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Vitiligo

What is vitiligo?

Vitiligo is a skin disorder that causes the skin to lose its color. Smooth lighter or white areas (called macules or patches) appear on a person’s skin. If vitiligo occurs in a hair-baring area, the hair in those areas may turn white as well. The condition occurs when melanocytes (the skin cells that produce melanin, the chemical that gives skin its color, or pigmentation) are destroyed by the body’s immune system.

How does vitiligo progress?

Vitiligo usually begins with a few small white patches that may gradually spread over the body over the course of several months. Vitiligo can develop on any part of the body, including the mucous membranes (moist lining of the mouth, nose, genital, and rectal areas), the eyes, and inner ears, but typically begins on the hands, forearms, feet, and face. Sometimes the patches continue to widen and spread, but usually they stay in the same place for years. The location of the macules shifts and changes over time, as certain areas of skin lose and regain their pigments. Vitiligo varies in the amount of skin affected; it may present with only few spots or may result in widespread loss of skin color if you are affected with the more generalized form of the disease.

What causes vitiligo?

Although the causes of vitiligo aren’t completely understood, there are a number of different theories:

  • Autoimmune disorder—The affected person’s immune system may develop antibodies that destroy melanocytes.
  • Genetic factors—Certain factors that may increase the chance of getting vitiligo can be inherited. About 30% of vitiligo cases run in families.
  • Neurogenic factors—A substance that is toxic to melanocytes may be released at nerve endings in the skin.
  • Self-destruction—A defect in the melanocytes causes them to destroy themselves.

Vitiligo may also be triggered by certain events, such as physical or emotional stress. Because none of the explanations seem to completely account for the condition, it’s possible that a combination of these factors is responsible for vitiligo.

What problems are associated with vitiligo?

Although vitiligo is mainly a cosmetic condition, people with vitiligo may experience a variety of problems:

  • Because they lack melanocytes, macules are more sensitive to sunlight than the rest of the skin, so they will burn rather than tan.
  • People with vitiligo may have some abnormalities in their retinas (the inner layer of the eye that contains light-sensitive cells) and some variation of color in their irises (the colored part of the eye). In some cases, there is some inflammation of the retina or iris, but vision is usually not affected.
  • People with vitiligo may be more likely to get other autoimmune diseases (in which the body’s immune system causes it to attack itself), such as hypothyroidism, diabetes, pernicious anemia, Addison’s disease, and alopecia areata.

What are the types of vitiligo?

Vitiligo can be segmental, which is restricted to one side of the body or one area, such as the hands or face. Vitiligo can also be generalized, which is the most common type, when macules appear in various places on the body. Other subtypes of vitiligo include focal, mucosal, trichrome, and universal vitiligo

How common is vitiligo?

Vitiligo occurs in about 1 to 2 percent of the United States’ and the world’s population. Vitiligo affects all races and genders equally; however, it is more visible in people with darker skin. Although vitiligo can develop in anyone at any age, it most commonly appears in people ages 10 to 30 years. Vitiligo rarely appears in the very young or very old.

How is vitiligo diagnosed?

Usually the white patches are easily visible on the skin, but physicians can use a Wood’s lamp, which shines ultraviolet (UV) light onto the skin to help differentiate from other skin conditions.

How is vitiligo treated?

There is no cure for vitiligo. The goal of medical treatment is to create a uniform skin tone by either restoring color (repigmentation) or eliminating the remaining color (depigmentation). Common treatments include:

  • Camouflage therapy:
    • Using sunscreen with an SPF of 30 or higher. Also, the sunscreen should shield ultraviolet B light and ultraviolet A light (UVB and UVA). Use of sunscreens minimizes tanning, thereby limiting the contrast between affected and normal skin.
    • Makeups help camouflage depigmented areas. Some recommended brands are Covermark and Dermablend.
    • Hair dyes if vitiligo affects the hair
    • Depigmentation therapy with the drug monobenzone can be used if the disease is extensive. This medication is applied to pigmented patches of skin and will turn them white to match the areas of vitiligo.
  • Repigmentation therapy:
    • Corticosteroids—can be taken orally or topically (as a cream put on the skin). Results may take up to 3 months to be seen. The doctor will monitor the patient for any side effects, which can include skin thinning or striae (stretch marks) if used for prolonged period of time.
    • Topical vitamin D analogs
    • Topical immunomodulators—such as calcineurin inhibitors
  • Light Therapy:
    • Narrow band ultraviolet B (NB-UVB) requires two to three treatment sessions per week for several months and is available in our Main Campus Dermatology Offices and selected Cleveland Clinic Family Health Centers.
    • Excimer Laser emits a wavelength of ultraviolet light at 308 nm close to that of narrow band UVB (311 nm). This is more practical for patients who do not have widespread or large lesions since it is delivered to small, targeted areas
  • Surgery:
    • Autologous (from the patient) skin grafts—Skin is taken from one part of the patient and used to cover another part. Possible complications include scarring, infection, or a failure to repigment.
    • Micropigmentation—A type of tattooing that is usually applied to the lips of people affected by vitiligo.

Vitiligo can cause psychological distress and has the ability to affect a person’s outlook and social interactions. The patient’s doctor may suggest that the patient receive counseling or attend a vitiligo support group.

What is the outlook for people with vitiligo?

About 10 to 20 percent of people who have vitiligo fully regain their skin color. People with the best chance of regaining skin color are those who are young, whose vitiligo reaches its peak in less than 6 months and is located mainly on the facial area. People who are less likely to regain their color are those who get vitiligo later in life on their lips and limbs, especially the hands.

References:

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 12/21/2012...#12419


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