Vitiligo

Cause

The exact cause of vitiligo is still unknown. The condition is possibly the result of an autoimmune disease. In autoimmune diseases, the immune system is aiming against tissues of our own body. In case of vitiligo, it is assumed that such immunological response causes destruction of pigment cells. It has been demonstrated that other autoimmune diseases occur more frequently in patients with vitiligo, such as certain diseases of the thyroid, diabetes and alopecia areata. Moreover, vitiligo often appears to be a familial disease, since multiple people within a family suffer from the disease. Even identical twins are apparently sensitive in the same way for developing the white vitiligo spots.
Some factors may trigger vitiligo. This applies, however, only to people who already have a predisposition to developing this condition. Known factors include serious diseases, surgery, pregnancy, childbirth, sunburn and skin damage from injuries. Emotional stress may also trigger or worsen vitiligo.

Symptoms

Vitiligo spots are white: all pigment has gone. The spots may differ in shape and size. The spots can also still grow. Around the spot is often an edge that is darker than the rest of the skin. Of course, the spots stand out mostly on a tanned or naturally pigmented skin. Although vitiligo spots can occur on the entire body, there are certain preferred sites where they can be found. This is the face, the hands and places in the pubic area. Even in places where the skin has been damaged, people predisposed to vitiligo can develop new discolored spots. Hair growing in vitiligo spots is usually white.

Diagnosis

Vitiligo is generally so easy to recognize that the diagnosis can be made on the basis of the characteristic skin defects. Additional laboratory tests are rarely needed.

Treatment

Vitiligo cannot be cured. However, it’s possible to counteract pigment loss and get lost pigment partially back. For this, different methods can be used:

• PUVA light therapy. With PUVA, the skin is made more sensitive to ultraviolet light. This is done with the aid of a light-sensitive substance. This light-sensitive substance is administered in the form of tablets or via the skin. Administering the agent is followed by radiation with a sun bed or with the help of sunlight. Ultimately, this treatment can ensure that the white spots disappear. In the short term, the spots can be distinguished more clearly, because the pigmented skin is brown from the treatment under the sun bed, and the white spots are not. Unfortunately, this treatment also involves risks.
• Corticosteroids. Vitiligo can be treated with corticosteroid creams. Up till now, it has not yet been proven that these creams affect pigment cells, but the creams can ensure that the white spots don’t grow. The creams can only be used for a short period of time, because there is risk of harmful side effects, such as a thin skin or additional risk of infection. A corticosteroid cream may also delay any wound healing.
• UV-B light therapy. With the help of ultraviolet B light, vitiligo spots can be irradiated. Ultraviolet B, like ultraviolet A, is a component of natural sunlight. It only has a more powerfull effect.
• Skin transplant. In case of skin transplant, normal pigmented skin is transplanted to the vitiligo spots. At the moment, this treatment of vitiligo is still in the experimental phase.

Prognosis

Vitiligo doesn’t pass, but in some cases spontaneous improvement may occur. In particular, vitiligo spots in the face often respond well to treatment. Vitiligo spots on hands and feet almost never improve. In most cases, the spots will remain and in the long run expand slowly.

Considerations

• Camouflage of vitiligo spots with a skin-colored makeup has no curative effect, but is a good method to make the most disfiguring skin defects less visible. Explanation about the possibilities of this method and instructions for use are given by a skin therapist. Next, this method can be applied at home. It’s important to remain precisely within the edges of the vitiligo spot, otherwise it can cause a dark edge.
• Note that vitiligo spots easily burn by exposure to sunlight. It’s therefore recommended to always protect the skin well from too much solar radiation by covering clothing or by using a sunscreen with a protection factor of 15 or higher. This also has the advantage that the healthy, pigment-producing skin contrasts less with the white, unpigmented skin.

Facts

• The Latin word vitiligo means ‘rash’. The word leukoderma means ‘white skin’.
• The prevalence of vitiligo is approximately 1%.
• Vitiligo can occur at any age, but in about half of patients, the condition is revealed before the age of 20 years and in 70 to 80% of patients, before the age of 30 years.