Vitiligo

1.    What is Vitiligo?

Vitiligo is a disorder of skin pigmentation caused by a decrease in the number of cells that create pigment in the top layer of the skin, also known as melanocytes.  This results in large, white patches throughout the body that can be both disfiguring and socially ostracizing to individuals, especially those who have darker skin tones.

2.    What Does Vitiligo Look Like?

Vitiligo is characterized by white, depigmented areas of the skin ranging from 5 millimeters to 5 centimeters in diameter, or more.  The degree of pigment loss can vary within each vitiligo patch. There may be different shades of pigment in a patch, or a border of darker skin may circle an area of light skin.  These patches may be either symmetrical on the body, or localized to one region, and may affect the hands, fingers, face, scalp, body folds, underarms, genitalia, and orifices such as the eyes, mouth, navel, and anus.

3.    Who Does Vitiligo Affect?

Vitiligo is common, affecting all races, all skin types, and both genders equally.   Most cases begin to appear on the skin before the age of 30.  Although the depigmented patches are much less obvious and often go untreated in very fair-skinned individuals, they are much more obvious and debilitating to darker-skinned individuals.  There is an increased association of vitiligo with diabetes and autoimmune diseases such as autoimmune thyroid disease.

4.    What Causes Vitiligo?

In vitiligo patches, immune cells called T-cells are activated to destroy melanocytes, however, the ultimate cause of their activation is yet undetermined.  It is believed that their activation may be due to either an overactive immune system or by a signal given off by melanocytes that are creating abnormal, toxic substances during the synthesis of melanin, the main product of these pigment cells in the skin. The onset of vitiligo may be attributed to physical trauma, illness, or emotional stress.  Patients with vitiligo often report that the death of a relative, a severe accident, or even a harsh sunburn had occurred directly preceding the appearance of their vitiligo.  More recently, data suggests a genetic link to certain types of vitiligo.  This may be especially true if there are other family members affected with vitiligo and/or autoimmune diseases in the family.  The course and severity of pigment loss differ with each person. Fair-skinned people usually notice the contrast between paler areas of vitiligo and suntanned skin during the summer. Year round, vitiligo is more obvious on people with darker skin. Individuals with severe cases can lose pigment all over the body. There is no way to predict how much pigment an individual will lose.

5.    How Can My Vitiligo Be Treated?

For mild vitiligo limited to small regions of the body topical steroids, non-steroidal topicals such as Elidel cream and Protopic ointment, and/or topical vitamin D-based treatments may be effective.  Topical Corticosteroids can thin the skin or even cause stretch marks in certain areas. They should be used under your dermatologist’s care.  Most people with vitiligo require narrow-band UVB light treatment, which can be administered 2-3 times per week until pigmentation returns.  While this therapy treats larger regions of the body, an Excimer laser may be used to target specific, localized regions of vitiligo.  This laser uses a carefully focused beam of narrow-band UVB light delivered through fiber optics, and allows higher doses of narrow-band UVB light with minimal exposure of nearby, healthy skin.  Patches of vitiligo are easily sunburned, and people with vitiligo have an increased risk to skin cancer. They should wear a sunscreen with a SPF of at least 30 should be used on all areas of vitiligo not covered by clothing. Avoid the sun when it is most intense to avoid burns. For more information on these treatments for vitiligo, or to schedule a visit, please call and speak with a representative at the Berman Skin Institute.