Vitiligo: Skin Pigment Loss and Treatment
What Is Vitiligo?
Vitiligo is a skin disorder in which cells called melanocytes are destroyed. The cells make melanin, the brown pigment that colors our skin. Without melanocytes, pigment can't be made. People with vitiligo often have irregularly-shaped patches of depigmented skin. The patches frequently enlarge over time and produce a mottled appearance.
I've had vitiligo patches on my hands and forearms for several years. Since I have pale skin, the white areas are most noticeable in summer when the rest of my skin tans. At other times of the year, the pigment loss is not a big problem. For people with darker skin or for people who have lost pigment in a more visible place, such as the face, the disorder may be much more problematic. The darker the skin, the more obvious the contrast between light patches and pigmented areas.
The cause of the melanocyte destruction in vitiligo isn't known for certain, but most researchers think that it arises due to an autoimmune problem. Our immune system normally destroys bacteria and viruses. In an autoimmune disease, the system mistakenly attacks the body's own cells.
Vitiligo isn't contagious. A person can't "catch" the disorder by touching someone's skin.
Types of Vitiligo
The classification of vitiligo varies. Today most dermatologists recognize two types—non-segmental and segmental. The non-segmental version is by far the most common type. According to the American Academy of Dermatology, the following features are the main characteristics of the condition.
- Depigmented patches appear on both sides of the body. They may have different shapes, however.
- The loss of pigment often begins on the hands, wrists, or feet or around the eyes or mouth.
- Depigmented patches often grow in size once they form.
- Loss of pigment may proceed for a while, then pause, and then start again. This start-and-stop cycle may occur repeatedly.
Segmental vitiligo develops in one part of the body and usually starts at an early age. Pigment loss often stops at a certain point and doesn't restart. The condition is frequently accompanied by a loss of hair color.
I have non-segmental vitiligo. The depigmentation is slowly spreading over my hands and forearms and has also appeared on my legs. In some people the pigment loss is located in other or additional areas and the condition progresses much more rapidly.
Depigmentation tends to first develop as small spots on areas exposed to sunlight, especially the face, lips, arms, and hands. It may be particularly noticeable around openings in the skin, such as the lips and the eyes. The spots may enlarge over time. New spots sometimes develop in areas that aren't normally exposed to the sun. The depigmented patches may be paler than the surrounding skin or may be completely white. The patches are flat and feel normal to the touch. They also have normal sensation.
Some people with vitiligo develop grey hair, eyelashes, eyebrows, and facial hair at a relatively young age (before 35). There may also be pigment loss inside the mouth. Pigment is sometimes lost from the retina, the light-sensitive layer at the back of each eyeball, although this seems to be a very rare process.
A doctor should be visited to check that light patches on the skin are vitiligo and not a symptom of another disorder, such as a yeast infection of the skin. Vitiligo is easiest to treat when it's in its beginning stages, so this is another reason to visit a doctor soon after depigmentation begins.
Function of Melanocytes, Melanosomes, and Melanin
People with vitiligo are often healthy, apart from their depigmented skin patches. Some have a previously diagnosed autoimmune disease, however. The most widely accepted theory for the origin of vitiligo is that it arises due to an autoimmune problem in which the immune system destroys melanocytes. People with the condition may have another autoimmune disorder as well, such as hyperthyroidism, a condition in which the thyroid gland is overactive, alopecia areata, a disorder in which hair is lost, or pernicious anemia, a disease in which the intestine cannot absorb enough vitamin B12 from food.
Another theory for the origin of vitiligo is that it's caused by a stressful event, such as a severe sunburn to the area that develops white spots, exposure to a chemical toxin from outside or inside the body, or serious psychological stress. There is much less support for this idea than the theory that the disorder is an autoimmune condition, however.
There seems to be an inherited component in some forms of vitiligo, since it sometimes runs in families. Certain genes are believed to make a person susceptible to loss of skin pigment.
Vitiligo affects both genders and all ethnic groups equally. It usually appears before the age of forty. About 1% to 2% of the world's population have the disorder.
Vitiligo is physically painless but may cause a lot of emotional turmoil. People with the disorder may be very self conscious about their appearance. For some people, the appearance of depigmented patches is a life-changing event. It may be an especially difficult condition for those with darker skin because the depigmented areas may be very obvious. The pigment loss may cause people to feel that they are losing their identity. In addition, people may be treated badly because of their appearance.
There is another way in which vitiligo may affect someone in addition to being embarrassing, depressing, or isolating. Melanin in skin gives us some protection from ultraviolet light in sunlight. Since depigmented patches lack melanin, it's extremely important that a person covers them with sunscreen to help prevent a sunburn and skin cancer.
Living With Vitiligo
There is no cure for vitiligo, but there are ways to improve the appearance of the skin. Very occasionally pigment returns to pale areas without any treatment. If the pigment doesn't return, however, a person has the choice of living with the missing pigment, covering the light areas with clothing, makeup or camouflage creams, using techniques to encourage pigment to reappear, or removing the remaining pigment from the skin so that all of the skin has the same color.
Possible treatments should be discussed with a doctor. This is especially important in the case of treatments that are designed to stimulate pigment reappearance or to remove pigment, since these may have serious side effects. Another factor to consider is that while vitiligo treatments may eliminate white spots, more depigmented patches may appear in the future. This means that a treatment may need to be repeated.
Dermatologists say that is very important that people of all skin colors wear sunscreen or sun-protective clothing, whether or not they have vitiligo. Melanin doesn't provide us with complete protection from all of the sun's dangerous radiation. Makeup and camouflage creams may not contain sunscreen.
Disguising Depigmented Skin Patches
The easiest and safest method to disguise vitiligo patches is to cover them with clothing. This isn't always possible or practical, however, so other strategies may be necessary.
If a suntan is avoided, light patches may not be very noticeable in people with pale skin. This is true for me. My skin was tanned in the photos of my hand and arm in this article, so the depigmented areas showed up. The problem is much harder to see when I'm not tanned, especially under some lighting conditions. I've been much more careful about avoiding a tan since I took the photos. This is mainly because a tan indicates that sunlight has affected my skin and that the pigment-free areas of the skin may have been damaged by the light.
Many people with vitiligo find it harder to disguise their condition than I do. Makeup can cover and hide light patches and may be sufficient to disguise some cases of the disorder. Another option is the use of camouflage creams, which come in a range of colors. They're often waterproof and stay on the skin for a long time. Stains and self-tanning products may also be effective. The safety of all products applied to the skin should be investigated before they're used.
Getting a perfect match between the appearance of pigmented and unpigmented skin may take practice and be time consuming. The woman in the video below does an excellent job of covering her light patches with makeup, however.
Using Makeup to Cover Vitiligo
Vitiligo treatments must be prescribed by a doctor. The doctor will know about the effectiveness, risks, and availability of different treatments. The descriptions below are given for general interest.
Corticosteroid and Immunomodulator Creams
One type of treatment for restoring pigment that may be prescribed is the use of a topical corticosteroid cream. A "topical" cream is one that is used on the skin. A corticosteroid cream may encourage pigment to reappear, although several months of treatment may be needed in order for the cream to work. The cream does have side effects. It may cause the skin to become thinner and may also cause skin striae to appear. Striae are irregular areas of skin that look like stripes or lines. They're sometimes known as stretch marks.
An immunomodulator cream may also restore pigment. This cream can suppress the action of the immune system in the skin. It may work where corticosteroids aren't tolerated. Modifying the activity of the immune system can sometimes be a risky activity, so a doctor's instructions should be followed carefully.
Psoralen photochemotherapy, or PUVA, requires the administration of a chemical called psoralen. The chemical is administered by mouth, as a cream rubbed on the skin, or by immersion in a liquid containing the chemical. Psoralen makes the skin more sensitive to ultraviolet light. After the psoralen treatment, the patient is exposed to ultraviolet A light. The skin turns pink at first and then the pink color is replaced by normal skin pigment, if all goes according to plan.
There is a serious concern associated with PUVA treatment. Shining ultraviolet light on skin increases the risk of skin cancer, just as it does when we are exposed to sunlight without wearing sunscreen. Multiple PUVA treatments increase the risk of cancer development. There's also a risk that the treatment will cause too much pigment to appear, or hyperpigmentation, resulting in darker than normal areas on the skin. These dark patches are usually temporary, however. Psoralen treatment may also lead to sunburn, so it's important to limit exposure to the sun after a treatment and to wear sunglasses. Another problem is that ingesting psoralen can cause unpleasant side effects, such as stomach upset and nausea.
Narrowband UVB Light
Narrowband UVB light is also used to restore pigment lost in vitiligo and is becoming popular. This light has two important advantages compared to PUVA treatment: it doesn't require a psoralen pre-treatment and it uses a narrow range of ultraviolet wavelengths in the UVB range, which are thought to be less dangerous than the light used in PUVA therapy. The UVB light is provided by light panels or by light cabinets, which are available in home versions. A doctor's guidance is needed if treatment is performed at home.
There is another option for someone with many large vitiligo patches. The remaining pigment can be removed from the skin by a chemical or a laser, allowing the skin to look the same color everywhere. If this treatment is performed, a person's whole skin surface is very susceptible to sun damage. Other possible treatments include a different type of laser treatment to stimulate repigmentation and the application of skin grafts. Specific vitamin supplements may also help, although this is not yet proven.
New techniques that may help vitiligo sufferers are available in some places. One of these is a melanocyte transfer. In this technique, melanocytes are obtained from a person's pigmented skin and allowed to multiply in a laboratory dish. The melanocytes are then transplanted into the patient's depigmented areas.
Many vitiligo treatments need to be used for months to see an effect. Certain treatments may help some people but not others. The good news is that there in an increasing range of treatments that a doctor can prescribe. In addition, research into the nature of the disorder is continuing. The latest discoveries support the idea that vitiligo is an autoimmune condition. Hopefully in the near future doctors will be able to treat the cause (or causes) of the disorder as well as its symptoms.
Some people are trying to remove the stigma that is often attached to pigment loss. Chantelle Brown-Young, also known as Winnie Harlow and Chantelle Winnie, is a Canadian model with prominent depigmented patches that she doesn't attempt to hide. She's becoming successful in her career and is raising awareness of vitiligo and the problems that it causes.
Chantelle Brown-Young (Winnie Harlow) Discusses Her Vitiligo
Coping With the Disorder
Humans have a wide range of skin colors, which add variety to life. It would be nice if a mixture of darker and lighter skin areas on a person's body was as acceptable to the general public as a monotone skin, but it often isn't. The situation may be improving in some places as public figures such as Winnie Harlow show their loss of pigment, however.
For some people, the effort needed to cover depigmented areas with makeup is very worthwhile. For them, revealing their vitiligo may be unthinkable due to their embarrassment or to the way in which they are treated. Other people remain confident and do nothing about their light patches, even when these are obvious. Some even embrace the patches as part of their identity and aren't disturbed by any unwanted attention. Every person with vitiligo needs to decide on their own approach to the disorder.
A Model With Vitiligo
Research and Support
If you're considering getting a treatment for vitiligo, do some research about the treatment and write some questions down to ask your doctor. If you do research on the Internet, make sure that you visit authoritative sites such as vitiligo associations and government health sites. There are a lot of websites which claim that they have a wonderful "cure" for the disorder, but their products are generally not clinically tested and may be completely useless or even harmful.
If you need support dealing with the disorder, your family and friends may be a great help. A vitiligo group in your area would most likely be a wonderful resource too, but there may not be one available. Meetings with an individual counselor can also be helpful. In addition, the last two sites mentioned below may be useful. Make sure that you visit one or more of these support sources if you need them. You don't have to deal with vitiligo on your own.
References and Help
© 2012 Linda Crampton