Vitiligo CAUSES SYMPTOMS DIAGNOSIS TREATMENTS AND ALTERNATIVE MEDICINE

vitiligo

DEFINITION

Vitiligo  is a disease that causes the loss of skin color in blotches. The
extent and rate of color loss from vitiligo is unpredictable. It can affect the skin on
any part of body. It may also affect hair, the inside of the mouth and even the
eyes.
Normally, the color of hair, skin and eyes is determined by melanin. Vitiligo occurs
when the cells that produce melanin die or stop functioning.
Vitiligo affects people of all skin types, but it may be more noticeable in people with
darker skin. The condition is not life-threatening or contagious. It can be stressful or
make you feel bad about yourself. Treatment for vitiligo may improve the
appearance of the affected skin but does not cure the disease.

SYMPTOMS

The main sign of vitiligo is color (pigment) loss that produces light or white patches
on your skin. Usually, the discoloration first shows on sun-exposed areas, such as
the hands, feet, arms, face and lips.
Vitiligo signs include:
Skin discoloration Premature whitening or graying of the hair on your scalp,
eyelashes, eyebrows or beard (usually before age 35)Loss of color in the tissues
that line the inside of your mouth and nose (mucous membranes)Loss of or change
in color of the inner layer of the eyeball (retina)Discolored patches around the
armpits, navel, genitals and rectum
Vitiligo can start at any age, but most often appears before age 20.
Depending on the type of vitiligo you have, the discolored patches may cover:
Many parts of your body. With this most common type, called generalized vitiligo,
the discolored 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.
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. Rarely, the skin gets its color back.

CAUSES

Vitiligo occurs when melanin-forming cells (melanocytes) die or stop producing
melanin — the pigment that gives your skin, hair and eyes color. The involved
patches of skin become lighter or white. Doctors don't know why the cells fail or die.
It may be related to:
A disorder in which your immune system attacks and destroys the melanocytes in
the skin Family history (heredity)A trigger event, such as sunburn, stress or exposure
to industrial chemicals

COMPLICATIONS

People with vitiligo may be at increased risk of:
Social or psychological distress Sunburn and skin cancer Eye problems, such as
inflammation of the iris (iritis)Hearing loss Side effects due to treatment, such as dry
skin and itching

TESTS AND DIAGNOSIS

Medical history and exam
If your doctor suspects you have vitiligo, he or she will ask about your medical
history, examine you and try to rule out other medical problems, such
as dermatitis or psoriasis. He or she may use a special lamp to shine ultraviolet light
onto the skin to determine whether you have vitiligo.
Skin biopsy and blood draw
In addition to gathering your personal and family medical history and examining your
skin, your doctor may:
Take a small sample (biopsy) of the affected skin Draw blood for lab tests

TREATMENTS AND DRUGS

Many treatments are available to help restore skin color or even out skin tone.
Results vary and are unpredictable. Some treatments have serious side effects. So
your doctor may suggest that you first try improving the appearance of your skin by
applying self-tanning products or makeup.
If you and your doctor decide to treat your condition with a drug or other therapy, the
process may take many months to judge its effectiveness. And you may have to try
more than one approach before you find the treatment that works best for you.

Medications

No drug can stop the process of vitiligo — the loss of pigment cells (melanocytes).
But some drugs, used alone or with light therapy, can help improve your skin's
appearance.
Creams that control inflammation. A topical corticosteroid may help return color to
(repigment) your skin, particularly if you start using it early in the disease. You may
not see a change in your skin's color for several months.
This type of cream is effective and easy to use. But it can cause side effects, such
as skin thinning or the appearance of streaks or lines on your skin.
Milder forms of the drug may be prescribed for children and for people who have
large areas of discolored skin.
A form of vitamin D. Topical calcipotriene (Dovonex) is a cream that can be used
with corticosteroids or ultraviolet light. Possible side effects include dry skin, rash
and itching.Medications that affect the immune system. Ointments containing
tacrolimus or pimecrolimus (calcineurin inhibitors) may be effective for people with
small areas of depigmentation, especially on the face and neck. This treatment may
have fewer side effects than corticosteroids and can be used with ultraviolet B
(UVB) light. The Food and Drug Administration (FDA) has warned about a possible
link between these drugs and lymphoma and skin cancer.
Combined medication and light therapy. This treatment combines a drug called
psoralen with light therapy (photochemotherapy) to return color to the light patches.
After you take psoralen by mouth or apply it to the affected skin, you're exposed to
ultraviolet A (UVA) or UVB light. Because the drug makes your skin more sensitive
to the light, your skin turns pink. As the skin heals, a more normal skin color
appears. You may need to repeat treatments up to three times a week for six to 12
months.
Possible side effects include severe sunburn, blistering, itching, over darkening of
the skin, and an increased risk of cataracts and skin cancer. It may help if for one to
two days after each treatment you apply sunscreen, wear UV-protective sunglasses
and avoid direct sunlight. Oral psoralen with UVA radiation is not recommended for
children under 12.
Light therapy. This treatment uses narrow band UVB light. You may receive
treatment in a doctor's office up to three times a week. And unlike
photochemotherapy, it doesn't require psoralen, which simplifies the process. The
best results are achieved on the face, trunk and limbs.Laser therapy. This procedure
brings color back to patches of light skin by treating them with an excimer laser,
which uses a specific wavelength of UVB light. It can be used only on small areas,
and it's often used in combination with a drug applied to the skin. Side effects can
include redness and blistering.
Removing the remaining color (depigmentation). This therapy may be an option if
your vitiligo is widespread and other treatments haven't worked. A medication with
monobenzone is applied to unaffected areas of skin. This gradually lightens it so
that it blends with the discolored areas. The therapy is done twice a day for nine
months or longer. You'll need to avoid skin-to-skin contact with other people for at
least two hours after you've applied the drug, so you don't transfer it to them.
Side effects can include redness, swelling, itching and dry skin. Depigmentation is
permanent, and you'll always be extremely sensitive to sunlight.

Surgery

Surgery may be an option for you if light therapy and drugs don't work. Surgery can
also be used with those therapies. The goal of the following techniques is to even
out your skin tone by restoring color.
Skin grafting. In this procedure, your doctor removes very small sections of your
normal, pigmented skin and attaches them to areas that have lost pigment. This
procedure is sometimes used if you have small patches of vitiligo. Possible risks
include infection, scarring, a cobblestone appearance, spotty color and failure of the
area to recolor.Blister grafting. In this procedure, your doctor creates blisters on your
pigmented skin, usually with suction. He or she then removes the tops of the blisters
and transplants them to an area of discolored skin. Possible risks include scarring, a
cobblestone appearance and failure of the area to recolor. The risk of scarring is
less with this procedure than with other types of skin grafting.Tattooing
(micropigmentation). In this technique, your doctor uses a special surgical
instrument to implant pigment into your skin. It's most effective around the lips,
especially in people with darker skin. Drawbacks include difficulty matching the skin
color, the tendency of tattoos to fade and their inability to tan. Also, the skin damage
caused by tattooing may trigger another patch of vitiligo.

ALTERNATIVE MEDICINE

Limited studies show that the herb Ginkgo biloba may return skin color in people
with slow-spreading vitiligo. Other studies show that folic acid and vitamin B-12 plus
sunlight may restore skin color for some people.
As with any over-the-counter (nonprescription) treatment, check with your doctor
before trying alternative medicine therapies to be sure they won't interact badly with
other treatments you may be using.