Definition

Vitiligo is a condition that causes the loss of skin color in patches. Usually, vitiligo appears as white patches and gets larger with time. Vitiligo is the most common cause of depigmentation. It may appear at any age, from childhood to adulthood, but peaks in the second and third decades. Its prevalence is approximately 0.1% to 2% of people worldwide, and it affects all races equally.

Causes

The exact cause of vitiligo is unknown. However, it is often associated with several autoimmune diseases, which involve the body's defenses attacking the body's own cells. In addition, the disease involves various other factors, such as genetics.

Vitiligo occurs when cells that produce melanin (melanocytes) die or stop functioning. Melanin is the pigment or substance that gives color to the skin, hair, and the rainbow membrane of the eye. In parts of the skin that experience melanocyte death, the skin color changes to lighter or white.

Risk Factors

Factors that are thought to be associated with vitiligo, such as:

• A disorder of the immune system (autoimmune condition)
• Family history (heredity)
• A trigger event, such as stress, severe sunburn or skin trauma, such as contact with a chemical

The family history that is a risk factor for vitiligo itself is also quite complicated, as it involves various genes. Not only that, but these genes may have to be exposed to certain environments to cause vitiligo.

Symptoms

Vitiligo signs include:

• Patchy loss of skin color, which usually first appears on the hands, face, and areas around body openings and the genitals
• Premature whitening or graying of the hair on your scalp, eyelashes, eyebrows, or beard
• Loss of color in the tissues that line the inside of the mouth and nose (mucous membranes)

Vitiligo usually starts with a pale-colored patch that gradually turns white. The center of the patch may be white and surrounded by pale skin around it. If there are blood vessels just under the skin, the patch may be pink instead of white.

The edges of the patch may be smooth or irregular, and they may also be inflamed, reddish, or darker than normal skin (hyperpigmentation).

Although the patches of vitiligo can be itchy, dry skin is not a symptom.

Depending on the surface area of the affected skin, vitiligo is divided into:

• Universal vitiligo. With this type, the discoloration affects nearly all skin surfaces.
• Generalized vitiligo. With this type, the discolored patches often progress similarly on corresponding body parts (symmetrically between the left and right body parts). This type is the most common.
• Segmental vitiligo. This type usually affects only one part or side of the body, tends to occur at a younger age, progresses for a year or two, then stops.
• Localized vitiligo. This type occurs in one or only a few areas of the body.
• Acrofacial vitiligo. With this type, the affected skin is on the face and hands, and around body openings, such as the eyes, nose, and ears.

It’s difficult to predict how this disease will progress. Sometimes the patches stop forming without treatment. In most cases, pigment loss spreads and eventually involves most of the skin. Occasionally, the skin gets its color back.

Diagnosis

The diagnosis of vitiligo is usually made through history, complaints, and examination. The doctor may ask for a history and complaints that precede or accompany vitiligo, including a history of medication use. The doctor will also make observations of the skin. In addition, patches may appear on healthy areas after certain injuries. This is known as the Koebner phenomenon. This phenomenon occurs in 20–60% of vitiligo patients.

The doctor may also perform a Wood's lamp examination. This lamp will emit long-wave ultraviolet light on the skin. In vitiligo patients, the skin that has lost its pigment will show a white color.

Laboratory tests may also be done. The doctor may take a small amount of skin tissue for a laboratory examination. This is called a biopsy. This examination can be done to see if there is a loss of melanocyte cells that causes vitiligo symptoms. Not only that, but other findings may indicate abnormalities in the skin.

In addition, the examination can be done to look for possible links between vitiligo and other conditions such as goiter (thyroid gland disorder), anemia (lack of red blood cells), poor nutrition, early graying, baldness, general body weakness, and so on.

Management

The treatment of vitiligo involves topical and systemic medications, phototherapy (light therapy), laser treatment, and surgery. Topical treatment modalities include:

• Corticosteroids
• Calcineurin inhibitors
• Vitamin-D analogs

Meanwhile, phototherapy can be effective in treating vitiligo because it induces the repigmentation of more melanin in the skin. If the size of the patch is not too large, your doctor may consider laser therapy.

Surgery treatment options are limited to segmental or localized vitiligo, which is limited to a small area. It involves the use of skin grafts that have melanocytes. The following patients are good candidates for surgical treatment:

• Segmental vitiligo
• Localized vitiligo involving small area
• Vitiligo in areas which usually do not re-pigment well (hairline, dorsal fingers, forehead, and ankles)
• The lesion must be stable

Complications

The course of vitiligo is difficult to predict. In some people, the skin color may return on its own (repigmentation). However, in some others, the skin color may disappear again (refractory).

The complications of vitiligo are social stigmatization and mental stress. In addition, as vitiligo is a loss of pigment, this loss can occur in the rainbow membrane of the eye, causing iritis. Not only that, skin that loses pigment is more prone to sunburn and is at risk of skin cancer.

People with vitiligo may also experience hearing loss because of the loss of cochlear melanocytes. Other complications are related to medications, like skin atrophy after prolonged use of topical steroids.

Prevention

Vitiligo is difficult to prevent due to its unknown cause and the influence of various factors. However, people with vitiligo need to be aware of sunburn. Therefore, vitiligo sufferers are advised to always wear sunscreen with a high sun protection factor (SPF) (e.g., SPF 30 or 50). If you feel very worried, embarrassed, or uncomfortable about your condition, you can talk to your doctor or consult a psychologist/psychiatrist. To prevent stress, you can also join a community or group of fellow vitiligo sufferers.

When to See a Doctor?

You can visit your doctor if you experience loss of skin color, the inside of your mouth and nose, or premature graying. Vitiligo cannot be cured, but treatment can stop or slow down the process of skin color loss and restore color to parts of the skin.

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