeks or months to appear. Side effects may include skin thinning or streaking.

Light Therapy

Light therapy exposes the skin to UVA or UVB light under medical supervision. The ultraviolet light activates melanocyte stem cells, encouraging melanin production. Phototherapy is often used along with other vitiligo treatments. Exposing the entire body can help prevent the spread of depigmentation. Light boxes or laser treatments may be used. Protective eye goggles are worn to avoid eye damage from the bright light.

Skin Grafts

In some cases, a skin graft can be used to restore color to vitiligo spots. During this surgery, the doctor removes a thin layer of pigmented skin from an unaffected area. They then transplant it to cover the white patch. Possible donor sites include the gluteal region. The color match may not be exact, but results can be long-lasting. Healing can take several weeks.

Lifestyle Changes for Vitiligo

Making certain lifestyle adjustments can help manage vitiligo symptoms. While lifestyle changes alone won’t cure vitiligo, they can minimize spreading and improve quality of life.

Sun Protection

It’s essential for vitiligo patients to protect their skin from sun exposure. UV radiation can worsen depigmentation and cause sunburns on discolored patches. Wear sunscreen, protective clothing, and wide-brimmed hats outdoors. Avoid prolonged sun exposure, especially during peak hours. Seek shade whenever possible.

Healthy Diet

Eat a balanced diet with plenty of antioxidants to support skin health. Foods high in vitamin C, vitamin E, zinc, and copper like fruits, vegetables, nuts, seeds, and legumes help protect against free radical damage. Some research also suggests vitamin D and B12 supplementation could slow vitiligo progression.

Stress Management

Stress may exacerbate vitiligo for some patients. Try relaxation techniques like meditation, yoga, deep breathing, and massage. Make time for hobbies and self-care. Consider counseling for mood disorders like anxiety or depression. Getting adequate sleep, exercise, and social connection also aids stress management.