Vitiligo – Know It All!

Editorial

All you need to know about vitiligo.

Know your ailment well, so you can manage it better!!

Vitiligo

Here we come with Vitiligo today!

Overview:

Vitiligo is a chronic (long-lasting) condition that causes the loss of pigment or colour in skin patches. This occurs when melanocytes are attacked and destroyed by pigment-making skin cells, causing the skin to turn a milky-white colour.

Normally, melanin influences the colour of hair and skin. Vitiligo happens when melanin-producing cells die or stop working. Vitiligo affects people of all skin types, but in individuals with darker skin, it may be more noticeable. The disease is not infectious or life-threatening. It can be awkward or make you feel bad about yourself.

Vitiligo treatment can restore colour to the skin affected. But the continuing loss of skin colour or recurrence does not prevent it.

It can also be defined as a disease where the skin produces white spots. Any place on the body can be impacted, and in many areas, most people with vitiligo have white patches.

Types:

Two types of vitiligo are available:

The most common type is non-segmental or generalised vitiligo. This occurs when white patches, such as on both hands or both knees, appear symmetrically on both sides of your body. This form of vitiligo may have rapid colour or pigment loss and tends to cover a large area.

Segmental vitiligo is much less common and occurs when the white patches, such as a leg, one side of the face, or arm, are only on one segment or side of your body. At an early age, this form of vitiligo sometimes starts and progresses for around 1 to 2 years and then typically ends.

The cause of vitiligo is unknown, but research indicates that autoimmune disease may be vitiligo. The autoimmune system works to fight off and defend your body from viruses, bacteria, and infection throughout your body. In individuals with autoimmune diseases, by mistake, immune cells attack the body’s own healthy tissues. It may be more likely that people with vitiligo may develop other autoimmune disorders.

Sometimes, a person with vitiligo may have family members who have the disease as well. There is no treatment for vitiligo, but treatment may help the appearance of skin tone more evenly.

Vitiligo

Who Gets The disease:

Anyone can get vitiligo, and at any age, it can grow. The white patches, however, begin to appear before age 20 for many people with vitiligo and may start in early childhood.

In individuals who have a family history of the condition or who have certain autoimmune disorders, vitiligo seems to be more prevalent, including:

  • Addison’s disease.
  • Pernicious anemia.
  • Psoriasis.
  • Rheumatoid arthritis.
  • Systemic lupus erythematosus.
  • Thyroid disease.
  • Type 1 diabetes.

Up to 2 % of the population has the condition, and an estimated 2 to 5 million Americans have it. Whether you’re a guy or a woman, it doesn’t matter.

It occurs early in life, between the ages of 10 and 30, in most cases. Before age 40, it will almost always turn up.

In families, Vitiligo may run. When anyone else in your family gets it, you are more likely to have it, too, or when people in your family have grey hair prematurely.

Your odds can also increase with autoimmune diseases, such as autoimmune thyroid disease (Hashimoto’s thyroiditis) or type 1 diabetes.

Causes and Risk Factors:

  • As it has lost its melanin, the skin does not have its characteristic colour. The pigment-forming cells known as melanocytes have been damaged for some reason.
  • We’re not sure why this is happening. It may be an autoimmune disease, where the body’s defences turn against your own cells instead of fighting invading germs.
  • While vitiligo affects all races equally, in dark-skinned people it’s more visible.

It may also be due to a disorder of the immune system (an autoimmune condition)

  • Family history (heredity)
  • A trigger event, such as stress, severe sunburn or skin trauma, such as contact with a chemical
Vitiligo

Symptoms:

Vitiligo signs include:

  • Patchy loss of skin colour, which usually first appears on the hands, face, and areas around body openings and the genitals
  • Premature whitening or greying of the hair on your scalp, eyelashes, eyebrows or beard
  • Loss of colour in the tissues that line the inside of your mouth and nose (mucous membranes)

Vitiligo can start at any age but usually appears before age 30. Depending on the type of vitiligo you have, it may affect:

  • Nearly all skin surfaces. With this type, called universal vitiligo, the discolouration affects nearly all skin surfaces.
  • Many parts of your body. With this most common type, called generalized vitiligo, the discoloured patches often progress similarly on corresponding body parts (symmetrically).
  • Only one side or part of your body. This type, called segmental vitiligo, tends to occur at a younger age, progress for a year or two, then stop.
  • One or only a few areas of your body. This type is called localized (focal) vitiligo.
  • The face and hands. With this type, called acrofacial vitiligo, the affected skin is on the face and hands, and around body openings, such as the eyes, nose and ears.

It’s difficult to predict how your disease will progress. Sometimes the patches stop forming without treatment. In most cases, pigment loss spreads and eventually involves most of your skin. Occasionally, the skin gets its color back.

Complications: People with vitiligo may be at increased risk of:

  • Social or psychological distress
  • Sunburn
  • Eye problems
  • Hearing loss
Vitiligo

Diagnosis:

Your doctor will ask about your family history and conduct a thorough physical exam in order to diagnose vitiligo. A close examination of your skin may be included in the exam. Doctors sometimes use a wood lamp, also referred to as a black light, which is an ultraviolet light that shines on your skin. The light makes your skin appear chalky if you have vitiligo.

Other examinations may include:

  • Blood tests to scan for other disorders of autoimmune nature.
  • An eye exam to check for uveitis, an inflammation of the part of the eye that happens with vitiligo sometimes.
  • A skin biopsy, which means taking a small sample of your skin under a microscope for examination. Doctors may examine the tissue for the missing melanocytes that are seen in a person with vitiligo’s depigmented skin.

Treatment Options:

Medications

The vitiligo process, the loss of pigment cells (melanocytes), can not be stopped by any drug. But some drugs, used alone, in combination or with light therapy, can help restore some skin tone.

Drugs that control inflammation. Applying a corticosteroid cream may return colour to the affected skin. When vitiligo is still in its early phases, this is most effective. This type of cream is efficient and easy to use, but for several months, you might not see changes in the colour of your skin. Skin thinning or the appearance of streaks or lines on your skin are potential side effects. For children and for people who have large areas of discoloured skin, milder forms of the drug may be prescribed. For people whose condition is worsening rapidly, corticosteroid pills or injections may be an alternative.

Medications that affect the immune system. For people with small areas of depigmentation, particularly on the face and neck, calcineurin inhibitor ointments such as tacrolimus (Protopic) or pimecrolimus (Elidel) might be effective. The U.S. Food and Drug Administration (FDA) has warned about a potential link between these medicines and skin cancer and lymphoma.

Therapies

  • Light therapy. It has been demonstrated that narrowband ultraviolet B (UVB) phototherapy stops or slows the progression of active vitiligo. When used with corticosteroids or inhibitors of calcineurin, it may be more effective. Two to three times a week, you’ll need therapy. Before you see any improvement, it could take one to three months and it could take six months or longer to see the full effect.
  • Talk to your doctor about the risks and benefits of using these drugs with phototherapy, given the FDA‘s warning about a possible risk of skin cancer using calcineurin inhibitors.
  • Smaller compact or mobile systems for narrowband ultraviolet B therapy are available for home use for people who can’t go to a doctor’s office for treatment. If required, talk to your doctor about this option as well.
  • Redness, itching and burning include possible side effects of narrowband ultraviolet B therapy. Typically, these side effects clear up within a few hours of treatment.

Combining psoralen and light therapy. This treatment blends light therapy (photochemotherapy) with a plant-derived substance called psoralen to return colour to the light patches. You are exposed to ultraviolet A (UVA) light after you have taken psoralen by mouth or applied it to the affected skin. Although successful, this method is more difficult to prescribe and has been replaced by narrow-band UVB therapy in many practices.

Removing the remaining colour (depigmentation). When your vitiligo is widespread and other treatments have not worked, this therapy may be an option. A depigmentation agent is added to regions of the skin that are untouched. This lightens the skin gradually so that it blends with the discoloured areas. Therapy is done for nine months or longer, once or twice a day. Redness, swelling, itching and very dry skin can be side effects. Depigmentation is irreversible.

Vitiligo

Surgery

Some people with stable conditions could be candidates for surgery if light therapy and drugs have not succeeded. By restoring colour, the following strategies are meant to balance our skin tone:

Skin grafting. Your doctor transfers very small sections of your healthy, pigmented skin to areas that have lost pigment during this procedure. If you have tiny patches of vitiligo, this technique is often used.

Possible risks include infection, scarring, the appearance of a cobblestone, spotty colour and failure to recolour the area.

Blister grafting. Your doctor develops blisters on your pigmented skin during this operation, usually with suction, and then transplants the tops of the blisters into discoloured skin.

Possible hazards include scarring, a cobblestone appearance and recolouration of the area failure. And another patch of vitiligo may trigger the skin damage caused by suction.

Cellular suspension transplant.

Your doctor creates blisters on your pigmented skin during this procedure, usually with suction, and then transplants the tops of the blisters into discoloured skin.

Possible hazards include scarring, a cobblestone appearance and recolouration of the area failure. And another patch of vitiligo can activate the skin damage caused by suction.

Coping up with vitiligo:

It can be tough to live with vitiligo. The changes in their appearance make some people with the disorder feel embarrassed, sad, ashamed, or upset. This can lead to low self-esteem and depression sometimes. It will help you deal with the condition and treat depression by finding support and help from a mental health professional.

You can better control the disease, in addition to the medications your doctor recommends, by:

  • To protect your skin against the sun. To help protect your skin from sunburn and long-term damage, use sunscreen and wear clothes.
  • Wearing makeup to conceal depigmented areas of skin, such as self-tanning lotions or dyes. Check with your doctor about the lotion or colourant that you should use.
  • Having a doctor who is specialised in treating vitiligo individuals.
  • To help you make choices about care, read about the condition and treatments.
  • Speaking to other individuals that have vitiligo. Consider seeking a support group for Vitiligo in your area or via an online forum.
  • Reaching out to family and friends for support.

References:

https://www.niams.nih.gov/health-topics/vitiligo/advanced#tab-living-with

https://www.mayoclinic.org/diseases-conditions/vitiligo/diagnosis-treatment/drc-20355916

https://www.aad.org/public/diseases/a-z/vitiligo-treatment

https://www.webmd.com/skin-problems-and-treatments/guide/vitiligo-common-cause-loss-skin-pigment#1

By,

Gopala Krishna Varshith,

Content Developer & Editor,

Clipo.

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