Vitiligo

Vitiligo is a skin condition that causes the skin to lose its natural color in patches.  It can affect the skin on any part of the body.  It may also affect hair, the genitalia, the pigment of the eyes and even the mucous membranes of the mouth.  The exact cause of this skin condition is unknown and is considered autoimmune meaning that the body is attacking itself.  The color cells of the skin are called melanocytes and these are the cells that are attacked and destroyed thus causing the affected areas to lose all pigment, i.e. turn white.  It affects men and women of all races but is more easily noticed on people with darker skin. Heredity can play a part in some but not all cases of vitiligo.  Some lighter-skinned patients may not even realize they have vitiligo until the summer months when they see light/white areas appear as the unaffected skin tans and the areas of vitiligo do not.  Half of the patients notice vitiligo before they are 20 years old.  It often begins on the hands, feet or face and tends to be progressive over time.  It can also be seen in an area that had a minor injury or had been affected by sunburn.  Because it is considered an autoimmune disease, people who have this condition may in fact be prone to other autoimmune diseases like alopecia areata (a type of hair loss), thyroid disease, anemia, and diabetes.  

The diagnosis of this condition is usually straight forward but sometimes a biopsy is needed to confirm it.  The condition is not harmful to the body but can cause psychological stress especially if the condition is affecting the face or other parts of skin that cannot be easily covered by either clothing or makeup.  Darker ethnicities can be dramatically traumatized as this condition may change their face to appear as a different ethnicity – as in converting their skin to look like Caucasian skin.  

There is no known cure for vitiligo at this time but medical treatments are available and new treatments are currently being tested.  The goal is to restore the pigment by allowing the melanocytes to be welcomed back to the areas where they used to live and work therefore allowing the natural color to reappear.  Medical treatments must target the immune system to reverse the destruction of the pigment cells.  The new pigment cells are usually recruited from either the base of the hair follicles, the edge of the patch of vitiligo or from areas of pigment that may still be remaining in the patch of vitiligo itself (if it has not already depigmented totally).  If repigmentation does occur it usually is slow and gradual and can take months to years.  

Topical treatments are usually tried and can be successful in counteracting this condition.  Prescription medications like topical steroid creams and newer non-steroidal anti-inflammatory topicals are likely to be the first line of therapy used.  These are the safest and simplest and require twice a day application and can take 3-6 months to show benefit.  This is the most common approach when vitiligo is newly diagnosed or seems to be advancing.  With some of these medications, there needs to be a rest and then restart schedule in order to allow maximum benefit and minimum risk of side effects from overuse.  Your dermatologist can best recommend a regimen for you.  There are other treatments available that involve trying to expose the depigmented skin to UV light in order to wake up the affected areas.  One medication, given either orally or topically, specifically makes the skin more sun-sensitive.  Sometimes the exposure is given in a controlled situation like a light box  and done in the providers office with artificial UV light or outside using natural sunlight. Surgical treatment is also utilized in some cases where areas of pigment from one area of the skin is transplanted into an area of vitiligo hoping that the pigment cells that that donor site will not be rejected and will then successfully spread into the depigmented area and provide pigment back into that zone.  This treatment results in scarring though of the donor site and the pigment that returns in the white area may be small and splotchy.  Some lasers have been studied and used to help treat vitiligo as well.  Newer oral medications are being studied and will hopefully be found to be helpful and then become therapeutic options hopefully in the very near future!

There is also the option of camouflaging the affected areas with makeup or sunless tanner.  These products will temporarily improve the vitiligo by allowing the areas to be hidden as the product colors the areas and allows uniform color to be seen by others instead of the stark contrast that may normally be seen.  There are some products that are better than others and can be used even if the person is exposed to water and sweat without washing/wearing off easily.  A form of tattooing called microtattooing can be used but it is usually not recommended as it is very difficult to perfectly match the persons own natural pigment to the tattoo permanent pigment.

Sun protection is an absolute must for patients with vitiligo!  The areas of vitiligo have no pigment cells and therefore no defense mechanism from the sun meaning that they will quickly and easily sunburn if not protected.  Plus the white areas will be more apparent as the surrounding skin will tan/darken with sun exposure making the areas of vitiligo more obvious.  Sun protective clothing as well as UVA/UVB sunscreen applied daily and avoiding prolonged sun exposure is highly recommended to patients to help manage this condition.