Vitiligo: Pictures, Causes, Symptoms, Diagnosis & Treatment

What is Vitiligo?

Vitiligo is a long term illness that affects the skin appearing in white patches with distinct borders on the skin. The hair that is growing within the area of the white spots also becomes white. Melanocytes are skin cells that produce the pigment melanin giving color to the skin and protecting it against harmful ultraviolet rays of the sun. When these melanocytes die, patches of the skin become discolored due to lack of melanin.

Image Source: Wikimedia

Areas Affected Due to Vitiligo

Although it commonly affects the skin, vitiligo may also act on the mucous lining of the mouth and nose. It may manifest itself in different degrees for various individuals, i.e., the patches may appear all over the body or may remain restricted to a particular area. The disease is neither life threatening nor contagious. However, people suffering from such a condition often deal with stigmatization which may affect them psychologically.

Vitiligo Causes

Autoimmune disorder: In this condition, the white blood cells which form the defense mechanism of the body attack healthy cells. They destroy these healthy cells by mistaking them to be foreign bodies and eventually kill them in an attempt to protect the body from diseases. In this case, the melanocytes are destroyed by the white blood cells leading to vitiligo.
Stress: Stress affects the immune system of the individual that results in the removal of the pigments from the skin. Damage of the nervous system leads to the skin receiving abnormal impulses and destruction of the skin cells. Both physical, as well as psychological stress is capable of increasing the risk of spreading vitiligo.
Viral cause: Melanin can be affected due to the skin being infected by a virus. These micro organisms feed on the melanocytes and obtain nourishment from them. It reduces the growth of melanin cells by killing them and resulting in vitiligo.
Chemical exposure: The skin can tolerate the effects of allergens and chemicals to an extent, after which the chemicals may affect the skin adversely. Corrosive chemicals are dangerous while others such as 4 – tertiary butyl phenol and 4 – tertiary butyl catechol cause minor effects like vitiligo.
Sunburn: The melanocytes may be damaged due to prolonged exposure to strong sunlight. Once the cells are dead melanin cannot be produced to provide color to the skin. It results in discoloring of the skin.
Cuts: Once the cuts have healed, it is often observed that the scar is of a lighter shade. This happens because the cuts allow micro organisms to infect the area causing vitiligo.
Hereditary: Many illnesses are passed on from one generation to the other via genes. Vitiligo is one of those illnesses that can occur due to the genetic content in an individual’s body.

Vitiligo Symptoms

Patchy loss of skin color
Loss of color in the tissues of the mucous lining present in the nose & mouth
Loss of color or change in color of the inner layer of the eye
Graying or premature whitening of hair eyelashes, eyebrows, beard or hair on the scalp
Discoloration appears first in areas that are exposed to the sun, such as arms, face, hands, feet, etc.
Flat white spots appear that are paler than the rest of the skin
Edges can become inflamed
Patches are completely irregular
Slight redness & itchiness
Discomfort
Soreness
Dryness in skin
Photosensitivity
Initially patches are symmetrical

Types of Vitiligo

Vitiligo can be differentiated into non segmental vitiligo and segmental vitiligo.

Segmental Vitiligo is more constant and stable as compared to non segmental vitiligo even though it spreads more rapidly. However, it is a type that occurs in lesser number of people affected by vitiligo and commonly appears in lower age groups. It usually affects the skin connected to the nerves arising in the dorsal roots of the spine. It responds well to topical treatment and is less erratic in nature.
Non-segmental Vitiligo is quite common affecting almost 90% of the people suffering from vitiligo. In this case, the patches are somewhat symmetrical as they appear on both sides of the body. It affects areas that are commonly exposed to the sun such as arms, eyes, back of the hands, elbows, mouth, knees, feet, etc.

It can be sub – categorized into the following:

Acrofacial Vitiligo: Affects the fingers and toes
Universal Vitilig: Very rare, the body is covered with depigmentation
Focal Vitiligo: Scattered white patches, commonly occurs in children in discreet areas
Generalized Vitiligo: Patches do not have a specific size or area
Mucosal Vitiligo: Mucous membranes and lips are observed to lose color

Tests & Diagnosis

Physical examination of the skin
Enquiry about the medical history of the individual
Checking to know whether other members of the family have suffered from skin conditions owing to genetic traits
Checking for autoimmune diseases
Tests to rule out other skin problems such as sunburns or rashes that may have caused white patches to appear
Checking for stress or physical illness
Biopsy

Complications

Vitiligo is not considered to be a contagious or a life threatening disease. However, people suffering from it are more susceptible to Addison’s disease, type 1 diabetes, pernicious anemia, Hashimoto’s thyroiditis and other thyroid problems under autoimmune diseases. People may also undergo depression due to the social stigma attached to its physical manifestation on the body. It also puts the individual at the risk of inflammation of the iris, loss of hearing and skin cancer.

Vitiligo Treatment

Phototherapy by UVA light: It includes increasing the skin’s sensitivity to ultraviolet light by intake of a drug. The skin is then exposed to high doses of UVA light as part of the treatment. The patient is given the treatment for sessions that are held twice a week for a period of 6 to 12 months.
Depigmenting: Strong topical ointments and lotions such as monobenzone, hydroquinone and mequinol are used for depigmentation. It is a procedure that is used in cases where more than 50% of the skin has been affected. The medication is used to reduce the color of the skin in areas which have not been affected in order to match the white spots. Time taken usually ranges from 12 to 14 months depending on the depth of the original skin tone. Exposure to sun for a long time must be avoided as it is a permanent treatment.
Phototherapy with UVB light: It is one of the simplest treatments for vitiligo. The skin is exposed to UVB lamps and is most effective if the lamps are used on a daily basis. Home treatment is encouraged unless the large areas of the body have been affected, in which case the patient needs to be treated at a hospital with 2 to 3 visit a week. However, this treatment is not very dependable.
Calcipotriene: It is a topical ointment in the form of Vitamin D. It needs to be used along with light treatments or corticosteroids. It may also cause itching, rashes and dry skin as its side effects.
Surgery: Skin grafting is a surgical procedure through which patches of healthy skin are removed and placed on the affected area to cover them. It is uncommon because if causes scarring two areas and is time consuming. Another surgical treatment is blistering where suction is used to produce blisters on normal skin. The top of the blister is then removed and placed on the affected patches lowering the risk of scarring.
Drugs that Affect the Immune System: Small patches on the skin can be treated by the use of calcineurin inhibitors present in ointments containing tacrolimus or pimecrolimus. However, these substances are also associated with lymphoma and skin cancer.
Skin Camouflage: In case the vitiligo is mild in its effect, it can be covered using cosmetics, colored creams, etc. Waterproof items must be used. Certain products can last for 12 – 18 hours on the face and up to 96 hours on other parts of the body. Tones that match the skin features must be selected for this purpose.
Psoralen: This drug is used to make the skin more susceptible to UV light. It can be used along with UVA or UVB light therapy. Normal coloration may return as the skin heals and the treatment has to be done twice or thrice a week for a period of 6 to 12 months. However, its increased usage also puts the person at a risk of skin damage, sunburn, skin cancer, etc. at a later point of time.
Topical corticosteroids: Creams and ointments containing steroids can be applied on the white patches to limit the spread of the patches. Restoration of original skin color has also been reported in some cases. However, they must not be used on the face. It is also advisable to stop using these products if they do not yield results or cause side effects.
Tattooing: Unusual but a kind of treatment where the pigment can be implanted in the affected region by the use of surgical instruments. It works well in people with darker skin color and around the lips. The drawbacks of this procedure include the fact that tattoos fade instead of getting tanned like normal skin and they are also capable of causing skin problems and triggering another patch or vitiligo.