Vitiligo, also called white spot disease or leukoderma, is a disease in which the skin loses its pigment due to the destruction of melanocytes.
Melanocytes are pigment cells located in the surface layer of the skin called the epidermis and are responsible for producing melanin. Melanin is a dark pigment that gives skin its color and protects against ultraviolet radiation. When melanocytes stop producing melanin, the skin becomes pale, leaving areas of white patches - this is called vitiligo.
Vitiligo can start at any age, but it often occurs between the ages of 20 and 30. Vitiligo may begin on the face above the eyes, or on the neck, armpits, groin, hands or knees. Vitiligo may appear as a few small pigmented patches or spread over the entire body. In many cases, initial pigment loss will occur, then, after several months, the number and size of the light areas become stable and may remain so for a long time. Episodes of pigment loss may appear again later.
Vitiligo is present in about 1 percent of the population.
The actual cause of vitiligo is unknown, however researchers believe that there are many factors and/or conditions listed below that contribute to the disease:
- Heredity (over 30 percent of affected persons have reported vitiligo in a parent, sibling, or child)
- Exposure to chemicals such as phenol (disinfectant) or catechol (used in dyeing or tanning)
- Emotional or physical stress
- Autoimmune disorder is which the body may be destroying its own melanocytes
- Autotoxic response is which the melanocytes self-destruct leaving a toxic residue, that, in turn destroys new melanocytes
- Skin injury
- Inflammatory skin disorders
- Associative disorders such as diabetes, pernicious anemia, hyper- and hypo-thyroidism, Addison's disease (adrenal insufficiency), uveitis (inflammation of the eyes) or alopecia areata (patches of hair loss).
The symptoms of vitiligo are:
- Chalk white patches of skin often located symmetrically on both sides of the body
- White hairs within depigmented patches
The medical history is important, but diagnosis can usually be made solely by observation of characteristic skin changes. For fair-skinned people, the doctor will use a special light, called a Wood's lamp, to shine on the skin in a dark room to identify the vitiliginous patches. In some cases, a skin biopsy may be required.
Depending on the severity of the condition, the treatment method may vary. Treatment methods include:
- Avoidance of tanning. For fair-skinned individuals, avoiding tanning of normal skin can make the areas of vitiligo almost unnoticeable.
- Use a sunscreen with an SPF of at least 30.
- Use a cosmetic cover-up solution. Make-up, self-tanning compounds with dihydroxyacetone, and dyes (such as Covermark, Walnut Stain, Vita Dye or Dermablend) help temporarily conceal the white patches of vitiligo.
- Repigmentation. The restoration of the normal pigment and can be achieved with repigmentation therapy or corticosteroids. To get repigmentation, new pigment cells must be produced from existing ones, such as ones found at the base of hair follicles, from the edge of the patch or from the patch itself if depigmentation is not complete.
In repigmentation therapy, a patient is given a psoralen drug (orally) and then is exposed to ultraviolet light A (UV-A) in the doctor's office. This therapy is called PUVA. When psoralen drugs are activated by UV-A, they stimulate repigmentation by increasing the availability of color-producing cells at the skin's surface. Psoralen is also available in a topical form that can be applied to the body for patients with small, scattered patches. Topical corticosteroids (such as Temovate or Psorcon) are prescribed for patients with small patches of vitiligo.
- Depigmentation is the destruction of the remaining melanocytes. Patients with vitiligo over half of their exposed body may want to consider using this method. A bleaching chemical called monobenzylether of hydroquinone (Benzoquin) is applied to normally pigmented skin. Treatment may take up to one year.
Is vitiligo contagious?
Could there be an underlying condition causing this?
Will this reoccur?
What treatment method do you recommend?
New techniques of using epidermal autografts and cultured epidermis combined with PUVA therapy offer the possibility of surgical correction with low risk of scarring.