Vitiligo is a condition that causes white patches of skin due to a loss of pigment in the cells and tissues of the body.
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Melanocytes (MEL-a-no-sites) are special skin cells that make the pigment* that colors the skin, hair, eyes, and body linings. If these cells die or cannot make pigment, the affected skin gets lighter or completely white, causing vitiligo (vit-i-LY-go). The hair in affected areas also may turn white, and people with dark skin may notice a loss of color inside their mouths. No one knows for sure what makes melanocytes die or stop working in vitiligo.
- * pigment
- (PIG-ment) is a substance that imparts color to another substance.
Vitiligo affects people of all races and both sexes equally. It affects one or two out of every 100 people. About half of all people who have vitiligo begin to lose pigment before they are 20 years old.
Vitiligo is common in people with certain immune system diseases and in children with parents who have the condition. However, most people with vitiligo have no immune system disease, and most children will not get vitiligo even if a parent has it. In fact, most people with vitiligo are in good general health and do not have a family history of the condition.
Vitiligo is more obvious in people with dark skin. Light-skinned people may notice the contrast between patches of vitiligo and areas of suntanned skin in the summer. The amount of pigment that is lost varies from person to person. The first white patches often occur on the hands, feet, arms, face, or lips. Other common areas for patches to appear are the armpits, the groin (the area where the inner thighs join the trunk), and around the navel (belly button) and genitals.
There is no way to know if vitiligo will spread to other parts of the body, but it usually does spread over time. For some people, this spread occurs rapidly, but for other people, it takes place over many years. Both sides of the body usually are affected in a similar way. There may be a few patches or there may be many.
To diagnose vitiligo, the doctor may ask about such things as a persons symptoms, whether or not the person has an immune system disorder, and whether or not vitiligo runs in the person’s family. The doctor also may suggest various tests to rule out other medical problems that can cause light skin patches.
Vitiligo does not always need treatment. For some people with light skin, simply avoiding a suntan on areas of normal skin is enough to make the patches of vitiligo almost unnoticeable. Other people use makeup, skin dyes, or self-tanning products to cover up the vitiligo. Self-tanning products are creams that give the skin a tan color, but not a true tan. The color tends to wear off after a few days. None of these things changes the condition, but they can make the vitiligo less noticeable. In children, vitiligo usually is just covered up.
In adults, if covering up the vitiligo is not enough, a medical treatment may be tried, although results often cannot be seen for 6 to 18 months. The choice of treatment depends on the person’s wishes, how many white patches the person has, and how widespread the patches are. Not every treatment works for every person. There are several choices:
- Corticosteroid (kor-ti-ko-STEER-oid) creams can be applied to the skin and sometimes can return color to small areas of vitiligo.
- PUVA, which stands for psoralen (SOR-a-len) and ultraviolet A therapy. Ultraviolet A is the part of sunlight that can cause the skin to tan, and psoralens are substances that react with ultraviolet light to darken the skin. This medication is taken by mouth or applied to the skin, and then the light patches of skin are exposed to ultraviolet A light from a special lamp.
- Skin grafting is an operation that involves moving skin from normal areas to white patches. It is useful only for a small number of people with vitiligo.
- Depigmentation therapy involves using medication to fade the normal skin to match the whitened areas of vitiligo.
The white patches of vitiligo have no natural protection from the sun and are very easily sunburned. People with vitiligo should be careful to avoid exposure to midday sun, to cover up with clothing and a hat, and to use a sunscreen with a high SPF (sun protection factor) rating.
American Academy of Dermatology, 930 North Meacham Road, Schaumburg, IL 60173. The American Academy of Dermatology publishes a pamphlet called Vitiligo and posts a fact sheet about it at its website. Telephone 888-462-DERM http://www.aad.org/aadpamphrework/Vitiligo.html
The U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases posts a fact sheet called Questions and Answers About Vitiligo at its website. To order a pamphlet, contact the NIAMS Information Clearinghouse, 1 AMS Circle, Bethesda, MD 20892-3675. Telephone 301-495-4484 http://www.nih.gov/niams/healthinfo/vitiligo.htm
National Vitiligo Foundation, Inc., P.O. Box 6337, Tyler, TX 75703. This is a national group for people with vitiligo. Telephone 903-531-0074 http://nvfi.org
Vitiligo is a condition in which a loss of cells that give color to the skin (melanocytes) results in smooth, white patches in the midst of normally pigmented skin.
Vitiligo is a common, often inherited disorder characterized by areas of well-defined, milky white skin. People with vitiligo may have eye abnormalities and also have a higher incidence of thyroid disease, diabetes mellitus, and pernicious anemia. Vitiligo affects about 1-2% of the world's population. It is more easily observed in sun-exposed areas of the body and in darker skin types, but it affects any area of the body and all races. Vitiligo seems to affect men and women equally, although women more frequently seek treatment for the disorder.
Vitiligo may appear as one or two well-defined white patches or it may appear over large portions of the body. Typical sites for generalized vitiligo are areas surrounding body openings, bony areas, fingers, and toes. It can begin at any age but about 50% of the time it starts before the age of 20.
Causes and symptoms
Vitiligo is a disorder with complex causes. People with vitiligo seem to inherit a genetic predisposition for the disorder, and the appearance of disorder can be brought on by a variety of precipitating causes. Many people report that their vitiligo first appeared following a traumatic or stressful event, such as an accident, job loss, death of a family member, severe sunburn, or serious illness. There are at least three theories about the underlying mechanism of vitiligo. One theory says nerve endings in the skin release a chemical that is toxic to the melanocytes. A second theory states that the melanocytes simply self-destruct. The third explanation is that vitiligo is a type of autoimmune disease in which the immune system targets the body's own cells and tissues.
The primary symptom of vitiligo is the loss of skin color. Hair growing from the affected skin areas also lacks color. In addition, people with vitiligo may have pigment abnormalities of the retina or iris of the eyes. A minority of patients also may have inflammation of the retina or iris, but vision is not usually impaired.
The diagnosis of vitiligo is usually made by observation. Progressive, white areas found at typical sites point to a diagnosis of vitiligo. If the diagnosis is not certain, the doctor will test for other conditions which can mimic vitiligo, such as chemical leukoderma or systemic lupus erythematosus. If the tests rule out other conditions, vitiligo is confirmed.
Autoimmune disease— A condition in which something triggers the immune system to react against and attack the body's own tissues.
Autologous transplantation— A procedure wherein the person donates blood or tissue to themselves.
Iris— The colored part of the eye.
Pernicious anemia— A disease in which red blood cells are abnormally formed due to the body's inability to absorb vitamin B12.
Retina— The innermost layer of the eye, it contains the rods and cones, specialized light-sensitive cells.
Vitiligo cannot be cured, but it can be managed. Cosmetics can be used to improve the appearance of the white areas not covered by clothing. Sunscreens prevent burning of the affected areas and also prevent the normal skin around the patches from becoming darker. Skin creams and oral medications are available for severe cases, but they have side effects that may make them undesirable. Autologous transplantation of skin is an option for those who are severely affected. Bleaching or depigmentation of the normal skin is another option.
In addition to treating the skin, attention should be paid to the psychological well-being of the individual. Extreme cases of vitiligo can be unattractive and may affect a person's outlook and social interactions.
The condition is usually gradually progressive. Sometimes the patches grow rapidly over a short period, and then the condition remains stable for many years.
No measures are currently known to prevent vitiligo.
Frontier's International Vitiligo Foundation. 4 Rozina Court, Owings Mills, MD 21117. (301) 594-0958.
National Foundation for Vitiligo and Pigment Disorders. 9032 South Normandy Drive, Centerville, OH 45459. (513) 885-5739.
National Vitiligo Foundation. P.O. Box 6337, Tyler, TX 75703. (903) 531-9767. 〈[email protected]〉.