Vitiligo

Vitiligo

Vitiligo is characterized by the growing patches of colorless skin. The extent and rate of color loss in vitiligo have no predictable pattern and can affect the skin on any part of the body including hair and oral cavity.

It has affected 0.5 -1% of people worldwide.

Symptoms

The common symptom of vitiligo is the sudden formation of colorless/white patches on the skin of any body part. After the appearance of a patch, it will stay for a while and start growing. However, once pigment gets disappears it rarely gets developed again.

Patches commonly appear on body folds, body openings, eyelashes, hair, around moles and on the previously damaged skin, inside oral cavity and nostrils.

Pathogenesis

It is a multifactorial polygenic disorder that involves both genetic and non-genetic factors. Various theories for the pathogenesis of vitiligo have been proposed, however, due to the complex pathogenesis, the exact pathophysiology is still unknown. 

As per the various theories, the destruction of melanocytes occurs due to the autoimmune mechanisms, cytotoxic mechanisms, intrinsic melanocyte defects, oxidant-antioxidant mechanisms, and neural mechanisms.

Comorbidities or associated conditions:

· Sunburn and skin cancer

· Eye problems, such as inflammation of the iris (iritis)

· Hearing loss

Spread of disease

There is no correlation between the stability of pigment lost patch and its spread. In some patients, patches do not spread. While in other people, the white patches often spread to other areas of the body slowly over many years or quickly. Some people observe increased white patches after physical or emotional stress. 

Diagnosis

Vitiligo patches are visible to eyes and doctors can make diagnoses by looking at the skin and checking the family history of vitiligo. The doctor can also use a wood’s lamp, which shines ultraviolet (UV) light onto the skin to differentiate the patch from normal skin. The doctor may take a small sample (biopsy) of the affected skin for examination, prescribe some blood tests and perform eye examination to differentiate from other medical conditions.

Treatment options

Therapy for vitiligo is aimed at restoring the color of white patches and make them look like normal skin. However, all the treatment options do not work for everybody and some of them show adverse effects.

Hence, it is important to note that patients with lighter skin do not require treatment. However, they need to use sunscreens to ensure the tanning of surrounding normal skin won’t occur and the patches will not get distinguished.

The choice of treatment mainly depends on the number and spread of patches, and personal preference of treatment.

Vitiligo Treatments

The current treatment options for vitiligo are enlisted below:

1. Medical treatment:

  • Topical Medicines 
  • Oral Medicines 
  • Combination of medicines plus ultraviolet A (UVA) light (PUVA)
  • Removing the color from surrounding normal skin to match the white patches.

2. Surgical treatment:

  • Use of skin grafts from a person's tissues from other areas
  • Sometimes, tattooing for small areas of skin is done

Other treatments include applying sunscreens, cosmetics to cover the white patches, and counselling and support.

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What Causes Vitiligo?

The color of hair and skin is determined by melanin. In vitiligo, melanocytes die or stop functioning. It is an autoimmune disorder in which immune system attacks on melanocytes. However, the exact reason for the pathogenesis is unknown.

It affects people of all skin types and races but occurs more prominently with dark skin people. It affects people of all ages but more common in 10-30 years and equally affects both genders. Although it is not a life-threatening or contagious disease, it may be stressful due to growing colorless patches that are aesthetically bad.

Other causes of vitiligo:

It runs in family history (heredity). If parents have vitiligo their children are more likely to have it. One in five people affected by vitiligo has their close relative affected by it. · People with other autoimmune diseases are more prone to vitiligo than people without any autoimmune disease. · Events of sunburn, stress or exposure to industrial chemicals may prove as a trigger.

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