Vitiligo: What are the symptoms, causes and treatment?

 What is vitiligo?

Vitiligo is a skin disorder of melanin pigment. Melanin is a pigment that attributes color to our skin. In case of death of melanin-producing cells, also called melanocytes or decreased cell function, the skin starts to lose the color in blotches or patches. This produces uneven skin color and it may be unappealing and cause self-image issues. 

When there is a lack of melanocytes( cells producing melanin pigment) in the skin layer, the skin shows loss in color, usually in patches/blotches. This loss of skin color may begin with the hands, feet, arms and typically anywhere on the body. Vitiligo is seen more often in black or brown-skinned people. 

My paternal aunt has vitiligo and I have seen her skin is discolored and has blotches all over her body. The discoloration may spread rapidly towards the lips around the mouth and nasal lining, hair and scalp, etc. It tends to increase with age. 

Vitiligo can start from childhood or between 20-30 years of age. It is not a contagious disease and thus does not spread by contact. It is not a life threatening condition but can start making a person uncomfortable and uneasy. Decreased self esteem due to damaged self image may be a matter of concern. 

There is no cure for vitiligo, however the process can be controlled by medical intervention.

What are the signs and symptoms of vitiligo? 

The signs and symptoms of vitiligo are:

• One of the major sign of vitiligo is the depigmentation of the skin in patches. Other associated symptoms are: itching where the new patch starts to form, social anxiety, depression and low confidence. 
• The patches often are small and begin to form on the hands, wrists and face. It may also form on the eye lids, hair and scalp. The skin discoloration can take place almost anywhere on the body.

What are the common parts of body one can get vitiligo? 

Vitiligo can occur generally all over the body. It is however more commonly seen in the following parts:

• Hands
• Forearms
• Feet
• Mucosa of nose and mouth
• Genitals
• Face, around lips and eyelids

What are the causes of vitiligo? 

The causes of vitiligo are not known. However it is believed to be linked to some significant changes in the immune response of the body. Genetic predisposition and environmental factors may be the cause but the facts are not yet been established. 

The assumed causes are:

• Autoimmunity
• Genetic mutations
• Environmental triggers, e.g. exposure to sunburns, UV rays, toxins etc.
• Stress

Who is more likely to get vitiligo? 

• Anyone who has lack of melanocytes in the skin may get vitiligo. However it can develop as early as childhood and or after 20 years of age. 
• People with dark brown or black skin are known to have vitiligo. 
• People who have other autoimmune disorders such as rheumatoid arthritis, psoriasis, thyroid disorders, type 1 diabetes, systemic lupus erythematous, Hashimoto's disease, scleroderma, etc.are more susceptible to have vitiligo.
• Anyone with a family history may be at more risk of having vitiligo. However it is not necessary that they will inherit such genes. Many people are still normal even when one of their parent has vitiligo.  

How is vitiligo diagnosed? 

Vitiligo can be clearly diagnosed by doing the physical examination of the skin. The typical skin lesions such as depigmentation of the skin distributed symmetrically on the body can be easily visible and thus vitiligo can be diagnosed. 

History of any other autoimmune diseases may help a lot. 

What are the different types of vitiligo? 

Vitiligo can be of different types based on the area involved and the distribution of the depigmentation. 

They are: 

• Generalised vitiligo: Most common type. Skin patches of lost color appears widely throughout on the body surface.
• Segmental: This type may have discolored patches confined to anyone side of the body, eg. hand or feet. It does not involve symmetrical distribution
• Mucosal vitiligo: When the skin color loss spreads rapidly to the nasal or mouth mucosa, it is called mucosal vitiligo. In some cases even the genitals may also have mucosal depigmentation. 
• Focal vitiligo: There occurs skin patches which are small and do not expand for almost 2 years or more. 

When the vitiligo develops on the hairs, it may cause whitening or greying of the hairs on the scalp, eyelid, eyebrows, nose, etc. 

What is the treatment of vitiligo? 

There is no need of treatment for vitiligo. However if the person is not happy or comfortable with the uneven skin tone, there are treatment options available to help them reduce the progression of depigmentation in the body. If a person 's mental health is affected, it is better to talk to the doctor to plan the best possible treatment to cover up the skin color-loss. Otherwise in most instances treatment is not needed as it is not dangerous to life.  

The treatment includes:

• Depigmentation therapy
• Surgery Using skin grafts
• Light therapy
• Psychological counselling to improve self image and self esteem
• Use of camouflage make up to cover up the skin patches
• Tattooing the larger areas that can be permanently covered by tattoos. 

How to prevent vitiligo? 

It is not possible to prevent vitiligo but certain steps may help to slow down the process of depigmentation. 

• Use sunscreen protection when going out.
• Take medications properly if you have autoimmune disorder. 
• Get medical checkup to plan best care for the lesions that develop before 20 years of age. It can be made medically possible to revert the skin loss if detected early.  

Vitiligo is a skin condition that is not of serious concern, however the color loss of skin may ruin the natural beauty and it may be not welcomed by many people. There are different treatment approaches for improving the skin contour cosmetically by an expert dermatologist.