Vitiligo
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Vitiligo is a medical condition that causes the skin to lose color. Some people develop a few spots that may lighten or turn completely white. Others can have widespread loss of skin color. Vitiligo can develop on any part of the body but commonly begins on hands, forearms, feet, or face. There is no way to predict how much color a person will lose.
THOSE AT RISK
Vitiligo affects both genders and all races, but is more noticeable in people with darker skin. The close "blood relatives" of a person with vitiligo have elevated risk of also developing vitiligo. Persons with vitiligo also have elevated risk of other autoimmune disorders such as thyroid disease, rheumatoid arthritis, psoriasis, and others.
CAUSES
Researchers have discovered that vitiligo develops when cells called melanocytes die or are destroyed by the body's immune system. As the cells die, an area of skin or hair turns white because the cells no longer make pigment.
Vitiligo is apparently caused by inheritance of multiple causal genes simultaneously, possibly in different combinations in different people, plus exposure to environmental risk factors or triggers that are not yet known. Phenols and stress, whether emotional or physical, are suspected to be environmental triggers, but research continues into these and other possibilities.
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| This 67-year-old man has multiple lesions of depigmentation of the face. |
DIAGNOSIS
When a dermatologist suspects vitiligo, the doctor visually examines the skin. A device called a Wood's lamp, which shines ultraviolet (UV) light onto the skin, may be used to help the dermatologist distinguish vitiligo from other skin conditions. The more prevalent types of vitiligo are:
- GENERALIZED
This is the most common. Generalized vitiligo often first appears on the hands, fingertips, wrists, around the eyes or mouth, or on the feet. It often begins with a rapid loss of skin color. Cycles of pigment loss, followed by times when the pigment does not change, may continue indefinitely over a person's life. Generalized vitiligo commonly spreads to the face, lips, hands, arms, legs, or genitals. This type also may be called bilateral vitiligo because it causes loss of skin color on both sides of the body.
- SEGMENTAL
This type tends to begin at an early age, progress for a year or two, and then stop. It is called segmental because color loss tends to be confined to one segment of the body. A segment of hair on the head, an eyelash, or an eyebrow may turn white, almost always on just one side of the body. Segmental vitiligo also may be called unilateral vitiligo because when it develops on the face, arm, trunk, or leg, it occurs on one side of the body.
- TRICHROME VITILIGO
Three shades of color — brown, tan, and white — develop on the skin.
TREATMENT
Skin color occasionally returns without treatment. Other people lose all of their pigment, causing the skin to become a white color. When the latter happens and the person no longer has patches of contrasting skin color, the person still has vitiligo. Most cases of vitiligo fall between these two extremes and can be successfully treated. Treatment options include:
- LIGHT THERAPY AND MEDICATIONS
When avoiding a tan and camouflaging do not produce satisfactory results, a dermatologist may recommend medical treatment. The goal of medical treatment is to creat a uniform skin tone by either restoring color (repigment) or eliminating the remaining color (depigment). The type of treatment selected depends on the type of vitiligo, severity, as well as the patient's preference, health, and age. Medical treatment for vitiligo includes:
- Narrow Band Ultraviolet B (NB-UVB). This therapy uses light to repigment the skin. NB-UVB requires two to three treatment sessions per week for several months. A standard phototherapy unit may be used to treat the patient. NB-UVB treatments are available in some doctor's offices, as well as from home units, if prescribed. Another source of NB-UVB is excimer lasers. These lasers tend to produce the best results on the face. The hands and feet seem least responsive. Laser treatment can be very expensive and time-consuming.
- PUVA. This therapy uses Ultraviolet A (UVA) light and a medication called psoralen to repigment the skin. The psoralen may be applied to the skin or taken as a pill. Psoralen, which is the "P" in PUVA, makes the skin very sensitive to light. This treatment is 50 percent to 75 percent effective in returning color to the skin on the face, trunk, upper arms, and upper legs. The hands and feet tend to respond poorly. PUVA is time-consuming. It requires at least one year of treatments given twice weekly. PUVA treatments should be given under a dermatologist's close supervision.
- Creams and ointments. Medications that are applied to the skin such as topical corticosteroids, tacrolimus, and calcipotriol can be used to repigment small areas. Topical corticosteroids tend to be more effective in people with darkly pigmented skin and often are most effective on the face. They also can add pigment to the neck, arms, and legs. To achieve faster results, a topical corticosteroid may be combined with calcipotriol. Tacrolimus often works best when combined with NB-UVB light. Patients who use creams and ointments must be carefully monitored.
- Depigmentation. For some patients with extensive vitiligo, removing the remaining pigment from the skin can be an effective way to achieve one skin color. To remove pigment, a dermatologist can prescribe a chemical called monobenzone. This treatment is considered permanent.
- Surgery. Surgical treatment involves transferring skin that has not been affected by vitiligo to patches where vitiligo occurs. Also called a skin graft, this treatment option tends to be most suitable for people who have segmental vitiligo and can produce excellent results. Grafting is only available in certain areas of the United States.
23-year-old woman has areas of
total depigmentation on the legs.
CAMOUFLAGING VITILIGO
Avoid tanning. In fair-skinned people, not tanning can make areas of vitiligo barely noticeable. This alone may successfully hide patches of vitiligo.
Everyone who has vitiligo can benefit from not tanning. Skin affected by vitiligo sunburns very easily. Disguising vitiligo with makeup, a self-tanner, or dye can be a safe, easy way to make vitiligo less noticeable. Waterproof cosmetics that match most skin colors are available. Self-tanners and dyes last longer than makeup. When selecting a self-tanner, pick one that contains a chemical called dihydroxyacetone. Dyes stain the skin and can add enough color to the white patches so that they closely match the surrounding skin. Please note that using dihydroxyacetone products can interfere with treatments and as such should not be used on a regular basis while treating.
Many people make a homemade stain with a rubbing alcohol base mixed with liquid food color, which is safe, does not interfere with treatment and can more closely match the individual's skin color.
CHILDREN AND VITILIGO
Children can be treated, but some vitiligo treatments are not appropriate for children. The treatments that can be used to treat children are creams and ointments, NB-UVB, and PUVA with topical psoralen. PUVA therapy that uses the psoralen pill usually is not recommended until after 12 years of age. Even then, the risk and benefits of this treatment must be carefully weighed.
RESEARCH
Researchers have identified several genes that may be involved in vitiligo and continue to look for involved genes. Once all of the genes have been identified, researchers may know what destroys the melanocytes, the cells that give skin its color. This may not lead to a cure, but it should give vitiligo patients better treatment options. The ultimate goal is to find a treatment that will permanently stop the skin from losing color.
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A dermatologist is a physician who specializes in treating the medical, surgical, and cosmetic conditions of the skin, hair, and nails. To learn more about vitiligo, visit www.aad.org or call toll free (888) 462-DERM (3376) to find a dermatologist in your area.
AAD Web site: www.aad.org
Toll-free: (888) 462-DERM (3376)
Images used with permission of the American Academy of Dermatology
National Library of Dermatologic Teaching Slides
© 2009 American Academy of Dermatology
Revised 1994, 2003, 2005, 2009
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