Vitiligo

Have questions about Vitiligo? All of your answers are here.

What causes a person to get Vitiligo?

The exact cause of vitiligo is not known. However, doctors and researchers have many different theories. One theory of theirs is that vitiligo is an autoimmune disease (where a person's immune system harshly reacts to the body's own tissues), which explains the depigmentation that occurs when a person has vitiligo. They believe that people with vitiligo receive three genes that make them receptive to depigmentation. Another theory doctors and researchers have is that the melanocytes inside a person's body destroy themselves. One other theory that is not scientifically proven is that a single event like sunburn or emotional distress triggered vitiligo. Vitiligo is also known to run in families.

What are the symptoms of Vitiligo?

People with Vitiligo start to notice the depigmentation on their skin, resulting in white patches. These white spots or patches are commonly formed on the body where the skin is exposed to the sun the most. These areas include the hands, feet, arms, face, and lips. Other areas where these white patches are known to form are the armpits, groin, around the mouth, nostrils, eyes, navel, genitals, and rectum. There are three patterns that Vitiligo commonly appears in. These three patterns are the focal pattern, the segmental pattern, and the generalized pattern. The focal pattern is when the depigmentation is narrowed to being in only one or a few areas on the body. The segmental pattern is when the white patches only develop on one side of a person's body. The generalized patter is the most common pattern for people with Vitiligo. This is when the depigmentation develops on both sides of a person's body in a symmetric order. People with Vitiligo also get other symptoms other than white patches on their skin. People with Vitiligo can get premature graying of the hair on their head, eyelashes, eyebrows, and beard. People with naturally darker skin may also notice a loss of color from inside of their mouths.

Can Vitiligo be treated?

Yes, Vitiligo can be treated. All the treatment does is improve the person affected by Vitiligo's appearance. Each person with vitiligo may not be able to do the same treatment. That is why there is a multitude of treatment options available. The treatment options for Vitiligo that are available now include medication and surgery.


Medical therapies:

There are numerous medical therapies available for people with Vitiligo. A lot of them are applied topically and all of these can reduce the appearance of vitiligo. The most commonly used medical treatments are: Topical steroid therapy, Psoralen photochemotherapy, Topical psoralen photochemotherapy, Oral psoralen photochemotherapy, and Depigmentation. Topical steroid therapy is using steroid creams which can bring back pigmentation in the white patches. These are more likely to work if they are applied in the first stages of the disease. Corticosteroids are drugs that are similar to hormones like cortisone. Corticosteriod creams are simplest and safe treatment for vitiligo. Doctors usually prescribe a mild dosage of this cream for children under 10 years old and a stronger dosage for adults. People with Vitiligo apply to the cream on the white patches for a minimum of 3 months. The side effects of these creams are skin thinning and skin striae (streaks or lines on the skin). These side effects occur majorly on the face, armpits, and/or in the genitals. To reduce the use of side effects people can use steroid creams. Psoralen photochemotherapy (psoralen and ultraviolet A therapy -PUVA- ) is the most effective of all treatment for Vitiligo in the United States. PUVA is used to repigment the white patches. The problems with PUVA is that it is expensive, takes up a lot of time, and the side effects may be severe. Psoralen is a drug that darken the skin by the chemicals contained in the drug that react with ultraviolet light. The treatment is used by taking it by orally or topically. The people that use this go under careful exposure to sunlight or UVA light from a special lamp. People who use this drug receive the treatment in their doctor's office so they can be watched for any side effects that may occur. Topical psoralen photochemotherapy is used for people with Vitiligo with a minimal amount of depigmented patches. The treatments are also done in their doctor's office under artificial UVA light two or three times a week. The doctor applies a thin coat of psoralen to the around 30 minutes before exposing you to enough UVA light to turn the white patches pink. Over the next couple weeks after the first dosage the doctor slowly increases the amount of UVA light. As time goes on the pink areas fade to a more normal skin color appears. After each treatment, the patients wash their skin with soap and water and then apply sunscreen before departing the doctor's office. The major potential side effects of topical PUVA therapy is severe sunburn, blistering, and an overabundance of darkening of the patient's skin. Oral psoralen photochemotherapy is used for patients with a lot of Vitiligo. For oral PUVA therapy, the patient takes a prescribed dose of psoralen orally around 2 hours before they are exposed to artificial UVA light or sunlight. The treatments are usually given two or three times a week. The side effects of oral psoralen are sunburn, nausea, vomitting, itching, an unusual amount of hair growth, and hyperpigmentation. Oral psoralen photochemotherapy can also increase the patient's risk of skin cancer. Depigmentation is when the doctor fades the patient's skin to match the color of the white patches on their skin. Patients use the drug monobenzone twice a day to their natural skin until they match the white patch areas. The patients undergoing depigmentation have to avoid direct skin-to-skin contact with other people for a minimum of 2 hours after applying the drug to the skin because the medicine may rub off on other people. The most common side effect of depigmentation is redness and swelling of the skin, itchiness and/ or dry skin.


Surgical therapies:

Surgical therapies should only be discussed until after failure of medical therapy because they are very expensive and time-consuming. The surgical therapies include: Autologous skin grafts, Skin grafts using blisters, Micropigmentation (tattooing), and Autologous melanocyte transplants. Autologous skin grafts is done by having the doctor remove the skin from one section (the normal, pigmented skin) of the patient's body and attach it to another area on their body (the depigmented skin). This is most commonly used for patient's with small patches of Vitiligo. One of the major problems that can occur from autologous skin grafts are infections that can occur on either the pigmented skin or the depigmented skin. Another problem that can arise is that both of the sites may start to scar, develop a cobblestone appearance, or create a spotty pigmentation. The worst possible outcome could be the failure to repigment. Skin grafts using blisters is when the doctor creates blisters on the patient's pigmented skin from heat, suction, or freezing cold. The top of the blisters created are then cut off and moved to a depigmented area on the patient's skin. The major problems that can come from skin grafts using blisters are scarring and not being able to repigment. The risks of blister grafting include scarring and lack of repigmentation. Micropigmentation, other wise known as tattooing, is when the doctor implants pigment into the depigmented skin. This procedure usually happens in the lip area for people with dark skin. A major probelm with micropigmentation is that the doctor will not always be able to match up the color to your normal skin perfectly. It works best for the lip area, particularly in people with dark skin. It is also somewhat pointless because the tattooing may fade over time. Doing this can also lead the patient's lips to blisters caused by the herpes virus. Autologous melanocyte transplants is when the doctor takes a sample from your normal skin and uses it to grow melanocytes in a laboratory dish. Once the melanocytes are done growing/ multiplied the doctor transplants them into the patient's depigmented skin. The problem with this is that it is only experimental and the side effects from it are unknown.


Additional therapies:

People with Vitiligo can do other things to help protect their skin and reduce the white patches. These things include: sunscreen and cosmetics. Sunscreen helps provide protection to people with vitiligo because they should limit sun exposure and use a sunscreen that protects them from UVA and ultraviolet B light. When a person tans the contrast between pigmented and depigmented skin becomes more noticeable. Cosmetics help people that have Vitiligo cover their depigmented areas with makeup or self-tanning lotions.

Is there research being done on Vitiligo?

Majority of the research on understanding, treating, and trying to prevent Vitiligo is done by NIAMS at the University of Colorado. They research the role that melanocytes have in Vitiligo. They are looking at the immune response and seeing if they can interrupt the melanocyte signals to stop depigmentation to spread. They are also looking at what genes trigger vitiligo in many different ethnic groups. So far, they have found a link between the gene, NALP1, and Vitiligo. This research can help find out ways to prevent Vitiligo from spreading.

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