Vitiligo is a pigmentary disorder which is characterised by depigmented or hypopigmented patches. It occurs when melanocytes (cells responsible for normal pigmentation of the skin) either die or are unable to function leading to absence or reduction in its numbers.
Cause
The cause of vitiligo is unknown but research has shown that it may arise from autoimmune, genetic (hereditary), oxidative stress, neural or viral cause. It might be associated with other autoimmune diseases. About 25% of patients have a history of vitiligo in the family (hereditary).
Most accepted theory for vitiligo is the autoimmune hypothesis. In this, there is T cell-mediated damage to melanocytes which leads to hypopigmentation.
Symptoms
About 1-2% of the general population has vitiligo. It begins in 2nd to 4th decade of life and is less common in children or elderly. Both sexes are equally affected.
Most common symptoms of vitiligo hypopigmented patches on different parts of the body. Patches are initially small but they may enlarge to form large patches. Skin lesions are most prominent on the face, hands and wrists. Depigmentation is particularly noticeable around body orifices, such as the mouth , eyes, nostrils, genitalia and umbilicus. Some lesions show hyperpigmentation around the edges. Affected skin may also show little erythema on sun exposed area due to increased sensitivity to sun-rays as a result of decreased melanin in the affected skin. It also turns hair white.
Patients who are stigmatised for their condition may experience depression or other similar mood disorders.
Types
Depending on extent of involvement, vitiligo can be classified into:
- Segmental (unilateral) vitiligo – This type only occurs in one segment of the body like a leg, face or arm. It often begins at an early age, progress or a year or so then stops.
- Non-segmental vitiligo – Also known as bilateral vitiligo, vitiligo vulgaris, and generalized vitiligo. This is the most common type of vitiligo. It appears on both side of the body, begins and expands rapidly and covers, expands and grows to a larger area.
Subtypes of vitiligo are:
- Localised
- Generalized
- Universal
Diagnosis
Vitiligo is diagnosed based on its clinical features and typical appearance of the patches (lesions).
Conditions which have similar presentation as vitiligo (differential diagnosis) is as follows:
- Leucoderma
- Pityriasis alba
- Tuberculoid leprosy
- Post-inflammatory hypopigmentation
- Tinea Versicolor
- Albinism
- Piebaldism
- Idiopathic guttate hypomelanosis
- Progressive macular hypomelanosis
- Primary adrenal insufficiency
Treatment
Vitiligo is a non-infectious disease and treatment is mainly directed at the cosmetic appearance of the disease. There is no treatment for complete repigmentation of skin. Treatment modalities for vitiligo are as follows:
- Topical steroids
- Phototherapy (Topical PUVA or UVB)
- Systemic steroids
- Dermato-Surgical techniques like mini punch grafting, shave grafting and suction blister grafting or tattooing.
- Immunomodulators like Tacrolimus
- Skin camouflage with cosmetic camouflage solutions
- Melanocyte transplantation
Localised and unstable vitiligo of short duration may respond to a potent topical steroid. Topical PUVA therapy is effective once patches have become stable. NHS has suggested using phototherapy only when primary treatments are ineffective as it has a higher risk of progressing into skin cancer.
Rapidly progressing, unstable and widespread vitiligo may be arrested by administration of systemic steroids.
Using UVB light from UVB lamps is the most common treatment for vitiligo. Treatment can be done at home or in the clinic. Adding psoralen, photosensitizer or an immunomodulator can increase the effectiveness of UVB treatment. UVA can also be used in combination with or without psoralen. But UVB is used more commonly as it is less damaging to the skin.
Notable cases
Michael Jackson had announced publicly that he had vitiligo universalis. Other cases include Jon Hamm, UFC fighter Scott Jorgensen and model Chantelle Brown-Young.
