Vitiligo: Causes, Symptoms and Treatments
vitiligo is a continual and long-term skin problem that produces patches of white depigmentation that develop and enlarge in certain sections of the skin.
The patches appear when melanocytes within the skin die off. Melanocytes are the cells responsible for producing the skin pigment – melanin – which gives skin its color and protects it from the sun’s UV rays.1
The total area of skin that can be affected by vitiligo varies greatly from individual to individual. Vitiligo can also affect the eyes, inside of mouth and hair. In the majority of cases, the affected areas remain discolored for the rest of the person’s life.
Contents of this article:
Fast facts on vitiligo
Here are some key points about vitiligo. More detail and supporting information is in the main article.
- Vitiligo can affect people of any age, race or gender
- Currently, there is no cure for vitiligo
- Vitiligo affects melanocytes that produce the pigment melanin
- The exact cause of vitiligo is not known, but some researchers believe it to be an autoimmune disorder
- Some scientists think that vitiligo might be caused by a virus
- You cannot catch vitiligo from another person
- Vitiligo is split into two categories: non-segmental and segmental vitiligo
- Exposure to UVA or UVB light can help some individuals with the condition
- If more than 50% of the skin is affected, depigmentation might be an option
Causes of vitiligo
Surprisingly, the causes of vitiligo are yet to be precisely established, but most of the research so far points to the following:
- An autoimmune disorder – the patient’s immune system becomes overactive and destroys the melanocytes2
- Genetic oxidative stress imbalance
- A stressful event
- Harm to the skin due to a critical sunburn or cut
- Exposure to some chemicals
- A neural cause
- Heredity – family link
- A viral cause.
Vitiligo is not transmittable; in other words, it is not contagious, people cannot catch it from each other.
Less than 1% of the population are affected by the appearance of vitiligo in their skin.3 It has no age, sex or ethnic discrimination, but studies have concluded that a larger percentage of cases seem to start around the age of 20.
Vitiligo signs and symptoms vary considerably from person to person. It is more pronounced in people with dark or tanned skin. Some may only acquire a handful of white dots that develop no further while others develop larger white patches that join together affecting larger areas of the skin.
Types of vitiligo
Scientists separate vitiligo into two types: non-segmental, and segmental vitiligo.
Non-segmental vitiligo is the most common type of vitiligo and occurs in up to 90% of people who have the disorder.
In non-segmental vitiligo, the patches often appear equally on both sides of the body, with some measure of symmetry. The symmetrical patches most commonly appear on skin that is exposed daily to the sun, such as the face, neck and hands, but can also appear in other areas:
- Backs of the hands
Non-segmental vitiligo is further broken down into sub-categories:
- Generalized vitiligo: no specific area or size of patches, this is the most common type
- Acrofacial vitiligo: mostly on the fingers or toes
- Mucosal vitiligo: depigmentation generally appears around the mucous membranes and lips
- Universal vitiligo: depigmentation covers most of the body, this is very rare
- Focal vitiligo: one, or a few, scattered white patches in a discrete area. Most often occurs in young children.
Segmental vitiligo has a different form; this condition spreads more rapidly but is considered more constant and stable than non-segmental. It is much less common and affects only about 10% of people with vitiligo.
Segmental vitiligo is more noticeable in early age groups, affecting about 30% of children diagnosed with vitiligo.
It is non-symmetrical and usually tends to affect areas of skin attached to nerves arising in the dorsal roots of the spine. It is more stable, less erratic and responds well to topical treatments.
Symptoms of vitiligo
The only symptom of vitiligo is the appearance of flat white spots or patches on the skin. Generally, the first white spot that becomes noticeable is on an area of the body that is exposed continuously to the sun.
Initially, the vitiligo starts as a simple spot, a little paler than the rest of the skin. But gradually, as time passes, this spot will become much paler until it becomes white.
The shape of these patches are completely irregular, and, at times, the edges can become a little inflamed with a slight red tone, sometimes resulting in itchiness. Other than the appearance of the spots and occasional itchiness, vitiligo does not cause any discomfort, irritation, soreness or dryness in the skin.
Vitiligo is photosensitive; patients should avoid exposing the skin to direct sunlight for a prolonged period.
Predicting whether vitiligo will spread, and by how much, is particularly difficult. The spread of white patches might occur in a matter of weeks for some, and for others, they might stabilize, not growing for months or even years.
If the first symptoms of the white patches are symmetrical (non-segmental vitiligo), the development is much slower than if the patches are in only one area of the body (segmental vitiligo).
Treatments for vitiligo
There are a number of remedies that can help decrease the visibility of vitiligo on the affected areas of the skin.
Phototherapy with UVB light
Exposing the affected skin to UVB lamps is a common treatment option. It is one of the simplest treatments and can easily be performed at home with a small lamp.
Home treatment is recommended because it is most effective when the patient uses the lamp daily. If these treatments are carried out in clinics, the patient needs to visit 2-3 times per week, which slows down recuperation time.
If the white spots are located across large areas of the body, UVB phototherapy will have to be performed in a hospital with a full body treatment. It is important to mention that even if evidence has suggested that UVB phototherapy, particularly when combined with other treatments, has a positive effect on vitiligo, it is still quite unpredictable and undependable.
There is still no real treatment that will totally re-pigment the skin to its full potential.
Phototherapy with UVA light
UVA treatment is most commonly conducted in a hospital clinic. Firstly, a drug is taken that increases the skin’s sensitivity to ultraviolet light. The affected skin undergoes a series of treatments, exposing it to high doses of UVA light.
To see any noticeable improvements, the patient will normally have several sessions. Progress will be evident after 6-12 month of twice-weekly sessions.
In many cases, when vitiligo is considered mild, some of the white patches can be camouflaged with cosmetic colored creams and makeup. The patient should select tones that best match their skin features.
If creams and makeup are correctly applied, they can last 12-18 hours on the face and up to 96 hours for the rest of the body. Most of the topical applications are waterproof.
When the affected area is widespread – covering 50% of the body or more – depigmentation can be an option. Depigmentation reduces the skin color in unaffected areas in order to match the whiter areas.
Depigmentation is achieved by the use of strong topical lotions or ointments, like monobenzone, mequinol or hydroquinone.
This treatment is permanent and can make the skin more fragile. Long exposure to the sun must be avoided. Depigmentation can take between 12-14 months depending on factors including the depth of the original skin tone.
Corticosteroid ointments are creams containing steroids. Some studies have concluded that applying topical corticosteroids to the white patches can stop the spread. In other cases, experts have reported total restoration of the original skin color. Corticosteroids should never be used on the face.
If, after one month of using any type of corticosteroid, the general practitioner sees that the vitiligo patches are not improving or that side effects are noticeable, treatment must stop.
On the other hand, if the condition has shown some improvement, the treatment should be paused for a couple of weeks before starting it again.
Calcipotriene is a form of vitamin D used as a topical ointment. It may be used in conjunction with corticosteroids or light treatment. Side effects can include rashes, dry skin and itching.
Drugs affecting the immune system
Ointments containing tacrolimus or pimecrolimus (calcineurin inhibitors) can help individuals with smaller patches of depigmentation. However, the US Food and Drug Administration (FDA) warns of a connection between these drugs and skin cancer and lymphoma.
Light therapy (UVA or UVB) can be combined with psoralen. This drug makes the skin more susceptible to UV light. As the skin heals, a more normal coloration sometimes returns. Treatment may need to be repeated two or three times a week for 6 to 12 months.
Psoralen increases the risk of sunburn and skin damage, therefore increasing the risk of skin cancer further down the line.
A skin graft is a surgical procedure which entails carefully removing healthy patches of pigmented skin and using them to cover affected areas. This procedure is not very common because it is time-consuming and can result in scarring in two places – the areas where the skin was taken and the area where it will be placed.
A procedure called blister grafting produces a lower risk of scarring. The procedure involves producing a blister on normal skin using suction. The top of the blister is then removed and placed on an area where pigment has been lost.
Using a surgical instrument, the pigment is implanted into the skin. It works best around the lips, especially in people with darker skin. Drawbacks can include difficulty matching the color of skin and the fact that tattoos fade but do not tan. Sometimes, skin damage caused by tattooing might spark the generation of another patch of vitiligo.
Possible vitiligo cure in the future
Recent research has thrown out some potentially useful medications for vitiligo.
Research into potential cures or treatments for vitiligo are ongoing. These are a handful of the most promising:
Researchers from the Institute for Pigmentary Disorders in association with E.M. Arndt University of Greifswald, Germany and the Centre for Skin Sciences, University of Bradford, UK, reported in The FASEB Journalin 2013 that they uncovered a new compound that may provide a cure for the loss of skin color associated with vitiligo.
The team discovered that those treated with a modified pseudocatalase (PC-KUS) recovered pigmentation in their skin, as well as their eyelashes. The compound also appeared to restore original hair color among people with gray hair.
Research has shown that low melanin levels in some vitiligo patients might be due to lower levels of α-melanocyte-stimulating hormone (alpha-MSH). Afamelanotide is a synthetic compound that mimics alpha-MSH.
In combination with UVB treatment afamelanotide seems to be effective.4
An arthritis drug – tofacitinib citrate – has shown some promise. It inhibits Janus kinase, an enzyme that seems to be implicated in the etiology of vitiligo.5
Complications linked to vitiligo
Although vitiligo does not develop into other diseases, people with the condition are more likely to have other autoimmune disorders, such as thyroid problems, Addison’s disease, Hashimoto’s thyroiditis,type 1 diabetes or pernicious anemia. The majority of vitiligo patients do not have these conditions, but a health care professional may recommend tests to rule them out.
If the vitiligo is noticeable by other people, embarrassment can lead to self-esteem problems, and in some cases depression.