Causes And Treatments For Vitiligo

Causes And Treatments For Vitiligo
Vitiligo (vit-ill-eye-go) is a pigmentation disorder in which melanocytes (the cells

that make pigment) in the skin, the tissues that line the inside of the mouth and nose and

genital and rectal areas (mucous membranes), and the retina of the eyes are destroyed. As

a result, white patches of skin appear on different parts of the body. The hair that grows

in areas affected by vitiligo may turn white.

The cause of vitiligo is not known, but doctors and researchers have several different

theories. One theory is that people develop antibodies that destroy the melanocytes in

their own bodies. Another theory is that melanocytes destroy themselves. Finally, some

people have reported that a single event such as sunburn or emotional distress triggered

vitiligo; however, these events have not been scientifically proven to cause vitiligo.

About 1 to 2 percent of the world's population, or 40 to 50 million people, have

vitiligo. In the United States, 2 to 5 million people have the disorder. Ninety-five

percent of people who have vitiligo develop it before their 40th birthday. The disorder

affects all races and both sexes equally.

Vitiligo seems to be more common in people with certain autoimmune diseases (diseases

in which a person's immune system reacts against the body's own organs or tissues). These

autoimmune diseases include hyperthyroidism (an overactive thyroid gland), adrenocortical

insufficiency (the adrenal gland does not produce enough of the hormone called

corticosteroid), alopecia areata (patches of baldness), and pernicious anemia (a low level

of red blood cells caused by failure of the body to absorb vitamin B12). Scientists do not

know the reason for the association between vitiligo and these autoimmune diseases.

However, most people with vitiligo have no other autoimmune disease.

Vitiligo may also be hereditary, that is, it can run in families. Children whose

parents have the disorder are more likely to develop vitiligo. However, most children will

not get vitiligo even if a parent has it, and most people with vitiligo do not have a

family history of the disorder.

People who develop vitiligo usually first notice white patches (depigmentation) on

their skin. These patches are more common in sun-exposed areas, including the hands, feet,

arms, face, and lips. Other common areas for white patches to appear are the armpits and

groin and around the mouth, eyes, nostrils, navel, and genitals.

Vitiligo generally appears in one of three patterns. In one pattern (focal pattern),

the depigmentation is limited to one or only a few areas. Some people develop depigmented

patches on only one side of their bodies (segmental pattern). But for most people who have

vitiligo, depigmentation occurs on different parts of the body (generalized pattern). In

addition to white patches on the skin, people with vitiligo may have premature graying of

the scalp hair, eyelashes, eyebrows, and beard. People with dark skin may notice a loss of

color inside their mouths.

There is no way to predict if vitiligo will spread. For some people, the depigmented

patches do not spread. The disorder is usually progressive, however, and over time the

white patches will spread to other areas of the body. For some people, vitiligo spreads

slowly, over many years. For other people, spreading occurs rapidly. Some people have

reported additional depigmentation following periods of physical or emotional stress.

The change in appearance caused by vitiligo can affect a person's emotional and

psychological well-being and may create difficulty in getting or keeping a job. People

with this disorder can experience emotional stress, particularly if vitiligo develops on

visible areas of the body, such as the face, hands, arms, feet, or on the genitals.

Adolescents, who are often particularly concerned about their appearance, can be

devastated by widespread vitiligo. Some people who have vitiligo feel embarrassed, ashamed,

depressed, or worried about how others will react.

Several strategies can help a person cope with vitiligo. First, it is important to find

a doctor who is knowledgeable about vitiligo and takes the disorder seriously. The doctor

should also be a good listener and be able to provide emotional support. Patients need to

let their doctor know if they are feeling depressed because doctors and other mental

health professionals can help people deal with depression. Patients should also learn as

much as possible about the disorder and treatment choices so that they can participate in

making important decisions about medical care.

Talking with other people who have vitiligo may also help a person cope. The National

Vitiligo Foundation can provide information about vitiligo and refer people to local

chapters that have support groups of patients, families, and physicians. Family and

friends are another source of support.

Some people with vitiligo have found that cosmetics that cover the white patches

improve their appearance and help them feel better about themselves. A person may need to

experiment with several brands of concealing cosmetics before finding the product that

works best.

The goal of treating vitiligo is to restore the function of the skin and to improve the

patient's appearance. Therapy for vitiligo takes a long time--it usually must be continued

for 6 to 18 months. The choice of therapy depends on the number of white patches and how

widespread they are and on the patient?s preference for treatment. Each patient responds

differently to therapy, and a particular treatment may not work for everyone. Current

treatment options for vitiligo include medical, surgical, and adjunctive therapies

(therapies that can be used along with surgical or medical treatments).

Topical Steroid Therapy -

Steroids may be helpful in repigmenting (returning the color to white patches) the skin,

particularly if started early in the disease. Corticosteroids are a group of drugs similar

to the hormones produced by the adrenal glands (such as cortisone). Doctors often

prescribe a mild topical corticosteroid cream for children under 10 years old and a

stronger one for adults.

Psoralen Photochemotherapy -

Psoralen photochemotherapy (psoralen and ultraviolet A therapy, or PUVA) is probably the

most beneficial treatment for vitiligo available in the United States. However, it is

time-consuming and care must be taken to avoid side effects, which can sometimes be

severe. Psoralens are drugs that contain chemicals that react with ultraviolet light to

cause darkening of the skin. The treatment involves taking psoralen by mouth (orally) or

applying it to the skin (topically).

Pseudocatalase with Calcium Cream -

Catalase is deficient in areas of skin with vitiligo. Pseudocatalase cream is an

externally applied product that functions like catalase in that it is used to inhibit the

progression of pigment loss in vitiligo. It contains calcium chloride, manganese chloride,

sodium bicarbonate, and distilled water in a Vanicream Skin Cream (Vanicream is a

registered U.S. trademark of Pharmaceutical Specialties, Inc.). This formulation is not

commercially available. Pseudocatalase works by removing peroxides from vitiligo affected

skin. Peroxides are responsible for the destruction of melanocytes (pigment cells).

Depigmentation -

Depigmentation involves fading the rest of the skin on the body to match the already white

areas. For people who have vitiligo on more than 50 percent of their body, depigmentation

may be the best treatment option. Patients apply the drug monobenzylether of hydroquinone

(monobenzone or Benoquin*) twice a day to pigmented areas until they match the already

depigmented areas. Patients must avoid direct skin-to-skin contact with other people for

at least 2 hours after applying the drug. The major side effect of depigmentation therapy

is inflammation (redness and swelling) of the skin. Patients may experience itching, dry

skin, or abnormal darkening of the membrane that covers the white of the eye.

Depigmentation is permanent and cannot be reversed. In addition, a person who undergoes

depigmentation will always be abnormally sensitive to sunlight.

Surgical Therapies -

All surgical therapies must be viewed as experimental because their effectiveness and side

effects remain to be fully defined.

Sunscreens -

People who have vitiligo, particularly those with fair skin, should use a sunscreen that

provides protection from both the UVA and UVB forms of ultraviolet light. Sunscreen helps

protect the skin from sunburn and long-term damage. Sunscreen also minimizes tanning,

which makes the contrast between normal and depigmented skin less noticeable.

Cosmetics -

Some patients with vitiligo camouflage depigmented patches with stains, makeup, or

self-tanning lotions. These cosmetic products can be particularly effective for people

whose vitiligo is limited on exposed areas of the body. Dermablend, Lydia O'Leary,

Clinique, Fashion Flair, Vitadye, and Chromelin offer makeup or dyes that patients may

find helpful for covering up depigmented patches.

Counseling and Support -

Many people with vitiligo find it helpful to get counseling from a mental health

professional. People often find they can talk to their counselor about issues that are

difficult to discuss with anyone else. A mental health counselor can also offer patients

support and help in coping with vitiligo.

If a patient does not want treatment, that is, either repigmentation or depigmentation,

they can avoid being out in the sun and keep the skin as light as possible so that the

Vitiligo is not so noticeable.

In the future, treatment for Vitiligo may involve immunosuppression and autologous

pigment cell transplantation.