Vitiligo: Understanding the Loss of Skin Colour

Vitiligo is a condition that causes depigmentation of parts of the skin. This happens because the cells that make pigment in the skin are destroyed by the immune system or self-destruct for reasons not yet known. These cells are called melanocytes.

The appearance of vitiligo can be distressing. This is particularly so for darker-skinned people where white patches are more noticeable.
Any area of skin can be affected. However, the most common sites involved are the face, neck, and scalp.

Vitiligo affects 0.5-1% of the worldwide population and may appear at any age. The condition is genetic, but it can also be triggered by stress; skin damage, such as severe sunburn; insect bites in susceptible people; or exposure to chemicals.

Vitiligo is not contagious and therefore cannot be contracted from another person.

There are two main types of vitiligo:

  • Unilateral (often called segmental) : Unilateral (segmental) vitiligo, the less common type of vitiligo, differs from generalized vitiligo in many important aspects. It more commonly begins in children and young adults and progresses for a limited period, usually 1–2 years, and then remains static for the life of the individual. It affects just one side of the body. In contrast to bilateral vitiligo, the distribution is asymmetrical on the skin. Segmental vitiligo is thought to be caused by chemicals released from the nerve endings of the skin. These chemicals are poisonous to the melanocyte skin cells.
  • Bilateral (usually termed generalized): Bilateral or generalized vitiligo the most common type of vitiligo can begin at any age and tends to progress intermittently over the life of the patient. It produces depigmentation that is remarkably symmetrical in distribution. There is no explanation for this symmetry.

Vitiligo is difficult to treat. Early treatment options include the following:

  • Sunscreens: Suncreens protect unpigmented involved skin from sunburn reaction and limit the tanning of normal pigmented skin. Sunscreens should be no less than SPF 30.
  • Topical Corticosteroid Creams: If there is no response to corticosteroids in 2 months, it is unlikely to be effective.
  • Immunosuppressant creams, such as pimecrolimus (Elidel) and tacrolimus (Protopic)
  • Phototherapy: It is one of the most common and successful vitiligo treatments, resulting in repigmentation of the pale skin patches by stimulating neighboring melanocytes into producing skin color again.
  • Topical Oxsoralen: This medication is used along with controlled ultraviolet light (UVA) to cause a return in skin color. Methoxsalen works by making the skin more sensitive to UVA light
  • Depigmentation: In extreme cases when more than 50% 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.

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