What is Vitiligo?

Vitiligo is a skin disorder that causes loss of skin colour in patches leading to the development of white patches on the skin. Any location on the body can be affected including the hair and even inside the mouth. Normally, the colour of our skin and hair is determined by a substance known as melanin. Vitiligo occurs when the cells that produce melanin stop functioning or get destroyed.

Vitiligo affects 1-2% of the population worldwide and it doesn’t matter if you are a male or a female. This condition can affect people of all skin types, but it is more noticeable in people with darker skin. It can occur at any age but most commonly appears during the age of 10-30 years. The condition is not life-threatening or contagious but it can cause significant stress and other psychological and social issues.

What are the signs and symptoms?

Vitiligo usually starts as a light coloured or pale patch of skin which gradually loses its colour completely and becomes white. The condition varies from person to person. Some people develop only a few white patches while others develop big white patches which may spread across large areas of their skin. The hair over different parts of the body may also lose colour and become white. After the white patches appear, they may remain the same for some time (stable) or they might get bigger and develop in new areas (unstable). You may have cycles of stability and instability. It is rare for the pigment to return once the white patches have developed unless the area is treated by a doctor.

Although any part of the skin can be affected, some of the commonly affected areas are:

Face
Fingers and wrists
Arms and Legs
Places that have been injured in the past
Genitals
Body folds (like armpits)
Areas around a mole
Inside your mouth
Eyelids and Hair

What are the types of Vitiligo?

Generalized Vitiligo: This is one of the most common types in which white patches show up all over your body.
Focal Vitiligo: The white patch occurs in one area and doesn’t spread to other parts.
Segmental Vitiligo: When the condition is confined to one area of your body, like your face or your hands. It occurs only on one side of the body (unilateral).
Universal Vitiligo: This is a rare type in which at least 80% of the skin is discoloured.
Trichrome Vitiligo: This is seen when there is an area of white skin, followed by an area of lighter discolouration, followed by regular-colour skin.

What causes Vitiligo?

A substance known as melanin is produced by skin cells called melanocytes, and it gives your skin its colour. Vitiligo is caused by the lack of the pigment, melanin which causes white patches to develop on your skin or hair. Although the actual cause is still unknown, there are a few different theories:

Autoimmune disorder: The person’s own immune system may develop antibodies that go on to destroy the melanocytes.
Genetic factors: Vitiligo has a higher chance of being inherited. About 30% of the cases run in families.
Neurogenic factors: The nerve endings in the skin may secrete a substance that may damage the melanocytes. This is seen in segmental vitiligo.
Self-destruction: A defect in the melanocytes causes them to destroy themselves.

What are the Risk Factors?

Other members of your family have it.
A disorder of the immune system (an autoimmune condition).
Family history of autoimmune conditions.

Triggers

Physical or emotional stress.
Stressful events, such as childbirth.
Skin damage, such as severe sunburn.
Skin damage, such as accidents or cuts (this is known as the Koebner response).
Exposure to certain chemicals – for example, at work.

Is Vitiligo Hereditary?

Vitiligo is not necessarily inherited, it can occur even in a person spontaneously without any family member being involved. However, around 30% of people who have vitiligo have at least one close relative who also has vitiligo so there is a higher chance of getting vitiligo if your family member is involved.

Is Vitiligo Contagious?

No, vitiligo is not contagious. A person with vitiligo is perfectly normal and only has a change in the colour of the skin. It cannot spread to another person who is in close contact or through touch. It is important to educate ourselves about the disorder so that we do not create any social barriers for those who are affected.

What problems are associated with vitiligo?

Although vitiligo is mainly a cosmetic condition, people with the condition may experience a variety of problems:

Higher chance of sunburn: Because of a lack of melanocytes, vitiliginous skin is more sensitive to sunlight than the rest of the skin.
Autoimmune diseases: Certain conditions in which the body’s immune system causes it to attack itself e.g. hypothyroidism, diabetes, pernicious anaemia, Addison’s disease, and alopecia areata.
Eye changes: Usually, there may be some retinal abnormalities or some variation of colour in the iris (the coloured part of the eye). In some cases, there may be inflammation of the retina or iris, but the vision is usually not affected.
Embarrassment or anxiety: People may feel anxious or embarrassed about their skin. Sometimes people may stare or say unkind things which could cause a person with vitiligo to develop low self-esteem or hurtful feelings. This, in turn, could lead to depression issues and make someone feel isolated. You should talk to your healthcare provider or your family and friends to help you find a solution.
Social or psychological distress: Vitiligo is a social disorder. More than the disorder itself, it is the society we live in which usually causes greater harm by making the person affected feel like an outsider. It is important to educate everyone about the condition and make them understand.
Hearing loss: It happens only in rare cases due to the loss of pigment in the inner ear.

Is there a cure?

Although vitiligo has no cure, prompt treatment might slow or stop the discolouring process and return colour to the existing patches on your skin.

When to see a doctor?

A skin specialist should be consulted who can help to diagnose the condition as well as provide appropriate treatment options.

Need to differentiate it from other skin conditions which cause loss of colour.
Your skin, hair or mucous membranes (inner lining of mouth, nose etc.) begins to lose colour.
Development of new patches or increase in the size of old patches.
Development of new patches on areas of skin injury like cuts or trauma.
Emotional effects of sadness or depression due to the existing white patches.
The cosmetic concern of the person.

Diagnosis

A skin specialist will be able to diagnose vitiligo after examining the affected areas of the skin. Usually, the physical examinations are sufficient for a dermatologist to diagnose the condition which can then be confirmed by Wood’s lamp examination. Be sure to mention all the relevant facts and ask any questions which you may have on your mind like:

Is there is a history of vitiligo in your family?
Is there is a history of other autoimmune conditions in your family?
Are new lesions developing at the site of injury?
Do you tan or burn easily in the sun?
Has any area of skin gotten better or worse?
Have you tried any treatments already?
What impact vitiligo has on your life? E.g. How much it affects your confidence and self-esteem, and whether it affects your job.

Wood’s lamp

It is an ultraviolet (UV) lamp that is used to look at your skin in more detail. It has to be performed in a dark room and the lamp will be held in front of your skin. If the patches are due to vitiligo, there will be a chalky white accentuation which your skin specialist will be able to distinguish.

Blood Tests

If your doctor is suspecting any other associated diseases e.g. autoimmune disorders or if your doctor wants to start certain medicines then he/she may advise you to undergo certain blood tests.

Skin biopsy

It can confirm the diagnosis but it is rarely done these days because the Wood’s Lamp examination is a gold standard with high accuracy.

Treatment

The treatment for vitiligo can be divided into 4 parts.

Diet and lifestyle modifications.
Natural Remedies
Medical Management
Surgical Management

To know more about the various treatment options, you can visit this link – Treatment of Vitiligo

To read about various myths and FAQs about the condition, you can visit this link – Myths and FAQs about vitiligo.