Vitiligo: Types, Symptoms, Causes, Risks, Complications, Diagnosis and Treatment

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Woman who suffer from vitiligo

1Overview

Vitiligo is a skin condition wherein there is a loss of skin color in blotches. The skin loses its natural color and as a result, patches of lighter skin appear. Some people can lose color inside the mouth, in the hair, and in the other parts of the body.

Normally, the skin contains melanin that determines the color of the skin and hair.
When the melanin cells stop functioning or die for a certain reason, vitiligo happens.
The condition may become more prominent in people who are dark-skinned.

Though the condition is not life-threatening or infectious, it can become a problem for people because it affects their physical appearance. The treatment for the condition may restore the color of the skin but can’t avoid the other parts of the body to have the condition.

The pale or light-colored areas caused by vitiligo may become susceptible to sunburn, so it’s vital to take extra care when under the sun. You can use a good sunscreen with a high sun protection factor (SPF).

2Types of vitiligo

There are two main types of vitiligo, including:

Non-segmental vitiligo

In non-segmental vitiligo, which is also dubbed as generalized or bilateral vitiligo, the patches appear on both sides of the body. These patches may appear on the arms, back of the hands, knees, skin around openings like the eyes and mouth, feet, and elbows.

This is the most common type of vitiligo, affecting approximately 9 out of ten people of those with the skin condition.

Segmental vitiligo

On the other hand, segmental vitiligo, which is otherwise called localized or unilateral vitiligo, the patches of lighter skin affect just one area of the body. This condition is less common and it affects mostly children. About 3 out of ten children with vitiligo have this type of skin disorder.

3Symptoms

The areas most affected by vitiligo include the fingers and wrists, around the eyes and mouth, armpits, genitals, groin and in the oral cavity.

It can also develop the scalp and hair roots. The main sign of vitiligo is the appearance of a loss of skin color in patches that can occur in any part of the body. The discoloration may appear first on the areas usually exposed to the sun like the feet, arms, lips, face, and hands.

The signs and symptoms include:

  • Premature graying or whitening of the hair on the parts of the body such as the bear, eyebrows, scalp, and eyelashes
  • Loss of skin color in patches
  • Loss of color in the retina, the inner layer of the eyeball

There’s no way of predicting how much of the skin may be affected and in some cases, the white patches are permanent.

4Causes

The pigment that gives the skin its normal color is called melanin, which is produced by the cells called melanocytes. Vitiligo is characterized by the lack of melanin, the pigment of the skin. In the condition, there are not enough working melanocytes to produce enough melanin for the skin.

The condition happens when the pigment-producing cells die or stop producing melanin, the pigment responsible for giving the skin, eyes and hair color. As a result, patches of skin with lighter color appear. The exact cause of why the cells die is still unclear up to today.

Vitiligo-stricken people are more likely to have other diseases, which is caused by autoimmunity like thyroid disease. For some studies, the role of the antibodies against the melanocytes may have caused their death and malfunction.

For instance, the most common type of vitiligo, non-segmental vitiligo, is thought to be an autoimmune disease. In these conditions, the immune system malfunctions, attacking even the healthy cells in the body, instead of the foreign bodies like viruses and bacteria.

For people with non-segmental vitiligo, the immune system destroys the skin cells responsible for making melanin.

Neurochemicals

In some cases, segmental vitiligo, which is the less common type, can be caused by the chemicals released from the nerve endings of the skin. These chemicals are toxic for melanocytes, which leads to their death or damage.

Triggers

There are some triggers that may stimulate the development of vitiligo, which includes:

  • Skin damage like severe cuts or sunburn (Koebner response)
  • Stressful life events like giving birth
  • Chemical exposure during work

5Risk factors

Some people are at a higher risk of developing vitiligo if:

Family history – Other people in the family have the same condition

History of other autoimmune diseases – People with family history an autoimmune disease are also at a higher risk of having vitiligo. Some of the autoimmune diseases include thyroid problems, pernicious anemia, rheumatoid arthritis or lupus.

Autoimmune disease – If you have another autoimmune disease, you are more likely to develop vitiligo.

Gene changes – People with gene changes that are linked to the non-segmental vitiligo type.

Melanoma – People with melanoma, skin cancer or cutaneous T-cell lymphoma, a type of lymphatic system cancer, are at a heightened risk of developing vitiligo.

6Complications

Individuals with vitiligo may have the..7e following conditions if the disease is not managed appropriately:

7Diagnosis

The diagnosis of vitiligo is easy to do.

Medical history and physical assessment

First, the doctor will always need to take the patient’s medical history and conduct a thorough physical assessment. If the doctor suspects a patient who has vitiligo, he will examine the skin and try to rule out other health issues such as psoriasis or dermatitis. A Wood’s lamp is used, it has an ultraviolet light, on the skin to determine whether the patient has vitiligo.

Blood test and skin biopsy

Aside from a complete physical exam and medical history interview, the doctor may take a sample of the affected skin and examine it under the microscope or take blood samples for further analysis, particularly of co-occurring medical diseases such as anemia and diabetes.

8Treatment

Various treatment options are available to help even out the skin tone and restore skin color. However, since vitiligo is assumed to be an autoimmune disease, it will always affect the skin in the other parts of the body. Some treatments, however, have serious side effects. Hence, consulting with a doctor is important.

The light patches are usually permanent and there are combinations of treatments including:

Medicines

There is no medicine to stop the appearance of light patches or the loss of pigment cells. However, some medicines and treatment options may help restore the skin tone.

Immune system medicines – Some medicines like ointments that have calcineurin inhibitors can be effective for individuals with just small skin areas with uneven skin tone, particularly on the neck and face.

Anti-inflammatory drugs – Corticosteroid creams can be applied to the affected skin to help restore the color and tone. This can be effective in the first stages of the disease when there are still small patches.

Surgery

An operation can be done if other treatments do not work. The goal of the surgery is still, to restore color.

Skin graft – Skin grafting is a procedure where the doctor can remove a small part of the normal skin and attach it to the affected area. This is done in areas where the patches are just small.

Micropigmentation – Also called tattooing, the procedure involves the usage of a small instrument to help implant pigment into the skin. The disadvantage of this procedure is the difficulty to balance or even out the skin tone. Also, tattooing may stimulate another patch to form.

Blister grafting – In this procedure, the doctor produces blisters on the normal skin area with the use of suction. The doctor then removes the blister tops and puts them on the affected skin. The possible complications include scarring and infection.

Therapy

Some therapy can be combined or initiated to produce positive results.

Removing the remaining color or depigmentation – This procedure is recommended for people with severe vitiligo that has affected most of the skin areas. The doctor will use a depigmenting agent to lighten the surrounding skin.

Light therapy and psoralen – The combination of light therapy and psoralen is used to help restore the color of the light or discolored patches.

Lifestyle remedies

The following are ways to help you take care of the skin:

  • Protect the skin from the harmful rays of the sun and other artificial UV light sources like tanning beds and salons.
  • Use sunscreen and protective clothing in the affected areas
  • Conceal the affected skin by using products like concealers.
  • Do not get a tattoo that’s not used to treat the lesions because it may produce more damage to the skin and as a result, new patches might emerge.

It is not possible to predict how each patient will respond to the various treatments. However, it is vital to remember that no one intervention works for everybody. The results may vary but the important thing is, to make sure the skin is protected from harm to prevent further damage to the skin.