Vitiligo

Vitiligo

Vitiligo is a skin condition resulting from loss of pigment which produces white patches. Any part of the body may be affected. Usually both sides of the body are affected. Common areas of involvement are the face, lips, hands, arms, legs, and genital areas.

Who Gets Vitiligo?

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. It may 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 thyroid disease.

What Determines Skin Colour?

Melanin, the pigment that determines colour 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.

How Does Vitiligo Develop?

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 colour. Although their skin is all one colour, 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.

How is Vitiligo Treated?

Sometimes the best treatment for vitiligo is no treatment at all. In fair-skinned individuals, 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 to skin cancer. They should wear a sunscreen with a SPF of at least 30 should be used on all areas of vitiligo not covered by clothing. 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 colours are available. Stains that dye the skin can be used to colour the white patches to more closely match normal skin colour. These stains gradually wear off. Self-tanning compounds contain a chemical called dihydroxyacetone that does not need melanocytes to make the skin a tan colour. The colour from self-tanning creams also slowly wears off. None of these change the disease, but they can improve appearance. Micropigmentation tattooing 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 permanent cures.

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 age 12, and then the risks and benefits of this treatment must be carefully weighed.

Repigmentation Therapy

Topical Corticosteroids - Creams containing corticosteroid compounds can be effective in returning piffrt'lent to small areas of vitiligo. These can be used along with other treatments. These agents can thil'1 the skin or even cause stretch marks in certain areas. They should be used under your dermatologist's care.

The above article was compiled by Dr. Dagmar Whitaker – www.capetowndermatologists.co.za