Vitiligo is a skin condition that is the result of the loss of pigmentation which causes patches of white skin, and can affect any area of the body. Typically it affects both sides of the body. Common areas of involvement are the lips, face, arms, hands, genital areas, and legs.
WHO IS AT RISK
Vitiligo affects between one and two percent of the population. Approximately half the people who develop this skin condition do so before the age of 20, and 20 percent have a family member who also has the condition. It is believed to be an autoimmune process (the body makes antibodies to its own pigment cells). Most people with vitiligo are in good general health, although vitiligo may occur with other autoimmune diseases such as diabetes or thyroid disease.
HOW IS SKIN COLOR DETERMINED?
Melanin is the pigment that determines the color of the hair, eyes, and skin; it is produced in cells called melanocytes. If these cells are unable to form melanin or have died, the skin becomes lighter or completely white.
THE DEVELOPMENT OF VITILIGO
Classic vitiligo shows areas of milky-white skin. However, the degree of pigment loss can vary within each vitiligo patch. There can be a variety of shades of pigment with in a patch, or a ring of darker pigmentation may encircle an area of lighter skin.
Vitiligo often begins with a rapid loss of pigment. This can continue until, for unknown reasons, the process stops. Cycles of pigment loss, followed by times where the pigment doesn't change, may continue indefinitely.
It is rare for skin pigment in vitiligo patients to return on its own. Some people who believe they no longer have vitiligo actually have lost all their pigment and no longer have patches of contrasting skin color. Although their skin is all one color, they still have vitiligo.
The course and severity of pigment loss differ with each person. Light-skinned people usually notice the contrast between areas of vitiligo and suntanned skin in the summer. Year round, vitiligo is more obvious on people with darker skin. Individuals with severe cases can lose pigment all over the body. There is no way to predict how much pigment an individual will lose.
In some cases the best treatment for vitiligo may be no treatment at all. In fair-skinned patients, avoiding tanning of normal skin can make areas of vitiligo almost unnoticeable because the (no pigment) white skin of vitiligo has no natural protection from sun. These areas are easily sunburned, and people with vitiligo have an increased risk of skin cancer. They should wear a sunscreen with a SPF of at least 30 s on all areas of vitiligo not covered by clothing. Avoid the intense midday sun to avoid burns.
Disguising vitiligo with self-tanning compounds or make-up is a safe and easy way to make it less conspicuous. Waterproof cosmetics are available to match most skin tones. Self-tanning compounds contain a chemical called dihydroxyacetone that does not need melanocytes to make the skin a tan color. The color from self-tanning creams will wear off slowly. Although none of these change the disease, although they can improve appearance.
If cover-ups and sunscreens do not provide satisfactory results, your doctor may recommend other treatment options. Typically the goal of treatment is to return normal pigment (a process called repigmentation); unfortunately none of the repigmentation options provide a permanent cure.
TREATMENT OF VITILIGO IN CHILDREN Aggressive treatment is generally not used in children. Sunscreen and cover-up measures are usually the best treatments. Topical corticosteroids can also be used, but must be monitored. PUVA is usually not recommended until after the age of 12, and then the risks and benefits of this treatment must be carefully weighed. Narrow Band UVB may be especially useful in treating children with vitiligo.
Topical Corticosteroids – These creams containing the corticosteroid compound can be very effective in returning the pigmentation to small spots affected by vitiligo. These can be used in conjunction with other treatment options. These agents can cause the skin to thin or even cause stretch marks in some areas. They should be used under your dermatologist's care.
PUVA is a form of repigmentation therapy where a type of medication known as psoralen is used. This chemical makes the skin very sensitive to light. Then the skin is treated with a special type of ultraviolet light call UVA. When vitiligo is contained to a few small areas, psoralens may be applied to the areas prior to the UVA treatments. Normally, psoralens are given in the form of a pill. Treatment with PUVA has a 50 to 70 percent chance of returning pigment to the face, upper arms, trunk, and upper legs. The hands and feet do not respond well to this treatment. Typically at least a year of twice weekly treatments is required. PUVA must be given under close supervision by your dermatologist. Side effects of PUVA include a reaction similar to sunburn. When it is used long-term, the skin may freckle and there is an increased risk of skin cancer. Due to the fact psoralens will make the eyes more light sensitive, UVA blocking eyeglasses have to be worn from the time of exposure to psoralen until sunset to prevent the risk of cataracts. PUVA is not usually used in children under the age of 12, in pregnant or breast feeding women, or in patients with certain medical conditions.
Narrow Band UVB (NBUVB) - is a type of phototherapy which requires treating the skin two or three times each week over the course of a few months. It is increasingly popular since oral psoralen does not need to be taken.
OTHER TREATMENT OPTIONS
Other treatment options include topical immunomodulators such as Tacrolimus which are used in areas where skin thinning would be a concern (head, neck, genitals). Excimer laser, if available, is another option showing some promise.
IS VITILIGO CURABLE?
At this time, the exact cause of vitiligo is not known; however, there may be an inherited component. Although treatment is available, there is no single cure. Research is ongoing in vitiligo and it is hoped that new treatments will be developed.
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