The disease. Vitiligo is a disease which causes the skin to lose color in patches. Some people will have a few patches, others many more. The condition isn’t contagious or life-threatening, but it can be emotionally devastating. It affects people of all skin colors and ethnicities, men and women, equally. Onset is usually before age 20 years.
Signs and symptoms. The loss of color, also called depigmentation, can affect any part of the body with pigment: skin, hair, inside the mouth, and/or the genitals. Most people won’t feel ill, but some say the white areas are slightly painful or itch.
Types. There are 2 types of vitiligo: segmental and non-segmental. Segmental disease appears on only one part of the body, progresses for about a year, then is stable. Non-segmental disease affects both sides of the body, often appearing first on the hands, feet, or around the eyes or mouth.
Subtypes. Vitiligo begins with a rapid loss of color, then stops spreading, but at some time the depigmentation will become active again. The on-again, off-again natural course of the disease is lifelong. There are three subtypes: localized, generalized, and universal. Localized vitiligo is limited to one or a few areas of the body. With generalized disease there are patches scattered on much of the body. Universal vitiligo, which is very rare, is an almost-complete loss of pigment. There is no way to predict how much pigment an individual will lose.
Causes. Melanocytes, which are the cells giving color to hair and skin, simply die. The cause is uncertain. Non-segmental disease may be an autoimmune condition, in which the body attacks its own tissue. Segmental disease may be caused by a problem with the body’s nervous system. Some people with vitiligo have thyroid disease.
Diagnosis. The diagnosis of vitiligo is made based on an individual’s personal and family medical history, as well as examination of the skin and thyroid function tests. If thyroid disease is present, treatment of the thyroid disease will control the vitiligo as well.
Treatment
There are a variety of options for treatment. The method(s) chosen depend on overall health, the type of vitiligo, age of the person affected, extent of disease, and what areas of the body are affected. Some people choose to forego treatment.
No medical treatment. Cosmetic options include makeup or skin dyes. These are often recommended for children, to avoid side effects of medication. It’s time-consuming because the products used must be applied repeatedly.Topical medication. Topical medications applied to small areas of skin may restore some pigment. Very potent corticosteroid creams are one type of topical medication. They work best on darkly pigmented skin and are more effective on the face than on the hands and feet. Not all topical medications can be used on the face.
Light treatment. A light box may be used on large areas of skin, and an eximer laser on small areas. It’s also more effective on the face than on hands and feet. About 70% of people respond, but about half of the repigmentation disappears by one year after treatment. By four years after treatment, almost 90% of the repigmentation has usually disappeared.
PUVA light and psoralen. Psoralen is a medication, topical or in pill form, that when combined with ultraviolet light, is about 50-75% effective in restoring pigment. It’s expensive and time-consuming, requiring twice-weekly visits to a hospital or treatment center for a year. Psoralen can affect eyesight; careful monitoring is required.
Surgery. Unaffected skin is removed and placed in areas from which affected skin has been removed. It shouldn’t be used in people who scar easily.
Unconventional treatments. Vitamins, minerals, amino acids and enzymes have been used spuriously, but not studied. There is no evidence to support their use; safety and side effects are unknown. There is some interest in the use of ginkgo biloba as a potential treatment. Some people respond to placebos, which contain no active substance.
Management tips. Protect skin from the sun. Depigmented skin burns easily, making vitiligo worse. Apply sunscreen every day – every two hours if outdoors, after being in water, and sweating. Wear clothing to protect your skin. Stay in the shade, especially in the middle of the day. Don’t use tanning beds or sunlamps. Don’t get tattoos. A new patch of vitiligo may appear at the site.
Many people who have vitiligo find comfort and encouragement by connecting with other people who have the condition. One group is Vitiligo Support International: http://www.vitiligosupport.org. Another is Vitiligo Friends: http://www.vitiligofriends.org.
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Faith A. Coleman, MD
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