Vitiligo: Causes, Symptoms & Treatment

Facts about Vitiligo

Vitiligo is a medical condition of the skin where there is loss or absence of melanin, a pigment, which is responsible for the color of the skin, eyes and hair.

Vitiligo in individuals with darker skin is more noticeable; however, people from different races can also be affected by this condition.

Vitiligo begins as small areas of pigment loss which increases slowly.

It is difficult to predict the natural course of vitiligo. In some cases, the formation of patches stops without any treatment. However, in majority of the cases, pigment loss increases and ultimately involves the majority of the skin surface.

Vitiligo is commonly seen in individuals aged 10 to 30 years; although people from any age can be affected by it.

As of now, vitiligo has no cure. The aim of treatment is to stop or slow down the pigment loss and try to bring back some color to the skin.

Treatment can take anywhere between 6 to 18 months. Patient needs to try multiple treatment modalities before finding the one treatment which benefits him/her.

Causes of Vitiligo

Vitiligo occurs when melanocytes, which are the cells which produce melanin, either fail to make melanin or if they are dead.

Melanin is the pigment which lends color to the skin, hair and eyes. Any problem with the production of the melanin results in the affected patch of the skin turning white.

According to the experts, this could be due to an immune system disorder.

Having a family history also puts you at an increased risk for having vitiligo.

There are some cases, where vitiligo appeared after the patient suffered sunburn or some mental distress.

Individuals with melanoma can also have pigment loss. However, no cause has been proved conclusively.

Symptoms of Vitiligo

  • Primary symptom is the loss of pigment resulting in irregular, milky-white patches, which gradually grow in size.
  • Premature graying/ whitening of the hair, eyebrows, eyelashes or beard.
  • Loss or alteration of color in the retina.
  • Loss of color in the mucous membranes which line the inside of the mouth.

Vitiligo or de-pigmentation often begins in those regions of the body which are exposed to sun the most, like hands, arms, feet, lips and face.

Treatment for Vitiligo

Treatment is done according to the number, location and size of the white vitiligo patches.

In some cases, treatment may not be required and the patient gets his/her skin color back without any treatment.

Self-measures like applying sunscreen and creams for camouflaging the white patches help in the overall appearance of the skin.

In individuals who are fair-skinned, their patchy areas can be almost unnoticeable if they avoid tanning. Treatment for vitiligo comprises of balancing the skin tone by restoring color through pigmentation or by destroying the remaining color.

Vitiligo Treatment Includes:

  • Corticosteroids:

Topical corticosteroids are an effective treatment which is also easy to use, but the patient needs to be monitored closely for side effects, which include skin thinning, skin striae etc.

Topical corticosteroid application works by restoring the skin color, i.e. re-pigmentation. Corticosteroid therapy especially works if it’s started early on in the disease.

For children, mild topical corticosteroid cream/ointment is prescribed. It may take some months before the results of this treatment are seen.

  • Vitamin D derivatives:

Vitamin D derivatives such as calcipotriene can also be used topically and also along
with corticosteroid therapy or UV light.

  • Topical Immunomodulators:

Topical Immunomodulators which have pimecrolimus or tacrolimus are beneficial if the de-pigmentation areas are small, particularly on face and neck.

The side effects are lesser than corticosteroid treatment.

This treatment can also be used in conjunction with ultraviolet B treatment; however, there is no data to support if this treatment is effective.

There is also a risk of skin cancer and lymphoma with this treatment.

  • Topical PUVA or Psoralen Plus Ultraviolet A :

Topical PUVA or Psoralen Plus Ultraviolet A, also known as photochemotherapy, is also an option especially if the de-pigmented patches on the body are less than 20 %.

This treatment makes skin more sensitive to the UV light.

There is also a variation of this treatment, which is known as water bath PUVA, where the patient lies in a tub of water for 15 minutes, which has psoralen in it, after which the patient is exposed to light.

Potential side effects of this treatment are acute sunburn, blistering. These side effects can be minimized by avoiding direct sunlight after the treatment.

  • Oral PUVA or Oral psoralen photochemotherapy:

Oral PUVA or Oral psoralen photochemotherapy is used when the de-pigmented areas are more than 20 % of the body.

In this treatment, oral psoralen is taken around two hours before UVA light exposure. Natural sunlight can also be used.

Short term side effects include: Sunburn, itching, nausea, vomiting, skin over-darkening and abnormal hair growth.

If this treatment is used for prolonged periods of time, then it increases the risk of skin cancer.

This treatment is not recommended for children below 10 years, as there is an increased risk of eye damage, such as cataracts.

  • Narrowband UVB (ultraviolet B) therapy :

Narrowband UVB (ultraviolet B) therapy utilizes a special type of UVB light with a specific wavelength of UV- B.

This treatment can be used instead of PUVA.

There is no need of psoralen pre-application, thus making this treatment more simple and easy.

Research is being done to find out if its effectiveness surpasses the PUVA treatment and the long-term safety of this treatment.

  • Excimer laser:

Excimer laser comprises of controlled beams of UVB light with a specific wavelength directed at the skin. This treatment can be used for mild cases of vitiligo and is usually done along with topical drugs.

Side effects include blistering and redness.

  • De-pigmentation therapy:

De-pigmentation therapy is used for vitiligo present over more than half of the skin. De-pigmentation treatment works by lightening the unaffected areas of the skin, so that it matches the affected areas, which have lost its natural color.

Application of monobenzone ether of hydroquinone to the pigmented or unaffected areas is done twice a day and this treatment is continued until the unaffected areas of the skin match the vitiligo covered patches on the skin.

Potential side effects of this treatment include swelling, redness, dry skin and itching.

Self-Measures for Vitiligo

  • Patients with vitiligo, especially those who are fair skinned, must use a sunscreen with a minimum SPF of 30 before stepping out in the sun.
  • The vitiligo patches can be camouflaged by using concealing cosmetics to give a normal appearance to the skin.
  • Self-tanners/ sunless tanning products can also be used to conceal the patches by adding color to the affected areas. This color won’t wash off; however, it tends to gradually fade when the dead skin cells get replaced.