Vitiligo Symptoms, Causes & Treatment Options

Vitiligo is a chronic disease that causes a patchy loss of pigmentation in the skin. It is thought to be caused by the body’s immune system attacking its own pigment-making cells.

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Contents

  1. Overview
  2. Symptoms
  3. Potential Causes
  4. Treatment, Prevention and Relief
  5. When to Seek Further Consultation
  6. References

What Is Vitiligo?

Summary

Vitiligo is an autoimmune depigmentation disorder of the skin. It usually presents as white, depigmented patches that are most likely to occur at the joints (knees, hips, elbows, wrists, fingers), eyelids, genitals, and armpits, though it can occur anywhere. Most vitiligo cases begin before age 30. Vitiligo can progress in its spread or may remain static for many years. It is difficult to predict the course vitiligo will take. Vitiligo is not life-threatening, but it can dramatically alter appearance, and for that reason can be life-altering. Many treatments exist that can slow or partially reverse vitiligo, but no definitive treatment has been developed.

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Vitiligo Symptoms

Main symptoms

Vitiligo is a chronic depigmentation disorder of the skin, meaning that areas of the skin will lose their pigment, becoming pale white, over long periods of time. The development of white patches of skin is called “leukoderma.” Though it can happen in people of all skin colors, vitiligo is more pronounced in individuals with darker skin. vitiligo can occur in several different patterns, described below:

  • Generalized (or non-segmental) vitiligo: In the most common form of vitiligo, white patches will occur on both sides of the body, most commonly cropping up on the hands, wrists, elbows, underarms, hips, knees, ankles, feet, eyelids, and lips.
  • Segmental vitiligo: This form of vitiligo occurs only on one side of the body. These often present in childhood and are less likely to progress.
  • Universal vitiligo: This is a severe form of vitiligo in which greater than 80% of the skin is affected.
  • Focal vitiligo: This form of vitiligo affects just a few isolated parts of the body. Certain types may just occur on the lips, fingers, and toes.
  • Koebnerised vitiligo: Patches may occur at sites of trauma, like bumps, scrapes, or friction.

It is common for the white patchy lesions to progress, starting with a few small lesions and increasing in size or number. The progression of vitiligo can vary in speed and it is difficult to predict the likelihood, speed, and extent of progression.

Repigmentation (reversal of vitiligo) can also occur at intervals. This will usually start around hair follicles and progress outward. Like progression, repigmentation is difficult to predict.

Other symptoms

Besides the loss of your natural skin color, vitiligo can also cause loss of pigmentation in the hair, eyes, mouth or genitals.

Though it is not life-threatening, vitiligo can cause dramatic changes in appearance that may lead to low self-esteem or depression.

Vitiligo Causes

Vitiligo is generally considered an autoimmune disorder. In vitiligo, it is likely that the body’s immune system is attacking its own pigmentation cells (called melanocytes). 15-20% of individuals with vitiligo are also affected by at least one other autoimmune disorder, most commonly, disorders of the thyroid [2].

The underlying cause of vitiligo is unknown. Vitiligo may be partially caused by inherited genes, and some people have reported vitiligo brought on by events like sunburns or emotional distress [1].

Vitiligo affects 0.5 - 1% of the population and can occur in any race, though it may be most common in India. In half of cases, pigment loss will begin before age 20, and in 80% of cases, it will start before age 30.

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Treatment Options, Relief, and Prevention for Vitiligo

Treatment

Before treatment, vitiligo must be diagnosed. This can occur by examination, or with a skin biopsy, where a small sample of skin is removed and examined under a microscope.

Once a diagnosis is established, many treatment options are available to slow or reverse the progression of vitiligo:

  • Cosmetic camouflage: Since no definitive treatment for vitiligo exists, cosmetic camouflage (a certain type of makeup) actually represents a good option. It can conceal vitiligo completely and has no adverse side effects.
  • Topical creams: Topical steroid creams (like triamcinolone for example) are often used in vitiligo. These medications decrease the body’s immune response and may prevent the progression of vitiligo. Topical calcineurin inhibitors (like tacrolimus or pimecrolimus) also suppress the autoimmune response taking place in vitiligo, using a different mechanism than steroid creams.
  • Phototherapy: Phototherapy, or light therapy, is the application of a special light (like NB-UVB for example) to the affected skin. Ultraviolet light can have an immunosuppressive effect that slows the progression of vitiligo and may lead to regrowth of pigment cells. Typically this treatment takes place 2 times per week for anywhere between 3 months and 2 years.
  • Systemic immunosuppressants: If topical immunosuppressants are not effective, systemic agents (like steroids, methotrexate, mycophenolate mofetil, or minocycline) may be used. These will have more powerful immunosuppressive effects, but may also have more adverse side effects.
  • Immunologic therapies: Some new immunologic therapies, (like topical ruxolitinib or systemic JAK inhibitors) are in development. These operate on the same basic principle as steroid creams, but with greater precision and efficiency.
  • Surgical treatments: Recently, surgical treatments for vitiligo are being developed, where pigment-producing melanocytes are transplanted into depigmented skin by various methods.
  • Depigmentation: In the most severe cases in individuals with naturally dark skin, depigmentation of the remaining normal skin may be a viable option.
  • Psychosocial treatment: Vitiligo can adversely affect self-confidence and mood – these effects should receive proper treatment as well.

Prevention

The slow, chronic, waxing and waning nature of vitiligo means that many of the techniques used to treat acute flares also act as treatments to prevent the next flare. A list of vitiligo flare prevention techniques is below:

  • Sun protection: Sun protection has two benefits in vitiligo sufferers: first, it prevents normal skin surrounding vitiligo lesions from becoming more pigmented. This aspect will be most helpful in pale-skinned vitiligo patients. Second, the lesions themselves lack pigment, making them vulnerable to sunburn.
  • Prevention of skin injury: Often, vitiligo lesions occur at sites of skin trauma or friction (called koebnerization). Thus, protecting skin against abrasion may also protect against the development of new vitiligo lesions. Topical medications, phototherapy, systemic immunosuppressants, and immunologic treatments: As described above, in addition to treating acute flares, these may also help to prevent new vitiligo lesions.

When to Seek Further Consultation for Vitiligo

Though vitiligo is not a life-threatening disease, it can have dramatic effects on appearance, which can be detrimental to self-confidence and quality of life. Vitiligo is also a chronic, progressive disease, that may start small and progress at a variable pace. For these reasons, anyone who suspects that they have vitiligo, and wishes to prevent its progression, should seek out further consultation with a dermatologist as soon as possible. Early diagnosis and treatment may help to prevent the progression of disease with one of the many available treatments. Further consultation with a medical professional may also help to determine if other autoimmune conditions are present.