What is Vitiligo?

Causes of Vitiligo

Vitiligo occurs when melanocytes, the skin cells responsible for producing melanin, are insufficient in number or dysfunctional. Melanin provides skin and hair with their natural colouration. In individuals with vitiligo, the inadequate functioning of melanocytes leads to reduced melanin production. This results in the development of white patches on the skin and hair. Several factors contribute to the onset of vitiligo, including:

1. Autoimmune conditions

Vitiligo is often associated with autoimmune disorders, where the immune system mistakenly attacks and destroys melanocytes. This autoimmune link suggests a genetic predisposition combined with environmental triggers.

2. Family history (heredity)

A significant risk factor for vitiligo is having a family member with the condition or other autoimmune diseases. This indicates a genetic susceptibility to autoimmune reactions that affect melanocytes.

3. Triggers

Various environmental and physiological factors can trigger or exacerbate vitiligo:

• Stressful events: Emotional stress or physical trauma like childbirth can induce or worsen vitiligo through mechanisms like the Koebner response (where skin damage leads to new patches).
• Skin damage: Severe sunburns, cuts, or abrasions that disrupt skin integrity can initiate vitiligo in susceptible individuals.
• Hormonal changes: Puberty or hormonal fluctuations may influence melanocyte function.
• Health conditions: Issues with liver or kidney function, as well as exposure to certain chemicals, are also implicated as potential triggers.

Risk factors of vitiligo

Vitiligo can affect anyone and can develop at any age. However, for many people with vitiligo, the white patches begin to appear before age 20 and can start in early childhood. Certain factors that may increase the risk of developing vitiligo, include:

• Family history: Individuals with a family history of vitiligo or other autoimmune diseases are more susceptible.
• Autoimmune diseases: Conditions such as Addison’s disease, anemia, type 1 diabetes, lupus, psoriasis, rheumatoid arthritis, and thyroid disorders are associated with an increased risk of vitiligo. Having these autoimmune diseases or having a family member who does can elevate the likelihood of developing vitiligo.

Key Facts of Vitiligo

Major Symptoms	Milky-white depigmented patches on the skin White or grey hair Mucous membrane (loss of pigment in mouth and nose)
Necessary Health Tests	Visual examination Family history Skin biopsy
Treatment	Topical creams (corticosteroid creams, calcineurin Inhibitors, calcipotriene) Phototherapy (light therapy) Depigmentation therapy Drugs Surgical treatments (skin grafting, blister grafting, melanocyte transplantation, micro pigmentation)

Symptoms of Vitiligo

The main symptom of vitiligo is a loss of natural skin colour or pigment, called depigmentation. The first symptom or white spot, that becomes noticeable is usually around the area of a sunburn or minor injury. Initially, patches can be small, pale spots that gradually turn white over time. These patches vary in size and shape and can occur anywhere on the body. In some cases, the edges of these patches may be inflamed and cause itchiness. Here are common symptoms of vitiligo:

1. Patches on skin

While vitiligo patches can appear anywhere on the body, they commonly first appear on areas exposed to sunlight, such as the hands, face (especially around the eyes and mouth), and arms. However, they can also develop in less exposed areas like the feet and genitals. These patches are typically milky-white in colour and become more noticeable over time as the affected areas lose more pigment.

2. White or grey hair

Vitiligo can also affect hair colour. In areas where the skin loses pigment, hair growing from those areas can turn white or grey. This can occur on the scalp, eyebrows, eyelashes, beard (in men), and body hair. The change in hair colour is due to a lack of melanin production in the hair follicles.

3. Mucous membrane

In addition to skin and hair, vitiligo can also affect mucous membranes, such as the inside of the mouth and the nose. These areas may lose pigment, resulting in patches of lighter colour. This can sometimes be one of the early signs of vitiligo.

You will often lose pigment quickly in several areas of your skin. After the white patches appear, they may stay the same for a while but get bigger later.

Diagnosis of Vitiligo

The diagnosis of vitiligo typically involves various options, such as a visual examination, family history, and skin biopsy.

1. Visual examination

The primary method of diagnosing vitiligo is a visual examination of the skin by a dermatologist or healthcare provider. The doctor may try to evaluate the characteristic depigmented patches on the skin. These patches are typically white or lighter than the surrounding skin due to the absence of melanin.

In some cases, a Wood’s lamp (black light) examination may be used. This special ultraviolet lamp can help detect depigmented areas that may not be easily visible under normal light.

2. Family history

Since vitiligo can be genetic, dermatologists often ask you about your family history. A positive family history of vitiligo increases the likelihood of an individual developing the condition. Vitiligo is associated with autoimmune disorders, so a history of other autoimmune conditions in the family may also be relevant. Apart from this, skin type (especially sensitive skin), and any injuries or trauma to areas where patches are visible are also examined to understand potential triggers or exacerbating factors.

3. Skin biopsy

A skin biopsy involves taking a small sample of affected skin for microscopic examination. This can help determine if there are any abnormalities in the skin structure, which can help confirm the diagnosis of vitiligo.

While a skin biopsy is not always necessary for diagnosing vitiligo, it may be performed in certain cases:

• To confirm the diagnosis when the clinical presentation is unclear.
• To rule out other skin conditions that may mimic vitiligo, such as post-inflammatory hypopigmentation or other pigmentary disorders.

Early diagnosis is crucial for starting appropriate treatment and managing the condition.

Treatment of Vitiligo

Treatment for vitiligo aims to restore pigmentation to the areas with milky-white patches, help melanocytes grow back and slow down the progression of vitiligo. It might take some time for the treatment to work and you might get new patches during this time. Common treatments for vitiligo include:

Medical treatment

1. Topical creams

• Corticosteroid creams: These reduce inflammation and can help repigment affected areas. Side effects may include acne lesions and skin thinning.
• Corticosteroid pills or injections: For rapidly progressing cases.
• Calcineurin Inhibitors: These creams also reduce inflammation and can be used in sensitive areas.
• Calcipotriene (Vitamin D Analog): Helps stimulate melanocyte function.

2. Phototherapy

Also called light therapy, it uses UVA light treatments to slow or stop the progressions of your vitiligo. This treatment option is performed with a combination of medicines your doctor prescribes to manage vitiligo.

3. Depigmentation therapy

In cases of extensive vitiligo, depigmentation therapy may be an option to lighten unaffected skin for a more uniform appearance. Doctors usually recommend this treatment for people who have vitiligo on more than half of their bodies. During this treatment, the patient may experience swelling, redness, itching, and dry skin.

4. Drug

While there is no specific medicine to treat or stop vitiligo, steroid drugs may be effective in treating vitiligo.

Surgical treatments

Procedures such as skin grafting, blister grafting, and melanocyte transplantation are considered for stable vitiligo patches that are not responsive to other treatments.

• Skin grafting: Involves transplanting healthy skin to areas with stable vitiligo patches.
• Blister grafting: Uses blisters raised on normally pigmented skin, which are then transplanted to vitiligo-affected areas.
• Melanocyte transplantation: Transfers melanocytes from healthy skin to depigmented areas.
• Micropigmentation: Tattooing to match the colour of surrounding skin.

Other therapies and management options

• Sunscreen: The lighter patches of skin are especially sensitive to sunlight, and they can burn quickly. Therefore, a dermatologist can advise you to use a suitable type of sunscreen.
• Skin camouflage: While many people feel comfortable about their vitiligo looks, it may not be comfortable for everyone with the condition. In cases of mild vitiligo, a person can camouflage the white patches with coloured cosmetic creams and makeup. They can select tones that best match their skin tone.

If you and your healthcare provider opt for drug, surgical, or therapeutic treatment for vitiligo, it can take several months to judge its effectiveness. It is common to try multiple approaches or a combination before finding the most effective treatment. Even if initial treatment succeeds, results may not be permanent, and new patches could develop. Your healthcare provider might recommend ongoing skin applications of topical creams to help maintain results and prevent relapse.