Overview
Vitiligo (not to be confused with the similar sound vertigo) is a disorder in which the cells that make pigment in the skin, retina and elsewhere are destroyed. As a result, white patches appear on different parts of the body. The hair that grows in areas affected by vitiligo also usually turns white. Vitiligo affects 1-2% of the population and affects both men and women of all races. It can begin at any age although about fifty percent of those who have vitiligo developed it before they turned 25.
Symptoms People who develop vitiligo usually first notice white patches on their skin. These patches are more common in sun-exposed areas, including the hands, feet, arms, face, and lips. Other common areas for white patches to appear are the armpits and groin and around the mouth, eyes, nostrils, navel, and genitals. Vitiligo generally appears in one of three patterns. - Focul pattern: the depigmentation is limited to one or only a few areas.
- Segmental pattern: the depigmentation patches appear on only one side of the body
- Generalized pattern: depigmentation occurs on different parts of the body
In addition to white patches on the skin, people with vitiligo may have premature graying of the scalp hair, eyelashes, eyebrows, and beard. People with dark skin may notice a loss of color inside their mouths. There is no way to predict if vitiligo will spread. The disorder is usually progressive, however, and over time the white patches will spread to other areas of the body. For some people, vitiligo spreads slowly, over many years. For others, spreading occurs a lot faster. Some people have reported additional de-pigmentation following periods of physical or emotional stress.
Causes
It is a complex disorder. Scientists still haven't found a cause. There is, however, some evidence that it is a result of a combination of auto-immune, genetic and environmental factors.
Treatment There are several treatment options available. They all must be continued for 6 to 18 months. The choice of therapy depends on the number of white patches and how widespread they are. Each patient responds differently to therapy, and a particular treatment may not work for everyone. Current treatment options include: Topical Steroid Therapy
Steroids may be helpful in re-pigmenting the skin (returning the color to white patches), particularly if started early in the disease. Corticosteroids are a group of drugs similar to the hormones produced by the adrenal glands (such as cortisone). Doctors often prescribe a mild topical corticosteroid cream for children under 10 years old and a stronger one for adults. Patients must apply the cream to the white patches on their skin for at least 3 months before seeing any results. This is the simplest and safest treatment for vitiligo.
Psoralen Photochemotherapy
Psoralen photochemotherapy is probably the most beneficial treatment for vitiligo. The goal is to re-pigment the white patches. However, it is time-consuming and can cause serious side effects. Psoralens are drugs that contain chemicals that react with ultraviolet light to cause darkening of the skin. The treatment involves taking psoralen by mouth or applying it to the skin. This is followed by carefully timed
exposure to ultraviolet A (UVA) light from a special lamp or to sunlight.
Patients usually receive treatments in their doctors' offices so they can be carefully monitored for possible side effects. At all other times, patients must minimize any exposure to sunlight.
Topical Psoralen Photochemotherapy
Topical psoralen photochemotherapy is typically prescribed to those who have only a small number of de-pigmented patches (affecting less than 20 percent of the body). It is also used for children who have localized patches of vitiligo. Treatments are done in a doctor's office under artificial UVA light once or twice a week. The doctor or nurse applies a thin coat of psoralen to the patient's de-pigmented patches. Half an hour later, the patient is exposed to enough UVA light to turn the affected area pink. The doctor usually increases the dose of UVA light slowly over many weeks. Eventually, the pink areas fade and a more normal skin color appears. After each treatment, the patient washes his or her skin with soap and water and applies a sunscreen before leaving the doctor's office.
There are two major potential side effects of topical PUVA therapy: - severe sunburn and blistering
- too much re-pigmentation or darkening of the treated patches or the normal skin surrounding the vitiligo (hyperpigmentation).
Patients can minimize their chances of sunburn if they avoid exposure to direct sunlight after each treatment. Hyperpigmentation is usually a temporary problem and eventually disappears when treatment is stopped.
Oral Psoralen Photochemotherapy
Oral PUVA therapy is prescribed to people with vitiligo that affects more than 20 percent of the body or for those who do not respond well to topical PUVA therapy. Oral psoralen is not recommended for children under 10 years of age because of an increased risk of damage to the eyes, such as cataracts. For oral PUVA therapy, the patient takes a prescribed dose of psoralen by mouth about 2 hours before exposure to artificial UVA light or sunlight. The doctor adjusts the dose of light until the skin areas being treated become pink. Treatments are usually given two or three times a week, but never 2 days in a row.
For patients who cannot go to a PUVA facility, the doctor may prescribe psoralen to be used with natural sunlight exposure. The doctor will give the patient careful instructions on carrying out treatment at home and monitor the patient during scheduled checkups.
Known side effects of oral psoralen include sunburn, nausea and vomiting, itching, abnormal hair growth, and hyper-pigmentation. Oral psoralen photochemotherapy may increase the risk of skin cancer. To avoid sunburn and reduce the risk of skin cancer, patients undergoing oral PUVA therapy should apply sunscreen and avoid direct sunlight for 24 to 48 hours after each treatment. Patients should also wear protective UVA sunglasses for 18 to 24 hours after each treatment to avoid eye damage, particularly cataracts.
De-pigmentation
De-pigmentation involves fading the rest of the skin on the body to match the already white areas. For people who have vitiligo on more than 50 percent of their bodies, this may be the best treatment option. Patients apply the drug monobenzylether of hydroquinone twice a day to pigmented areas until they match the already de-pigmented areas. Patients must avoid direct skin-to-skin contact with other people for at least 2 hours after applying the drug.
The major side effect of de-pigmentation therapy is redness and swelling of the skin. Patients may experience itching, dry skin, or abnormal darkening of the membrane that covers the white of the eye. De-pigmentation is permanent and cannot be reversed. In addition, a person who undergoes de-pigmentation will always be abnormally sensitive to sunlight.
Surgery
Surgical therapies, including skin grafting, are still considered experimental because their effectiveness and side effects haven't been fully defined.
Additional Therapies
Sunscreens
People who have vitiligo, particularly those with fair skin, should use a sunscreen that provides protection from both the UVA and UVB forms of ultraviolet light. Sunscreen helps protect the skin from sunburn and long-term damage. Sunscreen also minimizes tanning, which makes the contrast between normal and de-pigmented skin less noticeable.
Cosmetics
Some patients with vitiligo cover de-pigmented patches with stains, makeup, or self-tanning lotions. These cosmetic products can be particularly effective for people whose vitiligo is limited to exposed areas of the body.
Counseling and Support Groups
Vitiligo can have a significant effect on the psychological well being of the patient. This is especially true for darker skinned patients as the contrast between pigmented and de-pigmented skin can be quite drastic. In some cultures there is a stigma attached to having vitiligo. Those affected with the condition are sometimes thought to be evil or diseased and may be shunned by others in the community. People with vitiligo may feel depressed because of this stigma or because their appearance has changed dramatically. Many people with vitiligo find it helpful to get counseling from a mental health professional. People often find they can talk to their counselor about issues that are difficult to discuss with anyone else. A mental health counselor can also offer patients support and help in coping with vitiligo. In addition, it may be helpful to attend a vitiligo support group. | 