WHAT IS VITILIGO?
‘Own your vitiligo, don’t let your vitiligo own you’
Vitiligo is a skin disease that causes your skin to ‘depigment’, or lose its natural colour and become white.
This means that white patches appear on your skin, where your melanocytes get destroyed. Melanocytes are the cells that produce melanin, which not only gives your skin its colour but also protects it from the sun’s UV rays.
The disease can be slow-moving – you get one small patch on an unobtrusive place and it doesn’t change much.
Or it can progress very quickly – your skin loses colour rapidly and eventually you become 100% depigmented, or white.
Vitiligo is called a ‘chronic’ condition.
This means that there are treatments that can slow its progress and even give you back some pigment, and there are things you can do to manage it, but at the moment you cannot cure it completely. It will be with you for life.
TYPES OF VITILIGO
There are two types of vitiligo.
The most common is called non-segmental vitiligo.
You may have seen the model, Winnie Harlow, who has very distinctive non-segmental vitiligo. Around 90% of the people who have vitiligo will have this type.
Non-segmental vitiligo is:
Symmetrical – it shows up on both sides of your body in the same places and patches appear on your body in a mirror image
Appearance – it can appear first on any part of your body, but commonly appears on areas that are exposed to sun, for example the face, hands or feet or in skin folds, for example in the armpits. On the face it commonly appears first around the mouth and eyes. It is also very common to have vitiligo develop on the genitals and penis.
Pressure points – vitiligo also can appear in areas where there has been pressure or a cut on or to your skin. This is called the “Koebner phenomenon”. You may be advised to avoid tight clothing or shoes, but this is often not easy.
Skin texture – the skin affected by vitiligo remains smooth and unraised. The boundaries around patches of vitiligo may darken, or your remaining unaffected skin may darken, highlighting your white patches.
Treatment – the aim of treatments (see the section devoted to this) is to re-pigment, or get the colour back into, your white patches. It may not be possible to get all of the colour back on your body.
However you may respond well to treatment, and it is certainly worth exploring with both your GP and a dermatologist what options are available to you.
Research has shown that there are four conditions for a better outcome for treating someone’s vitiligo, which are: to treat the Face, treat Children, treat in the condition’s Early Phase, and treat Smaller Lesions
The difficulty is that no treatment has been shown to get back all of your natural skin colour, and often the vitiligo reappears again later.
 Report by A. Sasase, C Hihiro Honda and K Hayashibe Of the Shibata Clinic of Dermatology, Osaka at The XXIst International Pigment Cell & Melanoma Conference, 2011
For more information on ‘Treatments’ see our section covering this.
Segmental vitiligo is:
Less common, occurring in around 10% of reported cases.
Generally, more stable and develops less erratically
Responds well to treatments that are applied to the skin like creams or ointments.
Appears in areas of skin present over the nerves that come out of the dorsal roots of the spine.
The cause of vitiligo can be one of number of things. Research is still needed into the exact cause of the disease, although there are a number of explanations:
Auto-immune activity in the body – your body’s immune system may attack your healthy melanocyte cells and lead to the loss of pigment. Evidence for auto-immunity being the cause of vitiligo is partly proved by its association with other auto-immune disorders, for example, people with vitiligo may also have auto-immune hypothyroidism. It is also associated with Addison’s Disease and Type One Diabetes.
In an article for GPonline, Dr Viktoria Eleftheriadou noted that “In one study, a history of autoimmune thyroid disease was found in 34% of patients with vitiligo, suggesting that checking thyroid function or presence of autoantibodies to thyroid antigens may be helpful in the management of vitiligo in patients with suggestive symptoms or a personal/family history” A link to the article with references is in the “Something of Interest” section below.
Stress – there is no scientific study that directly links a patient’s experience of stress with the development of vitiligo, but many patients anecdotally report that they went through a period of stress and then their vitiligo either first appeared or grew in size.
Genetic Oxidative Stress – many women will know about ‘free radicals’ and their role in causing skin damage generally. The medical view of oxidative stress and its role in vitiligo is still under study, and not entirely clear. The idea behind it is that some people have an imbalance in their ‘oxides’, the oxygen-derived free radical in our bodies, and have a genetic predisposition to respond badly to its action on the skin.
Inheritance – some people have close relatives who also have vitiligo. It is not, however, a foregone conclusion for a child to get vitiligo if their parent has it.
Skin trauma or the Koebner phenomenon – a trauma to the skin, from a cut, sunburn, or pressure from clothes, jewelry or shoes, can lead to vitiligo developing in the area of affected skin. Skin may also become damaged by exposure to chemicals.
Genetics – according to the U.S National Library of Medicine, an increased risk of developing vitiligo has been associated with variations in over 30 genes, occurring in different combinations. The Library states: “Two of these genes are NLRP1 and PTPN22. The NLRP1 gene provides instructions for making a protein that is involved in the immune system, helping to regulate the process of inflammation. Inflammation occurs when the immune system sends signaling molecules and white blood cells to a site of injury or disease to fight microbial invaders and facilitate tissue repair. The body then stops (inhibits) the inflammatory response to prevent damage to its own cells and tissues.The PTPN22 gene provides instructions for making a protein involved in signaling that helps control the activity of immune system cells called T cells. T cells identify foreign substances and defend the body against infection.
The variations in the NLRP1 and PTPN22 genes that are associated with an increased risk of developing vitiligo likely affect the activity of the NLRP1 and PTPN22 proteins, making it more difficult for the body to control inflammation and prevent the immune system from attacking its own tissues.”
MIGHT IT BE ANYTHING ELSE?
Patients who go to the doctor with a small patch of white skin may also have other conditions, and not vitiligo. The main other conditions that cause depigmented skin are:
Two conditions that commonly cause depigmented skin are Tinea Versicolor or Pityriasis Versicolor.
Tinea Versicolor: This condition is a common fungal infection of the skin that causes small areas of either lighter or darker skin. It usually affects teenagers and young adults. If the skin is darker, it may well also be scaly.
Tinea versicolor is treatable with antifungal creams or shampoos.
Pityriasis Alba: This may also cause some small amount of loss of skin colour.
The condition is a mild form of eczema and is again generally seen in young people. It produces produces patches on the skin that are usually scaly, respond well to moisturizing creams and the patient regains their skin colour in due course.
SOMETHING OF INTEREST:
You may be interested to read the guidance given to General Practitioners in the UK via GPonline. This was written by a long-term supporter of vitiligo patients amongst the medical profession, Dr. Viktoria Eleftheriadou. She is currently involved in the Hi-Light trial at Nottingham Centre for Evidence Based Dermatology, and wrote the Cochrane Review on Vitiligo.
Read the guidance here and note in particular the recommendation to offer psychological support to all patients.