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What is Vitiligo? Vitiligo is an autoimmune disorder affecting the pigmentation of the skin that affects 0.5-2% of the worldwide population. It usually develops before the age of 30, but the onset of disease may be at any age. Vitiligo is classified as segmental and nonsegmental vitiligo. Vitiligo is the most common cause of depigmentation and is characterized by loss of color. It appears as well-demarcated chalk-white patches usually found on the hands, feet, arms, and face that may vary in size. Hair growing areas of the skin can also be affected, resulting in the growth of white hair. It can also be present in the mucous membranes of the mouth and nose. The presence of vitiligo can cause psychological stress, resulting in poor self-esteem and depression.
What causes Vitiligo?
Vitiligo is caused by the destruction of melanocytes. The pathogenesis of this is still unknown, but it is likely the result of the interactions of multiple factors.
- Genetics play a significant role. About 25 to 50% of people with vitiligo have relatives who are also affected. Several genes involved in the life cycle of melanocytes and their susceptibility to damage, and the function of the immune system, have been identified in relation to the development of disease.
- Oxidative stress is thought to cause initial damage to the melanocytes. The damage to the melanocytes decreases their adhesion to keratinocytes and induces them to release stress signals.
- Activation of an immune response to the damage where antibodies are created against cellular components of melanocytes.
- Decreased levels of protective factors (Regulatory T cells) that function to suppress the immune system and prevent the immune system from attacking the body’s normal cells.
- Abnormal functioning of the nervous system is also thought to be involved, specifically in the development of segmental vitiligo.
Damage to the skin, exposure to chemicals, severe sunburn, pregnancy, or emotional stress may precede the development of vitiligo. It is also commonly associated with other autoimmune disease such as autoimmune thyroiditis, alopecia areata, psoriasis, type 1 diabetes, rheumatoid arthritis, SLE, myasthenia gravis, and inflammatory bowel disease.
Are there treatments for Vitiligo?
There are options for management of vitiligo. Goals of treatments are usually based on the patient’s age, course and severity of disease, preference, and impact on their life. Treatments may slow the progress of the disease, encourage regeneration or melanocytes, or restore pigmentation to the patches. Some people may choose not to be treated.
- Cosmetic options such as makeup, tanners, and skin dyes are usually recommended for younger patients, as it is the safest option.
- Topical corticosteroids for use on small areas of depigmentation.
- Light therapy in the form of light box therapy for widespread vitiligo and excimer laser for smaller patches.
- PUVA light therapy using UVA and the photosensitizing drug Psoralen.
- Surgical options such as skin grafting
- Depigmentation of normal skin using topical agents in those who have very widespread disease and have lost most of their pigmentation.
Preventative measures to reduce the risk and extent of progression include the daily use of sunscreen and sun-protective clothing, staying in the shade, avoiding tanning beds, UV lamps, and tattoos, and managing psychological stress
Source: Bergqvist, C., & Ezzedine, K. (2020). Vitiligo: A Review. Dermatology, 236(6), 571–592. https://doi.org/10.1159/000506103