What is Vitiligo?
Vitiligo is a skin disorder in which patches of the skin lose their color. It is a lifelong problem that could affect any body regardless of your age, gender or ethnicity. About 1% of people in the world is affected by vitiligo with more than a hundred thousand cases each year in Nigeria. The growing patches develop when melanocytes responsible for production of the skin’s pigment known as melanin dies off or stops functioning or is destroyed by the body’s immune system.
The total area of skin that can be affected by vitiligo differs between individuals. Asides the skin, vitiligo affects the eyes, the hair and also underneath the mouth. In most cases, the areas of the body affected stays discolored and becomes a long-term disorder.
This condition is photosensitive which means that the affected areas of the body becomes more sensitive to sunlight. Predicting if the patches on the skin will spread or how it progresses with time is not easily detected but the spread could last for weeks or could remain normal for months or even years.
Patches tend to be more visible in dark or tanned skinned people when they are lighter. In most places, vitiligo appears in a more symmetrical pattern. Studies show that vitiligo is more likely to start at the age of 20 years.
Types of Vitiligo
There are basically two types of vitiligo.
· Non-segmental Vitiligo
· Segmental Vitiligo
This is when the first white patches are symmetrical. For instance, the patches are arranged proportionally. The development of this type will be much slower than if only one area of the body is affected. This is the most common type of vitiligo as 90% of vitiligo cases fall under this category.
Here, the patches are often equal on both sides of the body. Most times, the skin is the most commonly affected area as it is usually always exposed to the sun such as the face, neck and hands.
Other common areas include:
· Back of the hands
· Genitals and rectal area
This type is further categorized into five.
· Generalized: This is the most common type as there is no specificity of area to be affected or the size of the patches.
· Acrofacial: This affects the fingers or toes mostly.
· Mucosal: This is mostly seen around mucous membranes and lips.
· Universal: It’s a rare type as it covers most of the body parts.
· Focal: This develops in hidden areas with few white patches scattered. Often develops in young children.
This type progresses very fast and is more constant, normal and less consistent than the non-segmental type. It affects about 10% of the people with vitiligo as it is less common. It is non-symmetrical. It is usually more obvious in early age groups with 30% of children with vitiligo being affected. Segmental areas affects areas of skin connected to spinal nerves.
Symptoms of Vitiligo
Vitiligo has just one symptom which is appearance of flat white spots or patches on the skin.
The first white spot that becomes obvious is often an area of the body that tends to be exposed to the sun. It starts with a single spot which is usually a little lighter than other areas of the skin. However, as time progresses, it becomes paler until it finally turns white.
Patches on the skin are usually irregular in shape. However, these patches don’t cause any discomfort, irritation, soreness or dryness in the skin.
The effects of vitiligo differ between people. Some may have few white dots or patches while others may have larger white patches that affect much areas of skin or the body.
Facts about Vitiligo
· In India, vitiligo is referred to as “white leprosy”.
· Dark skinned people are more likely to encounter problems associated with social stigma because the contrast is greater and more evident than fair skinned people.
· There is no cure yet for this condition.
Causes of Vitiligo
The exact causes of vitiligo are still unknown.
Below are contributing factors:
· Exposure to chemicals
· Sunburn or cut
· Genetic oxidative stress imbalance
· Autoimmune disorder (whereby immune system destroys the melanocytes)
Vitiligo does not develop into other diseases but people diagnosed with this condition may have chances of experiencing:
· Painful sunburn
· Loss of hearing
· Eye problems such as changes to vision and production of tears
· Autoimmune disorder such as thyroid problems, type 1 diabetes, pernicious anemia etc.
Treatment of Vitiligo
According to the American Academy of Dermatology (AAD), Vitiligo is referred to as “more than just a cosmetic problem”. It is a health issue that requires urgent medical attention and care. There are several remedies that can help reduce the severity of this condition.
· Using sunscreen: Due to the patches of skin being sensitive to sunlight, they could get burnt easily. This treatment is highly recommended by the AAD.
· Phototherapy treatment options with UVB or UVA light: UVB light can be done at home which requires a small lamp daily or clinic which could last two or three times a week for a long time. UVA light is done in an healthcare center where a drug that increases the sensitivity of the skin to UV light is administered followed by high dose of UVA light. This could last up to 6-12 months twice a week before outcomes becomes evident.
· Skin Camouflage: In mild cases of vitiligo, some of the white patches can be camouflaged with colored cosmetic creams and makeup with tones that best matches the individual’s skin features. If creams and makeup are properly used, they can last for a long time.
· Depigmentation: This treatment is best suitable a widespread of an affected area covering about 50% of the body or more. It reduces the skin color in areas not affected to match paler patches or areas.
· Strong topical lotions or ointments such as menobenzone, mequinol etc. Here, treatment is permanent but can weaken the skin. Prolonged exposure to the sun should be prevented. This may last for a period of 12-14 months which can be influenced by factors such as the depth of original skin tone.
· Topical Corticosteroids: They are creams that are made up up of steroids. Some studies have it that application of topical corticosteroids to white patches on the skin can stop the spread. Corticosteroids should never be applied on the face.
Other treatment options include:
· Drugs that affect immune system such as Calcineurin inhibitors and ointments containing pimecrolimus or tacrolimus can help with smaller patches of depigmentation.
· Psoralen: This may be used in combination with UVA or UVB light therapy because it makes the skin more likely to be affected by UV light. Treatment may be repeated 2-3 times a week for a period of 6-12 months. It is not recommended for children below the age of 10 years.
· Skin grafts: Here, healthy patches of pigmented skin are used to cover affected areas. This method isn’t too common as it takes time and could cause side effects.
· Tattooing: Here, a surgery is conducted to Implant pigment into the skin. Best suitable for usage around the lips and in dark skinned people.
· Calcipotriene (Dovonex): It is a form of Vitamin D which can be applied as a topical ointment. It may be used alongside light treatment or corticosteroids. Side effects include rashes, dry and itchy skin.
Visible skin patches could come with a social stigma that can be very difficult to cope with. This can further lead to low self-esteem, anxiety and depression.
Anyone with this condition who experiences the above problems associated with the social stigma of vitiligo can talk to people who also have vitiligo or someone who can help.
Several treatment options are available to treat vitiligo. However, many people choose not to treat it. It is important to note that there is no treatment that can fully re-pigment the skin.