Vitiligo & Skin Pigmentation

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Vitiligo is a pigmentation disorder in which white patches are found on the skin. It can also occur inside the mouth and nose as well as in the eye. The white patches appear because the cells in the skin responsible for giving skin its colour are destroyed.

What causes vitiligo?

The exact cause of vitiligo is not currently known. It is known that there is a group of three genes which can make people more likely to get vitiligo. It is possible that vitiligo is caused by an autoimmune disease where the body attacks its own cells responsible for skin colour.

Who can get vitiligo?

Vitiligo is quite a common disease and is thought to be found in around 1 out of 50 people. Around half of those who have vitiligo will develop it before they turn 20 and almost all develop it before they are 40. It can affect all races but it is most noticeable if you have dark skin.

Vitiligo appears to be more common in people with some autoimmune conditions such as hyperthyroidism, adrenocortical insufficiency, alopecia areata and pernicious anaemia. It is unknown what causes this link and most people who have vitiligo will not have an autoimmune disease.

There is also a genetic component to vitiligo and it can be inherited. If your parents have vitiligo then you are more likely to develop it.

What are the symptoms of vitiligo?

The most obvious symptom of vitiligo is the white patches which appear on the skin. Often these are found on areas of the body which are repeatedly exposed to the sun, such as the face, arms and legs. Vitiligo can also be found in the armpits and groin as well as in the mouth and nose. Vitiligo is most often found symmetrically on both sides of the body but can also be limited to one or two areas, or found on just one side of the body.

Vitiligo which is limited to one or two areas or to one side of the body does not spread. The symmetrical patterned vitiligo can spread and usually will do so over time. This can occur slowly or quickly depending on the person.

Other symptoms of vitiligo include greying hair, including that of the eyebrows and beard.

Diagnosing vitiligo

Often, a doctor can tell you if you have vitiligo just by looking at your skin, especially if the white patches are found on sun exposed areas. Your doctor should ask you whether there is any family history of vitiligo as well as any family history of autoimmune diseases. To confirm the diagnosis, a sample of the affected skin may be taken and examined.

How can vitiligo be treated with drugs?

Vitiligo is a harmless condition but it can be treated in order to reduce the appearance. This treatment is usually long term and will depend upon how many patches you have, as well as where they are and how big they are. Different people respond differently to the treatments so what works for one person may not work for you.

Steroid creams can be applied to the area to help return colour to the skin. These are the safest treatments but may not be as effective as some others. This may become a long term treatment and usually no results can be seen for a few months.

Ultraviolet (UV) light treatment with additional use of a chemical called psoralen to sensitise the skin to the effects of light is used on people who have a small amount of patches in one location. It involves applying a thin coat of psoralen to the vitiligo patches for 30 minutes before using an artificial UV light. This should turn the vitiligo pink. The amount of UV will usually be increased over time- often over several weeks. After a long period of time the vitiligo should return to your normal skin colour. Side effects of this treatment include severe sunburn as well as darkening of the affected area and so whilst undergoing this treatment sunscreen should always be worn.

If you do not respond to UV light treatment with topical psoralen, or if you have vitiligo over much of your body, then oral psoralen can be given. Two hours after you take this you will be exposed to an artificial UV light. Side effects of this treatment include those for UV light therapy with topical psoralen, and additional increased risk of eye conditions such as cataracts.

Depigmentation treatment can be used to make the rest of your skin lighter so that the vitiligo is less noticeable. This is especially effective if the vitiligo is covering a large part of your body. Hydroquinone can be used to do this and is applied to the unaffected skin. Side effects of this treatment include inflammation, itching and dry skin. Depigmentation treatments are a permanent solution.

How can vitiligo be treated by surgery?

Surgical treatment of vitiligo should be used only after the above mentioned drugs have been tried. Surgical treatments are usually time consuming and expensive.

Skin grafts can be used, in which skin from an unaffected part of your body is removed and used to cover the area of vitiligo. This can only be done if you have small patches of vitiligo. There can be complications of skin grafts such as infection and scarring. It is also possible for the skin that is grafted to develop vitiligo.

The vitiligo affected areas can be tattooed to your normal skin colour. This is particularly effective on vitiligo found on the lips and if you are dark skinned. This tattooing technique is called “micropigmentation”. Problems with this method are that it can be difficult to get the perfect colour. Another problem is that the tattooed area will not change colour in the sun, unlike the rest of your skin. Tattooing vitiligo areas is a very expensive method.

It is possible for cells which give your skin its colour to be grown from a sample of your skin. These can then be transplanted into the vitiligo affected area. This is currently an experimental procedure.

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