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Vitiligo

Vitiligo

Definition

Vitiligo is a skin disorder characterized by the development of completely white patches of skin.

What is going on in the body?

Skin and hair color are determined by melanin, a pigment produced in cells known as melanocytes. When the melanocytes are damaged or die, they no longer produce melanin. The skin at that location thus becomes lighter in color.

Risks

What are the causes and risks of the disease?

Vitiligo occurs in all age ranges and all races. About half of the time, vitiligo develops before age 20.
No one knows the exact cause of vitiligo, but there are four reasonable possibilities:
  • Abnormal nerve cells produce toxic substances that damage melanocytes.
  • An autoimmune disorder causes the body to produce antibodies that attack and destroy the melanin pigment.
  • A genetic defect makes the melanocytes more susceptible to injury.
  • Melanocytes self-destruct.
Sunburn and stress may bring on vitiligo.

Prevention

What can be done to prevent the disease?

Many times, vitiligo cannot be prevented. Safety measures to avoid cuts and scrapes to the skin can be helpful. Sunscreen products can help prevent sunburns and may slow pigment loss. Stress management may lessen the impact of vitiligo.

Diagnosed

How is the disease diagnosed?

Diagnosis of vitiligo begins with a medical history and physical exam. A special exam with a Wood's light (black light) may reveal areas of skin without pigmentation. Blood tests, such as thyroid function tests, may also be ordered.

Long Term Effects

What are the long-term effects of the disease?

The pigment loss of vitiligo may continue and can be disfiguring. However, many people will go for years with stable pigment loss. Sometimes the pigment returns by itself. Treatment also can help pigmentation come back.

Other Risks

What are the risks to others?

Vitiligo is not contagious. Other family members may be at higher risk of developing vitiligo because of shared genetic factors. About one-fifth of persons with the condition have an affected family member.

Treatments

What are the treatments for the disease?

Many people, especially those with fair skin, choose conservative measures to treat vitiligo. These measures include the following:
  • applying skin dyes
  • avoiding tanning of normal skin around the vitiligo lesions, to lessen the contrast
  • covering skin lesions with makeup
  • using micropigmentation tattooing for small lesions
  • using self-tanning compounds containing dihydroxyacetone, which does not require melanocytes to cause a tan
Repigmentation treatment involves measures that return normal pigment to skin lesions.
These treatments include:
  • corticosteroid creams
  • PUVA, a combination of a medicine called psoralen and skin exposure to UVA, a type of ultraviolet light
  • narrowband UVB light therapy (may be from laser or intense pulsed light or filtered
  • UVB fluorescent lights)
  • immunomodulators, a potential new therapy
  • skin grafts of normal skin to depigmented skin lesions
Depigmentation treatment options may be used if the person has vitiligo over more than half of the body. A chemical called monobenzylether of hydroquinone is applied to normal skin areas. The goal is to change all skin areas to the same overall light color.

Side Effects

What are the side effects of the treatments?

PUVA or UVB therapy may produce skin burns and potentially increase risk of skin cancer as well as cataracts if eye protection is not used during treatment. Oral medicines can cause stomach upset and allergic reactions. Corticosteroid creams can cause skin thinning and stretch marks. Depigmentation is permanent and may cause severe sun sensitivity. Skin grafts can cause scarring and less than complete repigmentation.

After Treatment

What happens after treatment for the disease?

Recurrence or new sites of pigment loss are common. The individual may need lifelong treatment for vitiligo.

Monitor

How is the disease monitored?

Any new or worsening symptoms should be reported to the healthcare professional.

Sources

Professional Guide to Disease, SpringHouse, 1995

Vitiligo foundation at [hyperLink url="http://www.vitiligofoundation.org/" linkTitle="www.vitiligofoundation.org"]www.vitiligofoundation.org[/hyperLink]

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