Vitiligo is a condition characterized by local discoloration of the skin. It presents with well-defined milky-white patches of skin on various parts of the body such as hands, feet, armpits, around the mouth, eyes and genitals, as well as on sites of skin injury from various causes. Its severity differs from patient to patient. There is no way to predict how much pigment an individual will lose or how fast it will be lost.
It is an autoimmune disorder, which means that the body itself produces antibodies against melanocytes, which are the cells that produce melanin. The reason for this is not known. Although in 20% other family members also have vitiligo, it is not considered to be a hereditary disease.
Vitiligo affects every skin type, although it is more prominent in darker skin. It can be cosmetically very disabling and a source of stress for the patients but it is not a life threatening disease. It can occur at any age but most often occurs in people 10-30 years old. Males and females are equally affected. People with vitiligo are in good general health, however they face a higher risk of having other autoimmune diseases such as diabetes, thyroid disease, B12 deficiency, Addison disease, rheumatoid arthritis, psoriasis, and alopecia areata
The diagnosis of vitiligo is primarily based on clinical examination and may be facilitated by the use of a Wood’s lamp. Laboratory tests are not needed to confirm the diagnosis. Patients should routinely be asked about family history of vitiligo and about family or personal history of thyroid disease or other autoimmune diseases.
The most widely classified classification of vitiligo distinguishes it in segmental vitiligo (SV) and non-segmental vitiligo (NSV). The most common type of vitiligo is non-segmental vitiligo. Non segmental vitiligo can either occur in different areas of the body or remain in a specific area. It can be observed at any age. On the contrary, segmental vitiligo is located in a specific part of the body and is usually and it occurs mainly during adolescence.
Non segmental vitiligo is divided into the following categories:
- Generalized vitiligo: the most common one. Discolored spots occurring in a random distribution over the entire body surface
- Universalis vitiligo: refers to complete or nearly complete depigmentation of the skin (80–90% of body surface).
- Focal vitiligo: it is characterized by a few scattered white spots without an obvious distribution pattern. It usually occurs during childhood.
- Acro-facial vitiligo: depigmented macules limited to the distal extremities and/or the face.
- Mucous vitiligo: typically involves the oral and/or genital mucosae
The treatment of vitiligo is a dermatological challenge and remains currently unsatisfactory. Occasionally the lesions stop evolving spontaneously. In most cases, however disease progression is seen. Various therapeutic methods are available in order successful repigmentation to be achieved. This is more likely to happen on specific body areas such as face and trunk.
Treatment for vitiligo should be supervised and monitored by a dermatologist with experience in the problem. Choice of treatment depends on the subtype of the disease, the extent, distribution and activity of disease.
In those who have mild vitiligo, the treatment involves topical corticosteroids, which appear to be effective but have side effects including thinning of the skin and telangiectasias. Calcineurin inhibitors are an effective alternative topical therapy. For more extensive vitiligo cases, phototherapy (UVA or UVB) applied either alone or in combination with topical or systemic treatments (PUVA) may be considered. Treatment for at least 2–3 months is needed to determine its efficacy.