Vitiligo - information

Vitiligo is a skin condition in which there is a loss of brown color (pigment) from areas of skin, resulting in irregular white patches that feel like normal skin.

Causes, incidence, and risk factors

Vitiligo appears to occur when immune cells destroy the cells that produce brown pigment (melanocytes). This destruction is thought to be due to an autoimmune problem, but the cause is unknown.

Vitiligo may appear at any age. There is an increased rate of the condition in some families. The condition affects about 1 out of every 100 people in the United States.

Vitiligo is associated with three other autoimmune diseases:

• Addison's disease
• Hyperthyroidism
• Pernicious anemia

What are the symptoms vitiligo?

People who develop vitiligo usually first notice white patches (depigmentation) on their skin. These patches are more commonly found on sun-exposed areas of the body, including the hands, feet, arms, face, and lips. Other common areas for white patches to appear are the armpits and groin, and around the mouth, eyes, nostrils, navel, genitals, and rectum.

Vitiligo generally appears in one of three patterns:

focal pattern -- depigmentation limited to one or only a few areas segmental pattern -- depigmented patches that develop on one side of the body generalized pattern -- the most common pattern. Depigmentation occurs symmetrically on both sides of the body.

In addition to white patches on the skin, people with vitiligo may have premature graying of the scalp hair, eyelashes, eyebrows, and beard. People with dark skin may notice a loss of color inside their mouths.

Will the depigmented patches spread?

Focal pattern vitiligo and segmental vitiligo remain localized to one part of the body and do not spread. There is no way to predict if generalized vitiligo will spread. For some people, the depigmented patches do not spread. The disorder is usually progressive, however, and over time the white patches will spread to other areas of the body. For some people, vitiligo spreads slowly, over many years. For other people, spreading occurs rapidly. Some people have reported additional depigmentation following periods of physical or emotional stress.

How is vitiligo diagnosed?

The diagnosis of vitiligo is made based on a physical examination, medical history, and laboratory tests.

A doctor will likely suspect vitiligo if you report (or the physical examination reveals) white patches of skin on the body-particularly on sun-exposed areas, including the hands, feet, arms, face, and lips. If vitiligo is suspected, the doctor will ask about your medical history. Important factors in the diagnosis include a family history of vitiligo; a rash, sunburn, or other skin trauma that occurred at the site of vitiligo 2 to 3 months before depigmentation started; stress or physical illness; and premature graying of the hair (before age 35). In addition, the doctor will ask whether you or anyone in your family has had any autoimmune diseases and whether you are very sensitive to the sun.

To help confirm the diagnosis, the doctor may take a small sample (biopsy) of the affected skin to examine under a microscope. In vitiligo, the skin sample will usually show a complete absence of pigment-producing melanocytes. On the other hand, the presence of inflamed cells in the sample may suggest that another condition is responsible for the loss of pigmentation.

Because vitiligo may be associated with pernicious anemia (a condition in which an insufficient amount of vitamin B12 is absorbed from the gastrointestinal tract) or hyperthyroidism (an overactive thyroid gland), the doctor may also take a blood sample to check the blood-cell count and thyroid function. For some patients, the doctor may recommend an eye examination to check for uveitis (inflammation of part of the eye), which sometimes occurs with vitiligo. A blood test to look for the presence of antinuclear antibodies (a type of autoantibody) may also be done. This test helps determine if the patient has another autoimmune disease.

Treatment

• Phototherapy, a medical procedure in which your skin is carefully exposed to ultraviolet light. Phototherapy may be given alone, or after you take a drug that makes your skin sensitive to light. A dermatologist performs this treatment.
• Medicines applied to the skin, such as:
  • Corticosteroid creams or ointments
  • Immunosuppressant creams or ointments, such as pimecrolimus (Elidel) and tacrolimus (Protopic)
  • Topical drugs such as methoxsalen (Oxsoralen)

Skin may be moved (grafted) from normally pigmented areas and placed onto areas where there is pigment loss.

Several cover-up makeups or skin dyes can mask vitiligo. Ask your health care provider for the names of these products.

In extreme cases when most of the body is affected, the remaining skin that still has pigment may be depigmented. This is a permanent change that is used as a last resort.

It is important to remember that skin without pigment is at greater risk for sun damage. Be sure to apply a broad-spectrum (UVA and UVB), high-SPF sunscreen or sunblock and use appropriate safeguards against sun exposure.