Vitiligo

What is vitiligo?

Vitiligo is a skin condition of white patches resulting from loss of pigment. Any part of the body may be affected. Usually both sides of the body are similarly affected by a few to many milky-white patches. Common areas of involvement are the face, lips, hands, arms, legs and genital areas.

Vitiligo affects one or two of every 100 people. About half the people who develop it do so before the age of 20; about one fifth have a family member with this condition. Most people with vitiligo are in good general health.

What causes vitiligo?

Melanin, the pigment that determines color of skin, hair, and eyes, is produced in cells called melanocytes. If these cells die or cannot form melanin, the skin becomes lighter or completely white. Vitiligo is the result of the disappearance of the skin’s melanocytes. No one knows why this happens for sure.

How Does Vitiligo Develop?

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 virtually everywhere. There is no way to predict how much pigment an individual will lose.

Typical vitiligo shows areas of milky-white skin. However, the degree of pigment loss can vary within each vitiligo patch. There may be different shades of pigment in a patch or a border of darker skin may circle an area of light skin.

Vitiligo often begins with a rapid loss of pigment. This may 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. While their skin is all one color, they still have vitiligo.

How is Vitiligo Treated?

In fair-skinned individuals, avoiding tanning of normal skin can make areas of vitiligo almost unnoticeable.

  • The white skin of vitiligo has no natural protection from sun. These areas are very easily sunburned. A sunscreen with a SPF of at least 30 should be used on all areas of vitiligo not covered by clothing.
  • Some recommendations include Ombrelle ® SPF 30 and SPF 60, GlyDerm ® Super Sunblock SPF25, and Neutrogena ® UVA/UVB Sunblock SPF30 and 45. Avoid the sun when it is most intense to avoid burns.
  • Disguising vitiligo with make-up, self-tanning compounds or dyes is a safe, easy way to make it less noticeable. Waterproof cosmetics to match almost all skin colors are available at many large department stores. Stains that dye the skin can be used to dye the white patches to more closely match normal skin color. These stains gradually wear off. 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 also slowly wears off. None of these change the disease, but they can improve appearance.
  • Micropigmentation tatooing of small areas may be helpful.
  • If sunscreens and cover-ups are not satisfactory, your doctor may recommend other treatment. Treatment can be aimed at returning normal pigment (repigmentation) or destroying remaining pigment (depigmentation). None of the repigmentation methods are total, permanent cures.

Topical Corticosteroids

Creams containing corticosteroid compounds can be effective in returning pigment to small areas of vitiligo. These can be used along with other treatments. These agents can thin the skin or even cause stretch marks in certain areas. They should be used under your dermatologist’s care.

Narrow Bank UVB (NBUVB) is a form of repigmentation light therapy where prescribed , controlled doses of ultraviolet B light is given to the patient. Treatment with NBUVB has a 50-70% chance of returning color on the face, trunk, and upper arms and upper legs. Hands and feet respond very poorly. Usually at least a year of twice weekly treatments are required. NBUVB must be given under very close supervision by your dermatologist. Side effects of NBUVB include sunburn-type reactions.

Grafting

Transfer of skin from normal to white areas is a treatment available only in certain areas of the country and is useful for only a small group of vitiligo patients. It does not generally result in total return of pigment in treated areas.

Depigmentation Therapy

For some patients with severe involvement, the most practical treatment for vitiligo is to remove remaining pigment from normal skin and make the whole body an even white color. This is done with a chemical called monobenzylether of hydroquinone. This therapy takes about a year to complete. The pigment removal is permanent.

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. NBUVB can also be used.

Is Vitiligo Curable?

Research is ongoing in vitiligo and it is hoped that new treatments will be developed. At this time, the exact cause of vitiligo is not known and although treatment is available, there is no single cure.