Vitiligo

Vitiligo is a skin condition characterized by the loss of natural skin pigment in patches, resulting in areas that appear white. It affects up to 2% of the global population and can manifest on any part of the body, including the genitals and mouth. Sometimes, hair in the depigmented areas may also lose its color. The extent of skin affected by vitiligo can vary, with some individuals developing only a few small patches, while others experience widespread skin changes. Although vitiligo is not life-threatening, it can have significant psychological and emotional effects, such as reduced self-esteem and depression. There are, however, various treatment options available to effectively manage the condition.

Causes

Vitiligo is primarily considered an autoimmune disorder where the immune system mistakenly attacks melanocytes, the skin cells that produce melanin, leading to white patches. While the condition can emerge at any age, it commonly begins before age 20, with children between 5 and 10 years old being particularly vulnerable. Vitiligo affects both genders, though women tend to develop it at a younger age than men.

Genetic predisposition plays a role in vitiligo, as having a first-degree relative with the condition increases your risk to about 6%. However, genetics alone are not decisive, as identical twins show only a 20% concordance if one has vitiligo. Various environmental factors, such as chemical exposure (e.g., Phenol in paints and adhesives) and stressful events like pregnancy or severe psychological stress, can trigger vitiligo. Other autoimmune disorders, particularly thyroid diseases, and conditions like alopecia areata, increase the risk of vitiligo.

Symptoms

Vitiligo primarily manifests as patches of white skin that can develop anywhere on the body, varying greatly in size and quantity from person to person. Typically, these skin changes occur without physical discomfort.

There are common patterns of vitiligo distribution:

• Generalized Vitiligo: The most prevalent form, with numerous patches scattered across different parts of the body, often starting on hands, feet, or around the eyes or mouth.

• Localized Vitiligo: Involves one or two patches that generally do not expand.

• Universal Vitiligo: A rare form affecting the majority of the skin.

Other health issues associated with vitiligo include hearing loss (affecting 10% to 40% of people), eye problems such as night blindness and sensitivity to light, increased susceptibility to sunburn, and psychological effects like low self-esteem, anxiety, and depression.

Diagnosis

Diagnosing vitiligo usually involves a physical examination of the skin by a healthcare provider, who may use a Wood's lamp, a black light, to highlight affected areas. As other conditions can mimic vitiligo's appearance, a skin biopsy might be necessary. This involves numbing the skin and taking a small tissue sample for lab analysis. Due to the association of vitiligo with other autoimmune disorders, your provider may inquire about any you or your family members have. As hearing loss can accompany vitiligo, you might also undergo a hearing test.

Treatments

When creams are insufficient for managing vitiligo, light therapy, or phototherapy, is often the next treatment option. Treatment plans are individualized based on the location and extent of vitiligo and its impact on the person.

Phototherapy uses specific light wavelengths to treat affected skin, usually administered in a provider’s office. Common forms include Narrowband Ultraviolet B (NBUVB), Psoralen and Ultraviolet A (PUVA), and the Excimer laser. Regular use of broad-spectrum sunscreen with an SPF of 30 or higher is essential to prevent sunburn.

For stable patches, surgical methods like skin transplants may be considered, though they come with risks such as infection. Depigmentation treatments involve lightening the natural skin to match areas with vitiligo. Make-up, self-tanners, or tattoos can also be used to conceal patches.

Medications

Several medications are commonly used to treat vitiligo:

• Corticosteroid Creams: Often the first line of treatment, these creams, such as Fluticasone and Clobetasol, help restore skin color.

• Opzelura (Ruxolitinib): The only FDA-approved cream for re-pigmenting vitiligo-affected skin, suitable for those aged 12 and older.

• Topical Calcineurin Inhibitors: Used for sensitive areas due to fewer side effects, examples include Tacrolimus and Pimecrolimus.

• Janus Kinase (JAK) Inhibitors: Including Opzelura, these block immune signals causing inflammation. Other JAK inhibitors are under investigation.

• Vitamin D Preparations: Calcipotriene ointments reduce immune responses, often paired with steroids.

Early treatment is vital as delays can allow vitiligo to spread. Rapidly progressing cases may require oral corticosteroids.

Living

Vitiligo is a visible condition that can affect self-perception, leading to self-esteem and mental health challenges, particularly in children. Emotional support is critical, and mental health specialists can offer valuable assistance. Engaging with others who have similar experiences, through online communities like Vitiligo Friends or the Vitiligo Support Group, can provide comfort. Further information is available through the American Academy of Dermatology Association and National Institutes of Health.