Vitiligo - A Skin Disorder With Pigment Loss
What is Vitiligo?
Vitiligo is a skin disorder in which melanocytes are destroyed. These are the skin cells which make a brown pigment called melanin that colors our skin. Without melanocytes, skin pigment can't be made. The pigment is characteristically lost in patches, producing a mottled appearance. The patches may enlarge over time.
I've had vitiligo on my hands and forearms for several years. Since I have pale skin, the white patches are most noticeable in summer when the rest of my skin tans. At other times of year the pigment loss is not a big problem. For people with darker skin or for people who have vitiligo in a more visible place, such as the face, the vitiligo may be much more problematic. The darker the skin, the more obvious the contrast between the light patches and the dark skin.
The cause of the melanocyte destruction in vitiligo isn't known for certain, but it may be due to an autoimmune problem. Our immune system normally destroys bacteria and viruses. In an autoimmune disease the immune system mistakenly attacks the body's own cells. It's thought that in vitiligo the immune system destroys melanocytes in parts of the skin, causing a loss of pigment.
In addition to the variation in the location of vitiligo patches in patients, the speed of pigment loss also varies. My vitiligo is slowly spreading over my hands and forearms and has started to develop on my legs. In some people, the disorder progresses much more rapidly.
Skin Structure and Melanocytes
Types of Vitiligo
There are three possible patterns of depigmentation in vitiligo (although sometimes additional classifications are used).
- In a focal pattern, there are only a few areas without pigment or there may be only a single depigmented patch.
- In a segmental pattern, depigmentation occurs on only one side of the body.
- In generalized vitiligo,the depigmentation develops symmetrically on both sides of the body, The light patches on one side may not be identical in appearance to those on the other side, however. This is the most common type of vitiligo.
I have generalized vitiligo. Both my right and left hand and forearm are affected.
Symptoms of Generalized Vitiligo
Focal and segmental vitiligo don't spread, but generalized vitiligo often does. The loss of pigment may take place very slowly over a number of years or it may be more rapid. The depigmentation tends to first develop as small spots on areas exposed to sunlight, especially the face, lips, arms and hands. It may be particularly noticeable around openings in the skin, such as the lips and the eyes. The spots may enlarge over time. New spots sometimes develop in areas that aren't normally exposed to the sun. The depigmented patches may be paler than the surrounding skin or may be completely white.
Some people with vitiligo develop grey hair, eyelashes, eyebrows and facial hair at a relatively young age (before 35). There may also be pigment loss inside the mouth. Pigment is sometimes lost from the retina, the light-sensitive layer at the back of each eyeball, although this seems to be a very rare process.
People with vitiligo may have areas of increased pigmentation around their depigmented areas, which is known as hyperpigmentation. Both the depigmented areas and the hyperpigmented areas are flat and feel normal to the touch and they have normal sensation. Vitiligo isn't contagious - a person can't "catch" the disorder by touching someone else's skin.
A doctor should be visited to check that light patches on the skin are vitiligo and not a symptom of another disorder, such as a yeast infection of the skin. Vitiligo is easiest to treat when it's in its beginning stages, so this is another reason to visit a doctor soon after depigmentation begins.
Causes of Vitiligo
Vitiligo affects both genders and all ethnic groups equally. It usually develops earlier in life, before the age of forty. About 1% to 2% of the world's population have vitiligo.
People with vitiligo may be healthy, apart from their depigmented skin patches. However, some have one or more autoimmune diseases. The most widely accepted theory for the origin of vitiligo is that it arises due to an autoimmune problem in which the immune system destroys or damages melanocytes. People with vitiligo may have another autoimmune disease as well, such as hyperthyroidism, a condition in which the thyroid gland is overactive, alopecia areata, a disorder in which hair is lost, or pernicious anemia, a disease in which the intestine cannot absorb enough vitamin B12 from food.
Another theory for the origin of vitiligo is that it's caused by a stressful event, such as a severe sunburn to the area that develops white spots, exposure to a chemical toxin from outside or inside the body, or serious psychological stress. There is much less support for this idea than the theory that vitiligo is an autoimmune condition, however.
There seems to be an inherited component in some forms of vitiligo, since it sometimes runs in families. Genes have been identified that are believed to play a role in making a person susceptible to loss of skin pigment.
Vitiligo is physically painless but may cause a lot of emotional turmoil. People may be very self conscious about their pigment loss and their appearance. For some people the appearance of depigmented patches is a life-changing event. It may be an especially difficult condition for people with darker skin because the depigmented areas may be very obvious. In addition, people may feel that they are losing their identity by losing their pigment. Another problem for vitiligo patients is that they may be treated badly because of their appearance.
There is another way in which vitiligo may affect someone in addition to being embarrassing, depressing or isolating. Melanin in skin gives us some protection from ultraviolet light in sunlight. Since the depigmented patches in vitiligo lack melanin, it's extremely important that a person covers them with sunscreen to help prevent a sunburn and skin cancer.
Dermatologists say that is very important that people of all skin colors wear sunscreen, whether or not they have vitiligo. Melanin doesn't provide us with complete protection from all of the sun's dangerous radiation.
Treatments For Vitiligo
There is no cure for vitiligo, but there are ways to improve the appearance of the skin. Very occasionally pigment returns to pale areas without any treatment. If the pigment doesn't return, however, a person has the choice of living with the missing pigment and using sunscreen carefully, disguising the light areas (a method which may still require the application of sunscreen), using techniques to encourage pigment to reappear or removing the remaining pigment from the skin so that all of the skin has the same color.
Whatever method is chosen, the treatment should be discussed in detail with a doctor. This is especially important in the case of treatments that are designed to stimulate pigment reappearance or to remove pigment, since these may have serious side effects. Another factor to consider is that vitiligo treatments may well eliminate white spots, but more depigmented patches may appear in the future. This means that a treatment may need to be repeated.
Using Makeup to Cover Vitiligo
Disguising Vitiligo Skin Patches
The easiest and safest method to disguise vitiligo patches is to cover them with clothing. This isn't always possible or practical, however, so other strategies may be necessary. If a suntan is avoided, the light patches may not be very noticeable in people with pale skin. This is true for me. My skin was tanned in the photos of my hand and arm in this article, so the vitiligo showed up. The problem is much harder to see when I'm not tanned, especially under some lighting conditions. I'm been much more careful about avoidIng a tan since I took the photos. This is not so much because a tan shows up my vitiligo but because it indicates that sunlight has affected my skin and that the pigment-free areas of my skin may have been damaged by the light.
Makeup can cover and hide light patches and may be sufficient to disguise some cases of vitiligo. Another option is the use of camouflage creams, which come in a range of colors from light to dark. They're often waterproof and stay on the skin for a long time. Stains and self-tanning products can also be used (although like all products applied to the skin the safety of the chosen product should be investigated). The woman in the video above does an excellent job of covering her vitiligo with makeup. The process may be time consuming, though.
Losing Skin Pigment
Vitiligo treatments must be prescribed by a doctor. The doctor will know about the effectiveness and risks of different treatments. He or she will also know about any new developments in vitiligo treatment. The descriptions below are given for general interest.
Stimulating Skin Pigment to Reappear - Topical Creams
One type of treatment for restoring pigment that may be prescribed is the use of a topical corticosteroid cream. A "topical" cream is one that is used on the skin. A corticosteroid cream may encourage pigment to reappear, although several months of treatment may be needed in order for the cream to work. The cream does have side effects. It may cause the skin to become thinner and may also cause skin striae to appear. Striae are irregular areas of skin that look like stripes or lines. They're sometimes known as stretch marks.
An immunomodulator cream may also restore pigment. This cream can suppress the action of the immune system in the skin. It may work where corticosteroids aren't tolerated. However, modifying the activity of the immune system can be a risky activity.
Psoralen photochemotherapy, or PUVA, requires the administration of a chemical called psoralen. The chemical is administered by mouth, as a cream rubbed on the skin or by immersion in a liquid containing the chemical. Psoralen makes the skin more sensitive to ultraviolet light. After the psoralen treatment, the patient is exposed to ultraviolet A light. The skin turns pink at first and then the pink color is replaced by normal skin pigment, if all goes according to plan.
There is a serious concern with PUVA treatment. Shining ultraviolet light on skin increases the risk of skin cancer, just as it does if we go out into the sun without wearing sunscreen. Multiple PUVA treatments increase the risk of cancer development. There's also a risk that the treatment will cause too much pigment to appear, or hyperpigmentation, resulting in darker than normal areas on the skin. These dark patches are usually temporary, however. Psoralen treatment may also lead to sunburn, so it's important to limit exposure to the sun after a treatment and to wear sunglasses. In addition, ingesting psoralen can cause unpleasant side effects such as stomach upset and nausea.
Narrowband UVB Light
Narrowband UVB light is also used to restore pigment lost in vitiligo and is becoming popular. This light has two important advantages compared to PUVA treatment: it doesn't require a psoralen pre-treatment and it uses a narrow range of ultraviolet wavelengths in the UVB range, which are thought to be less dangerous than the light used in PUVA therapy. The UVB light is provided by light panels or by light cabinets, which are available in home versions. A doctor's guidance is needed if treatment is performed at home.
There is another option for someone with many large vitiligo patches. The remaining pigment can be removed from the skin by a chemical or a laser, allowing the skin to look the same color everywhere. If this treatment is performed, a person's whole skin surface is very susceptible to sun damage. Other possible treatments include a different type of laser treatment to stimulate repigmentation and the application of skin grafts. Special vitamin supplements may also help, although this is not yet proven.
New techniques that may help vitiligo sufferers are currently being investigated. One of these is a melanocyte transfer. In this technique, melanocytes are obtained from a person's pigmented skin and allowed to multiply in a laboratory dish. The melanocytes are then transplanted into the patient's depigmented areas.
Many vitiligo treatments need to be used for months to see an effect and not every treatment helps every person. The good news is that there in an increasing range of treatments that a doctor can prescribe. Hopefully in the near future doctors will be able to treat the cause (or causes) of vitiligo as well as the symptoms of the disorder.
Living With Vitiligo
Extensive vitiligo can be psychologically devastating. Some people are trying to remove the stigma that is attached to the condition. Chantelle Brown-Young, also known as Winnie Harlow and Chantelle Winnie, is a Canadian model with prominent depigmented patches. She's becoming successful in her career and is raising awareness of vitiligo and the problems that it causes.
Chantelle Brown-Young (Winnie Harlow) talks about her Vitiligo
Coping With Vitiligo
Humans have a wide range of skin colors, which add variety to life. It would be nice if a mixture of darker and lighter skin areas on a person's body was as acceptable to the general public as a monotone skin, but it often isn't, especially in some cultures. Multicolored people or people who lose their normal color are often treated badly.
Some people remain confident and do nothing about their light patches, even when these are obvious, although this may be a psychological challenge. It's important to protect the pale areas from sun damage, but other than that vitiligo causes no harm to the body (as far as scientists know). For other people with vitiligo, however, revealing their vitiligo or the true extent of the disorder is unthinkable due to their embarrassment or to the way in which they are treated.
If you're considering getting a treatment for vitiligo, do some research about the treatment and write some questions down to ask your doctor. If you do research on the Internet, make sure that you visit authoritative sites such as vitiligo associations and government health sites. There are a lot of websites which claim that they have a wonderful "cure" for vitiligo, but their products are generally not clinically tested and may be completely useless or even harmful.
If you need support dealing with vitiligo, your family and friends may be a great help. A vitiligo group in your area would most likely be a wonderful resource too, but there may not be one available. Meetings with an individual counselor can also be helpful. In addition, some sections of the last two sites linked to below may be useful. Make sure that you visit one or more of these support sources if you need them. You don't have to deal with vitiligo on your own.
References and Useful Links
© 2012 Linda Crampton
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