Vitiligo: Types, Symptoms, Causes, and Treatment

Overview 

Vitiligo is a chronic disease of depigmented white macules and patches resulting from destroying melanocytes in the affected skin. 

This article will give you comprehensive information about vitiligo, its signs and symptoms, the triggering factors, and the treatment.

Let’s read this article to learn all about vitiligo.

What is Vitiligo?

Vitiligo is an autoimmune disorder that causes patches of skin to lose color or pigment. It happens when melanocytes (skin cells that make pigment) are attacked and destroyed, causing the skin to turn a milky-white color. 

Vitiligo is common and affects approximately 1% of the world’s population. It has no apparent sex predilection and may occur shortly after birth until late adulthood, although over half of the individuals are affected before age 20. It can appear anywhere on the skin. 

Anyone can get vitiligo, and it can develop at any age. However, in many people with vitiligo, the white patches appear before age 20 and can start in early childhood. It’s more common in people who have a family history of the autoimmune disorder or who have certain diseases, such as:

• Addison’s disease
• Pernicious anemia
• Psoriasis
• Rheumatoid arthritis
• Systemic lupus erythematosus
• Thyroid disease
• Type 1 diabetes

Types of Vitiligo

Segmental 

It typically affects just one side of your body. It can also be referred to as unilateral vitiligo.

Segmental vitiligo impacts about 98% of people. It is more prominent in children. Three out of 10 children with vitiligo have segmental vitiligo. People with segmental vitiligo typically develop this condition as children or young adults. It usually progresses for a year or two and then stops.

With segmental vitiligo, loss of skin color develops in patches on just one area of the body. It can be one leg, one side of the face, or several places on just one side of the body. Moreover, hair loss over areas of discoloration occurs in about half the people with this form of vitiligo. It is less strongly associated with autoimmune diseases.

Generalized Vitiligo 

Generalized vitiligo is also known as non-segmental or bilateral vitiligo, the most common type of this condition. In this type, depigmented patches appear symmetrically on both sides of the body. For example, it may seem like matching spots on both arms or legs.

Furthermore, with generalized vitiligo, the color loss is rapid and widespread, covering large body sections. In most cases, this type of vitiligo can progress and then stop, switching through an on-again, off-again cycle. 

Subtypes 

Some subtypes of vitiligo describe how much of the skin is affected.

Focal 

This rare type of vitiligo develops in a single area and doesn’t spread throughout the body in a predictable pattern after a short period.

Mucosal

It usually affects the mucous membranes of the mouth or genitals.

Universal 

It is the most severe subtype of vitiligo. With this disease level, almost all skin pigmentation is gone, and the skin is depigmented. This type of vitiligo is the most extensive one but also rare.

How Does Vitiligo Start?

It usually starts with small white macules or patches that may gradually spread over the body. Vitiligo typically begins on the hands, feet, and face. Still, it can develop on any body part, including the mucous membranes, the eyes, and the inner ears.

Sometimes, larger patches may continue to spread, but they typically stay in the same place for many years. However, the place of smaller macules shifts and changes over time as some areas of skin lose and regain their pigment.

The amount of affected skin varies from person to person. Many people experience a few depigmented areas, while others have a widespread loss of skin color.

Symptoms 

A common symptom of vitiligo is the loss of skin coloring in patchy areas around the body. This depigmentation can appear in a few different ways:

• Vitiligo can appear as milky-white patches on the skin, appearing anywhere but most commonly on the hands, feet, arms, or face.
• Your hair can also turn white over areas of depigmentation on the skin. It applies to the hair on the head and in places like eyebrows, eyelashes, or even a beard.
• Vitiligo may also appear on mucous membranes like the inside of the mouth or nose.

Causes of Vitiligo 

A lack of pigmentation in the skin causes vitiligo. The reason is unknown. Studies suggest vitiligo could be the result of the following:

• An autoimmune condition: The immune system mistakes healthy cells (melanocytes) as foreign invaders like bacteria that can harm your body. It makes the immune system overreact and develop antibodies to destroy the melanocytes.
• Genetic changes: A mutation or modifications to the body’s DNA can affect the melanocyte’s function. There are over 20 genes that can increase your risk of developing vitiligo.
• Stress: The amount of pigment the melanocyte cells produce may change if you experience any emotional anxiety or physical stress on the body, especially after an injury.
• Environmental triggers: Factors like UV rays and toxic chemical exposure can affect the function of melanocyte cells.

Diagnosis 

A visual examination by a dermatologist usually leads to an accurate diagnosis of vitiligo. Your dermatologist may use a Wood’s lamp to look at your skin. This lamp uses an ultraviolet (UV) light that shines onto the skin to help your doctor differentiate vitiligo from other skin conditions. In addition, your dermatologist may ask about your medical and family medical history.

Skin Biopsy

Your doctor may need more information about the skin cells to confirm the diagnosis. A skin biopsy can definitively differentiate between missing and malfunctioning melanocytes. In addition, vitiligo can be diagnosed if these pigment-producing cells are missing. A rare form of skin cancer known as Hypopigmented mycosis fungoides may cause white patches due to malfunctioning melanocytes. Skin biopsy can rule out this possibility and help determine the exact disease.

Blood tests 

Your doctor may recommend blood tests if he finds out you have vitiligo. Also, individuals with vitiligo have a higher risk of developing other autoimmune diseases like thyroid disease. Blood tests can find out about these autoimmune diseases.

Treatment for Vitiligo

The doctor may prescribe a medication that stops the immune system from destroying the melanocytes and improving your skin’s appearance. In most cases, the goals of the treatment are to:

• Slow down or stop the disease from progressing.
• Encourage the regrowth of melanocytes.
• Restore color to the white patches of your skin, which can help your skin color look more even.

Topical Medications

Topical medications can add color to your skin or calm inflammation. The most common topical cure for vitiligo is a potent topical corticosteroid. Still, even this treatment can take five to six months to restore some color, which only happens for about half of the people who use it. Corticosteroids carry many side effects, like making the skin thinner and more delicate. For this reason, it’s only used for small areas, and not all varieties of corticosteroids are for the face. This medication option is most effective in people with darker skin tones and is least effective on the hands and feet. 

Opzelura (ruxolitinib) is a topical medication approved by the Food and Drug Administration (FDA) to treat eczema and vitiligo. This medication is a Janus kinase (JAK) inhibitor for preventing inflammation.

Tacrolimus ointment or pimecrolimus creams are some other options for children and adults. One advantage of these medications is that individuals can use them longer than corticosteroids. These work best to treat the skin.

Another medication that can restore lost pigment is calcipotriene. While not effective when used alone, it can be effective with a corticosteroid. Moreover, applying these medications as directed can increase the re-pigmentation and shorten the time it takes to get results. 

Phototherapy

For many people with vitiligo, dermatologists may recommend phototherapy, also known as light therapy. Additionally, phototherapy can be considered an initial or successive treatment if topical medications don’t work. Photo Therapies work by using light to restore lost color to your skin. It usually requires a significant time commitment. 

Narrowband UVB

It is the light treatment of choice for generalized, non-segmental vitiligo. Narrowband UVB is considered safe enough to use on children or pregnant women. This treatment can also be performed in clinics or at home with small, medium, or large devices. It may work even better when combined with topical medication.

Surgical procedures 

In cases where medication and phototherapies don’t work, surgical procedures may be considered. Surgery can only be generally considered in adults whose white patches haven’t changed for at least seven months. Different surgical techniques are used to treat vitiligo, most of which involve transferring skin or skin cells from an area of skin that is still pigmented to a depigmented place. Two surgical procedures treat vitiligo, i.e., tissue grafting and cellular grafting. In either case, the top layer of the non-pigmented skin is usually removed to enable the transplant.

How to Prevent Vitiligo?

There are different ways to help you prevent vitiligo.

1. Protect your skin from the sun. Skin that has lost its natural color tends to sunburn very quickly. A bad sunburn can worsen the condition. If you have a lighter skin tone, there is another reason to protect your skin from the sun. Without a tan, the lighter spots and patches are often less noticeable.
2. Avoid cuts, scrapes, and burns. For most people, a skin injury triggers new spots or patches.
3. Avoid using tanning beds or sun lamps. These aren’t safe alternatives to the sun. However, these, too, can burn your skin that has lost pigment and can worsen vitiligo.
4. Support your immune system with a healthy lifestyle. Vitiligo is an autoimmune disease, which means the immune system attacks healthy cells. Therefore, doctors recommend you reduce stress and eat a nutritious diet to support your immune system. Additionally, stress can cause new vitiligo patches to appear. Some practical ways to reduce stress include deep breathing, meditation, and exercise.

Complications 

It may cause the following:

• Skin sensitivity: Macules and patches lack melanocytes, making the skin susceptible to sunlight and can cause the skin to burn quickly instead of tanning.  
• Eye abnormalities: People with vitiligo may experience some irregularities in their retinas and some variation of color in their irises. In some cases, the retina, or iris, is inflammation but vision usually is not affected.
• Predisposition to autoimmune conditions: Individuals with vitiligo may be more likely to get other autoimmune disorders affecting their body’s immune system. Therefore, common autoimmune diseases include hypothyroidism, diabetes, and anemia.

Difference Between Vitiligo and Tinea Versicolor

Vitiligo is often mistaken for tinea versicolor. The main difference between these two conditions is that the spots caused by vitiligo are smooth, while tinea versicolor spots can have a scaly texture. Another difference is that an autoimmune disorder causes vitiligo, whereas tinea versicolor is caused by a fungal infection. 

When Should I See My Doctor?

Contact your doctor if:

• Your skin starts losing pigment or color rapidly.
• Depigmentation spreads to a large area of the body.

The changes to the skin may affect your mental health and well-being. Therefore, you can consult professional doctors at your doctor’s online application to get the required treatment.

FAQs About Vitiligo Answered by Your Doctors Online Team