Imagine a Jackson Pollock painting on someone’s skin—random patches and spots where the color just disappears. That's vitiligo, a skin disorder that mercilessly steals away pigmentation, leaving behind a mosaic of lighter or non-pigmented areas. It affects approximately 74 million individuals worldwide. In this article, I, Dr. Alpana, MD, DNB, a clinical dermatologist extraordinaire (sorry, my team insists that I write this), discuss the basics of vitiligo and uncover some common myths. I also cover the various treatment modalities and the strides medical research has made.
Tables of Contents
What is Vitiligo?
Vitiligo is a chronic skin disorder characterized by the destruction of melanocytes, the cells responsible for skin color. This results in the loss of skin pigment, melanin, leading to the appearance of white patches or areas devoid of color.
These depigmented areas can manifest anywhere on the body, including sun-exposed regions like the face, hands, arms, and feet, as well as internal areas such as the mouth, genitals, nostrils, eyes, and ears. Vitiligo can also impact the color of hair in affected areas, causing it to turn gray or white.
It's worth highlighting that vitiligo, a non-contagious condition, cannot be passed from person to person. It doesn't discriminate based on skin color, affecting individuals across the spectrum. Those with darker skin tones or tans may experience a more pronounced contrast between their natural skin color and the lighter patches.
Some Common Myths about Vitiligo
Myth: Vitiligo is contagious and can spread from person to person.
Fact: Vitiligo is not contagious. It is a non-communicable condition that cannot be transmitted through physical contact or any other means.
Myth: Vitiligo occurs due to bad karma or a curse of god.
Fact: Vitiligo is an autoimmune skin disorder that can affect anyone, irrespective of their beliefs. Vitiligo occurs when the immune system mistakenly attacks and destroys the pigment-producing cells in the skin called melanocytes.
Myth: Only people with lighter skin tones can develop vitiligo.
Fact: Vitiligo can affect individuals of any skin color, including those with darker skin tones or tans. The contrast between natural skin color and lighter patches may be more noticeable in people with darker skin.
Myth: Vitiligo can be cured completely.
Fact: While there is currently no known cure for vitiligo, various treatment options exist to help manage the condition, reduce the appearance of depigmented patches, and potentially stimulate repigmentation.
Myth: Sunscreen is not necessary for individuals with vitiligo.
Fact: Sun protection is crucial for people with vitiligo, as the depigmented patches are more susceptible to sunburn and increased risk of skin cancer. Applying sunscreen with a high SPF and wearing protective clothing can help safeguard the skin.
Myth: Consuming dairy products after eating fish causes vitiligo
Fact: There is no scientific evidence to support the claim that consuming dairy products, fish or any other food causes vitiligo. Vitiligo is a complex condition influenced by genetics and autoimmune processes, and so far there is no conclusive evidence that any food plays a role in its development.
Myth: Vitiligo only affects the skin.
Fact: Vitiligo can also affect hair, resulting in premature graying or whitening of affected hair strands and oral or genital mucosa.
It is essential to dispel myths surrounding vitiligo and promote accurate information to reduce stigma and create a supportive environment for individuals living with this condition.
Causes of Vitiligo in Adults and Children
Vitiligo is caused by an amalgamation of multiple factors. Various factors, such as genetic predisposition, environmental triggers, and other autoimmune disorders like pernicious anemia, autoimmune thyroiditis, diabetes, alopecia areata, lupus, etc., may contribute to the development of vitiligo in both adults and children.
Other theories suggest the role of excessive free radicals and deficiency of antioxidants in the pathogenesis of vitiligo.
How Does Vitiligo Start?
Vitiligo typically begins with the appearance of small, lighter patches on the skin. Different types of vitiligo, including non-segmental, segmental, and mixed type, determine the pattern and rate of color loss. Most commonly, the first depigmented patch of vitiligo appears on the extremities of hands, feet, or face. These patches may remain the same size for an extended period or gradually expand in size. New patches can emerge in proximity to existing ones or appear in distant areas of the body. The progression and extent of vitiligo can vary widely among individuals.
What Causes Vitiligo to Spread?
The spread of vitiligo is influenced by several factors, including the type of vitiligo an individual has. Non-segmental vitiligo, the most common type, tends to spread slowly over time, with intermittent development of new patches throughout an individual's life. Segmental vitiligo, on the other hand, often exhibits rapid color loss on one side of the body and tends to stabilize after several months, with minimal to no development of new patches. Mixed-type vitiligo is a rare form characterized by a combination of segmental vitiligo and color loss beyond the segmental areas.
Another important aspect that contributes to the spread of vitiligo is a phenomenon called Koebnerization. Koebnerization refers to developing new vitiligo patches in areas of the skin that have been injured or traumatized. This can occur due to cuts, burns, or even friction on the skin's surface. Individuals with vitiligo should be cautious about potential skin injuries, as they may trigger the appearance of new patches in those areas.
Is Vitiligo Dangerous?
Vitiligo is not dangerous or life-threatening in any way. However, it can have significant psychological and emotional impacts on individuals, affecting their self-esteem and quality of life. The visible changes in skin appearance may lead to social stigmatization and psychological distress. Individuals with vitiligo should seek appropriate medical care and emotional support to manage the condition effectively.
Is Vitiligo Curable?
Vitiligo is not curable but treatable. While there is currently no known cure for vitiligo, various treatment options are available that can help restore lost skin color and slow down the progression of the disease. Research has shown that achieving an even skin tone can significantly improve both the physical and mental well-being of individuals with vitiligo.
To diagnose vitiligo, dermatologists review the patient's medical history, examine the skin, and may use a Wood's lamp for better visibility. They may also conduct blood tests to check for autoimmune diseases associated with vitiligo.
Can Dietary Supplements Treat Vitiligo?
Although research on the effects of certain nutrients and supplements in treating vitiligo is ongoing, their effectiveness remains inconclusive. Diet alone cannot cure vitiligo, but a healthy diet may support overall well-being and potentially complement other treatments for vitiligo.
According to a 2022 review, a combination of vitamin B12, folic acid, and exposure to sunlight has been found beneficial in promoting repigmentation. Additionally, when zinc and phenylalanine supplements are used alongside vitiligo medication, these substances are found to promote the synthesis of melanin. Furthermore, research focusing on herbal supplements like Ginkgo biloba, Polypodium leucotomos, and phenylalanine has indicated that they are rich in antioxidants, and contribute to the process of repigmentation.
Additionally, a diet rich in antioxidants, omega 3 fatty acids, vitamins C, E, and D, as well as minerals like copper and zinc, may support immune system balance.
If you want more details on this, I have an entire article talking about vitiligo diet.
What are the Treatment Options?
Treatment for vitiligo aims to restore lost skin color, prevent the spread of the condition to unaffected areas, and manage the psychological impact of the disease. The choice of treatment depends on the type and extent of vitiligo, the age and overall health of the individual, and their treatment goals. Some common treatment options include:
Topical medication Topical corticosteroids: These are commonly prescribed medications that are applied directly to the affected skin. They work by reducing inflammation and suppressing the immune response in the skin. Corticosteroids can help promote repigmentation and slow down the progression of vitiligo. However, long-term use of high-potency corticosteroids may have side effects such as skin thinning, pigmentation changes, and stretch marks. Topical calcineurin inhibitors: Tacrolimus and pimecrolimus are calcineurin inhibitors used for topical therapy in vitiligo. They modulate the immune response in the skin and help in repigmentation. These medications are often considered as alternatives to corticosteroids, especially for sensitive areas such as the face and genitals. However, they may cause temporary burning or itching at the application site. Topical calcipotriene: Calcipotriene is a synthetic form of vitamin D that can be used topically to help stimulate repigmentation in vitiligo patches. It works by regulating the growth and differentiation of skin cells. It is often used in combination with other treatment modalities, such as corticosteroids or phototherapy. JAK inhibitors: These are available both orally and topically. Janus kinase (JAK) inhibitors are a newer class of medications that have shown promise in the treatment of vitiligo. This group includes drugs like tofacitinib and ruxolitinib, which work by inhibiting specific enzymes involved in the immune response. JAK inhibitors can help halt the progression of vitiligo and promote repigmentation. However, their long-term safety and efficacy in vitiligo treatment are still being studied, and they may have potential side effects. Recently FDA has approved topical 1.5% ruxolitinib cream for non-segmental vitiligo in patients over the age of 12 years.
Light therapy Phototherapy, which involves exposing the skin to specific wavelengths of ultraviolet light, can help restore natural skin color. This is generally suitable in case of particular conditions: - Extensive vitiligo (like vitiligo vulgaris), - If other drugs are contraindicated - If other medical therapies haven't led to a satisfactory response - If a patient is refractory to other medications - High-risk groups - children and older adults are the ideal groups for narrow-band phototherapy
Oral Medication In cases where vitiligo is spreading rapidly, oral corticosteroids such as prednisone may be prescribed to slow down the progression of the disease.
Surgical Options When other treatments fail, surgery may be considered to restore skin color. Two common surgical procedures are tissue grafts and cell transplants. Skin grafts involve transferring pigmented skin from healthy areas to vitiligo-affected regions, while cellular grafts transfer cells from removed skin to repigment the affected areas. The two most common methods of cell grafts include cultured melanocyte grafting and cultured or non-cultured epidermal cell grafting.
Cosmetic Solutions Patients who prefer not to pursue medical treatment can opt for temporary solutions like camouflage makeup, self-tanner, or skin dyes. These products help even out skin tone and provide immediate cosmetic benefits.
Depigmentation Depigmentation therapy is an extreme option suitable for patients who have lost most of their natural skin color and do not wish to pursue treatments aimed at restoring color. This permanent treatment involves applying depigmenting agents like Monobenzyl ether of hydroquinone (MBEH) and 88% phenol or lasers to remove the remaining pigment gradually. It is widely believed that Michael Jackson, a well-known figure who had vitiligo, reportedly underwent depigmentation therapy.
Be informed that medication efficacy can vary from person to person, and the choice of medication depends on the individual's age, site and extent of involvement, and comorbidities. These medications can only be prescribed by dermatologists or physicians specializing in treating vitiligo.
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