Vitiligo Basics

Vitiligo is a medical condition that causes the skin to lose its color. While some people develop a few spots that lighten or turn completely white, others may have more widespread color loss. Vitiligo can develop on any part of the body and sometimes, it can cause a patch of hair to turn white.

For many, skin color may eventually return on its own, but for some people the color loss can be permanent if not treated. Research shows that about 20% of people living with Vitiligo have a blood relative who has Vitiligo.

The most common type of Vitiligo, Generalized Vitiligo, may be an autoimmune disease. An autoimmune disease develops when the body mistakes a part of itself as foreign.Vitiligo develops when cells called melanocytes, the cells that give our skin and hair color, are attacked by the immune system and stop functioning. Although scientists do not completely understand why these cells die, we do know that Vitiligo is not contagious.

A dermatologist can diagnose Vitiligo by examining the patient’s skin, reviewing his or her medical history or through testing (skin biopsy). If the diagnosis is Vitiligo, further blood tests may be recommended to look for other autoimmune disorders. An eye exam also may be recommended to check for uveitis, an inflammation of part of the eye, which can sometimes occur with Vitiligo.

The different types of Vitiligo are:

• Generalized: This is the most common type of Vitiligo. With this type, skin typically loses color equally on both sides of the body. In its early stages, color loss may be rapid and it is then followed by a period of little or no color loss.

• Localized: Also known as Segmental Vitiligo, this type causes color loss on one part, or segment, of the skin. Hair color also may be lost in the involved area. Often, a bit of hair on the head, an eyelash, or eyebrow can turn white.
Color loss often occurs for a year or two, and then stops.

• Acrofacial: Color loss occurs only on the head, hands, and feet.

• Universal: Color loss occurs throughout most of the body.

Treatment options

Currently, there is no known cure for Vitiligo, but various treatments can help to repigment the skin. Research shows that for patients living with Vitiligo, a more even skin tone can greatly improve their psychological and physical well-being. Treatments are customizable to the type of Vitiligo and the specific area of the body affected, as well the patient’s preferences, age, and general health.

Light Therapy
Patients may receive NB-UVB therapy by standing in a light box a few times per week, or by getting localized laser treatments. NB-UVB works best on the face and trunk of the body. Hands and feet have not responded to this treatment as desired. Another type of light therapy that can be used to treat Vitiligo is PUVA. This treatment combines Psoralen, a medication that can be applied to the skin or taken in pill form and can make skin more reactive to light.

Topical Treatments
Topical medicines are applied at home as directed. Medicines that a dermatologist may prescribe include a topical corticosteroid, tacrolimus ointment, pimecrolimus cream, or calcipotriol (a vitamin D compound). Like light therapy, topical medications work slowly to return color to the skin. For faster results, a dermatologist may combine treatments.

Skin grafting
This is a surgical procedure during which a skin graft of healthy skin that has not lost color is removed and placed over skin that has lost color. This treatment can produce excellent results. It has a tendency to be most effective for people with Localized Vitiligo.

Depigmentation

This is only an option for patients who have lost most of their skin color. Depigmentation removes the remaining color from the skin, leaving a person with completely white skin. To remove the remaining color, a patient must apply a prescription cream once or twice a day to the skin with color. This must be done for one to four years.

Depigmentation can be an effective way to achieve a more uniform skin color. Before starting depigmentation, the pros and cons should be carefully weighed as this treatment is permanent.

Treating children
Vitiligo often develops at a young age. Children can be treated, but they have a more limited range of options. They may benefit from the use of certain prescription creams and ointments, as well as light therapy or Excimer laser.

Makeup, self-tanners and dyes

Cosmetics and self-tanners may provide instant results and avoid possible side effects. But there are drawbacks: some products require daily application, which can be time-consuming, and mastering the necessary techniques of their application can take practice, especially when wanting to achieve the most natural look possible.
A great variety of camouflage makeup, self-tanners, and dyes are available. Your dermatologist can help you choose a product that matches your skin tone.

When choosing a self-tanner, it is important to know that some brands contain a chemical called dihydroxyacetone, a chemical that can interfere with some medicines used to treat Vitiligo. Always let your dermatologist know if you are using a self-tanner.

Parents of children with Vitiligo should discuss these options with their dermatologist.

Sun protection is essential

Anyone who has been diagnosed with Vitiligo can benefit from sun protection. Skin that has lost color can sunburn very easily, which can exacerbate Vitiligo.

For people with pale skin, avoiding the sun often makes their Vitiligo less noticeable or can even eliminate the need for treatment.

When sun avoidance is not possible, applying sunscreen every day helps to protect from skin cancer. Make sure that your sunscreen offers UVA/UVB protection (label should say “broad spectrum”) and that it is a water-resistant formula with an SPF level of 30 or higher.

Vitiligo Research

Researches around the world are currently studying Vitiligo to better understand its causes and promising treatment options. While some scholars are focusing on the role that the immune system plays in this condition, others are researching its genetic components.