This condition can also affect mucous membranes and the retina of the eye. The hair that grows in areas affected by vitiligo may also turn white.
The reason for the loss of pigment from various parts of the body is not well understood, although it may be an autoimmune disease. People with a family history of vitiligo are more likely to have the condition.
- pernicious anemia
- Addison's disease
Symptoms and Complications
Symptoms of vitiligo include the appearance of irregular white patches, or various degrees of depigmentation on the body. People often notice the loss of pigment on the following areas first:
The other areas where white patches due to vitiligo may occur are:
In addition to giving skin its colour, melanin also protects the skin from the sun. Lack of pigmentation in the skin leads to a greater risk of sun sensitivity in affected areas. Vitiligo increases the chance of sunburn and the development of skin cancer in people with the condition.
Vitiligo is not a contagious condition.
Making the Diagnosis
To determine the presence of vitiligo, your doctor will need to perform a physical examination. He or she may also ask about your general health and family history of vitiligo (to see if there is a genetic link). Other factors leading to the onset of vitiligo often include a rash, sunburn, or trauma (e.g., a scrape or wound) to the area where vitiligo is first noticed.
To get a better idea of which skin areas have been affected, your doctor will shine a Wood's lamp on the affected skin in a dark room. Ultraviolet (UV) light from the Wood's lamp causes the skin to appear different colours depending on the underlying condition of the skin. With vitiligo, there is no colour and so the skin appears very white, with no pigment. The Wood's lamp allows doctors to see areas affected by vitiligo that may appear normal under regular light.
To test for conditions or diseases associated with vitiligo, your doctor may take a blood sample to check:
- the blood cell count (related to pernicious anemia)
- the TSH function of the thyroid (related to hyperthyroidism)
- the number of antinuclear antibodies (ANA) to determine if you have an autoimmune disease (related to Addison's disease or other autoimmune diseases)
The doctor may need to do a biopsy of the affected areas and look at the cells under a microscope. In some cases, an examination of the eyes may be necessary.
Treatment and Prevention
Various types of treatment are available for vitiligo, although in many cases treatment is difficult. People with fair skin may need to avoid the sun to prevent tanning. If the pigmented skin is not tanned, the affected areas are less noticeable.
Two types of cream exist that contain compounds that help regain pigment in the skin. Creams containing corticosteroid compounds can help regain pigment in small white patches where vitiligo occurs, although they may damage the skin and must be carefully prescribed. Other creams containing immunomodulator compounds help regain pigment in the white patches.
For people with a greater contrast between the affected and unaffected areas, the following options exist to help disguise or treat vitiligo:
Waterproof makeup is available in many different colours to match many different skin colours. This is a good choice to effectively cover affected white patches and is safe for everyone, including children.
Stains may be useful to dye the skin a colour that more closely matches the unaffected areas. Certain self-tanning products contain dihydroxyacetone, which produces a tan and does not require the melanocytes in the skin to produce melanin. The tan fades over time and must be repeated. Micropigmentation tattooing is useful for small white patches associated with vitiligo. This method also adds colour to the white patch.
With grafting, doctors transplant skin to the affected area(s) from another part of the body. However, despite the transplant, pigment does not always return to the vitiligo-affected area.
Psoralen treatment, also called psoralen photochemotherapy (PUVA), uses a combination of a psoralen medication as well as exposure to UVA ultraviolet light. In this process, the person either takes psoralen orally (by mouth) or applies a cream containing psoralen to the skin before exposure to the ultraviolet light. Exposure to ultraviolet light causes a high sensitivity to light and increases the possibility of pigment returning to the affected areas. Many risks are associated with this type of treatment, due to the damaging effects of UVA light. Some of the side effects include:
- increased risk of skin cancer
- hyperpigmentation(dark spots on the skin)
If taking a psoralen medication orally, these additional side effects may occur:
- damage to eyes due to light sensitivity
- abnormal hair growth
A dermatologist must closely supervise this treatment. It is not recommended for children.
Narrow-band UVB phototherapy uses UVB light to stimulate repigmentation of the affected areas of skin. An excimer laser may also be used to treat vitiligo in limited areas.
Chemical or laser depigmentation is a treatment in which a person may choose to remove the pigmentation from the unaffected skin areas to better match the affected areas. This is used in cases where vitiligo is extensive. The person uses a cream containing monobenzyl ether of hydroquinone to remove the remaining pigment. This process takes a long time to complete, sometimes a year or more. Removal of pigment is permanent.
Repigmentation, a treatment that aims to restore pigment in affected areas, is another treatment option for people with vitiligo. Choices for repigmentation include:
- self-tanning products
- micropigmentation tattooing
- creams containing corticosteroid compounds
- creams containing immunomodulator compounds
- phototherapy (psoralen photochemotherapy and narrow-band UVB phototherapy)
There is no cure for vitiligo. No methods prevent vitiligo, but using sunscreens with a sun protection factor (SPF) of at least 30 to protect your skin from the sun is always a healthy decision.
Emotional support is another important part of vitiligo therapy. The skin changes caused by vitiligo can affect people emotionally and socially. Joining a support group or seeing a counsellor can help people cope with these effects.