Vitiligo

Vitiligo is a condition in which a loss of cells that give color to the skin (melanocytes) results in smooth, white patches in the midst of normally pigmented skin.

Description

Vitiligo is a common, often inherited disorder characterized by areas of well-defined, milky white skin. People with vitiligo may have eye abnormalities and also have a higher incidence of thyroid disease, diabetes mellitus, and pernicious anemia. Vitiligo affects about 1-2% of the world's population. It is more easily observed in sun-exposed areas of the body and in darker skin types, but it affects any area of the body and all races. Vitiligo seems to affect men and women equally, although women more frequently seek treatment for the disorder.

Vitiligo may appear as one or two well-defined white patches or it may appear over large portions of the body. Typical sites for generalized vitiligo are areas surrounding body openings, bony areas, fingers, and toes. It can begin at any age but about 50% of the time it starts before the age of 20.

Causes and symptoms

Vitiligo is a disorder with complex causes. People with vitiligo seem to inherit a genetic predisposition for the disorder, and the appearance of disorder can be brought on by a variety of precipitating causes. Many people report that their vitiligo first appeared following a traumatic or stressful event, such as an accident, job loss, death of a family member, severe sunburn, or serious illness. There are at least three theories about the underlying mechanism of vitiligo. One theory says nerve endings in the skin release a chemical that is toxic to the melanocytes. A second theory states that the melanocytes simply self-destruct. The third explanation is that vitiligo is a type of autoimmune disease in which the immune system targets the body's own cells and tissues.

The primary symptom of vitiligo is the loss of skin color. Hair growing from the affected skin areas also lacks color. In addition, people with vitiligo may have pigment abnormalities of the retina or iris of the eyes. A minority of patients also may have inflammation of the retina or iris, but vision is not usually impaired.

Diagnosis

The diagnosis of vitiligo is usually made by observation. Progressive, white areas found at typical sites point

Loss of pigmentation is one characteristic of vitiligo, as seen on this woman's hand. (Custom Medical Stock Photo. Reproduced by permission.)

to a diagnosis of vitiligo. If the diagnosis is not certain, the doctor will test for other conditions which can mimic vitiligo, such as chemical leukoderma or systemic lupus erythematosus. If the tests rule out other conditions, vitiligo is confirmed.

Treatment

Vitiligo cannot be cured, but it can be managed. Cosmetics can be used to improve the appearance of the white areas not covered by clothing. Sunscreens prevent burning of the affected areas and also prevent the normal skin around the patches from becoming darker. Skin creams and oral medications are available for severe cases, but they have side effects that may make them undesirable. Autologous transplantation of skin is an option for those who are severely affected. Bleaching or depigmentation of the normal skin is another option.

In addition to treating the skin, attention should be paid to the psychological well-being of the individual. Extreme cases of vitiligo can be unattractive and may affect a person's outlook and social interactions.

Prognosis

The condition is usually gradually progressive. Sometimes the patches grow rapidly over a short period, and then the condition remains stable for many years.

Prevention

No measures are currently known to prevent vitiligo.