Vitiligo - dermatological clinical picture

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The vitiligo It is a long-term problem in which growing patches of skin lose their color. It can affect people of any age, gender or ethnic group.

The patches appear when the melanocytes inside the skin die. Melanocytes are the cells responsible for producing the skin pigment, melanin, which gives skin its color and protects it from the UV rays of the sun.

Globally, it appears to affect 0.5 to 2 percent of people.

Quick facts about vitiligo

Here are some key points about vitiligo. More details are in the main article.

  • Vitiligo can affect people of any age, gender, or ethnicity.
  • There is no cure, and it is generally a life-long condition.
  • The exact cause is unknown, but it may be due to an autoimmune disorder or a virus.
  • Vitiligo is not contagious.
  • Treatment options may include exposure to UVA or UVB light and skin depigmentation in severe cases.

What is Vitiligo?

Vitiligo is a skin condition in which skin spots lose their color.

The total area of skin that can be affected by vitiligo varies from person to person. It can also affect the eyes, the inside of the mouth and the hair. In most cases, the affected areas remain discolored for the rest of the person's life.

The condition is photosensitive. This means that the affected areas will be more sensitive to sunlight than those that are not.

It is difficult to predict whether and to what extent patches will spread. The spread can take weeks or the patches can remain stable for months or years.

Lighter patches tend to be more visible on people with dark or tan skin.

Treatment

Vitiligo is described by the American Academy of Dermatology (AAD) as "more than a cosmetic problem." It is a health problem that needs medical attention.

A number of medications can help decrease the visibility of the condition.

Use sunscreen

The AAD recommends using a sunscreen, because the lighter patches on the skin are especially sensitive to sunlight and can easily burn. A dermatologist can advise on a suitable type.

Phototherapy with UVB light.

Exposure to ultraviolet B (UVB) lamps is a common treatment option. Home treatment requires a small lamp and allows daily use, which is more effective.

If the treatment is carried out in a clinic, you will need 2 to 3 visits per week and the treatment time will be longer.

If there are white spots on large areas of the body, it can be used UVB phototherapy. This involves full body treatment. It is done in a hospital.

UVB phototherapy, combined with other treatments, can have a positive effect on vitiligo. However, the result is not entirely predictable, and there is still no treatment that completely pigments the skin again.

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Phototherapy with UVA light.

UVA treatment is generally performed in a healthcare setting. First, the patient takes a medication that increases the skin's sensitivity to UV light. Then, in a series of treatments, the affected skin is exposed to high doses of UVA light.

Progress it will be evident after 6 to 12 months of sessions twice a week.

Skin Camouflage

In cases of mild vitiligo, the patient can camouflage some of the white patches with colored cosmetic creams and makeup. They must select the tones that best suit the characteristics of their skin.

If creams and makeup are applied correctly, they can last 12 to 18 hours on the face and up to 96 hours for the rest of the body. Most topical applications are waterproof.

Depigmenting

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There are a variety of treatments available for vitiligo, although many people choose not to treat it.

When the affected area is spread out, covering 50 percent of the body or more, depigmentation may be an option. This reduces the color of the skin on the unaffected parts to match the whiter areas.

Depigmentation is accomplished by applying strong topical lotions or ointments, such as monobenzone, mequinol, or hydroquinone.

The treatment is permanent, but it can make the skin more fragile. Prolonged exposure to the sun should be avoided. Depigmentation can take 12 to 14 months, depending on factors such as the depth of the original skin tone.

Topical corticosteroids

Corticosteroid ointments are creams that contain steroids. Some studies have concluded that applying topical corticosteroids to white patches can stop the spread.. Others have reported a full restoration of the original skin color. Corticosteroids should never be used on the face.

If there is any improvement after a month, the treatment should be interrupted for a couple of weeks before starting again.

If there is no improvement after one month, or if side effects occur, treatment should be stopped.

Calcipotriene (Dovonex)

Calcipotriene is a form of vitamin D that is used as a topical ointment. It can be used with corticosteroids or light treatment. Side effects include skin rashes, dry skin, and itching.

Medicines that affect the immune system.

Ointments containing tacrolimus or pimecrolimus, medications known as calcineurin inhibitors, can help with small patches of depigmentation. However, the United States Food and Drug Administration (FDA) warns of a connection between these drugs and skin cancer and lymphoma.

Psoralen

Psoralen can be used with UVA or UVB light therapy, as it makes the skin more susceptible to UV light. As skin heals, a more normal coloring sometimes returns. The treatment may need to be repeated two to three times a week for 6 to 12 months.

Psoralen increases the risk of sunburn and skin damage, and therefore also of long-term skin cancer. Not recommended for children under 10 years old.

Skin grafts

In a skin graft, a surgeon carefully removes healthy patches of pigmented skin and uses them to cover the affected areas.

This procedure is not very common, because it takes time and can cause scarring in the area where the skin comes from and the area where it is placed.

Blister grafting involves producing a blister on normal skin using suction. The top of the ampoule is then removed and placed in an area where the pigment has been lost. There is a lower risk of scarring.

Tattoos

Surgery is used to implant pigment into the skin. It works best around the lips, especially in people with darker skin.

Drawbacks can include difficulty matching skin color and the fact that tattoos fade but do not tan. Sometimes skin damage caused by tattoos can trigger another vitiligo patch.

Possible cures for the future

Research on possible cures or vitiligo treatments is ongoing. These are some of the most promising findings.

Pseudocatalase

In 2013, researchers announced that they had found a new compound that could provide a cure for the loss of skin color associated with vitiligo.

Participants in a study who were treated with a modified pseudocatalase (PC-KUS) recovered pigmentation in their skin and eyelashes. The compound also seemed to restore the original hair color among people with gray hair.

Afamelanotide

Low melanin levels in some people with vitiligo may be due to lower levels of the melanocyte-stimulating hormone α (alpha-MSH). Afamelanotide is a synthetic compound that mimics alpha-MSH.

In combination with UVB treatment, afamelanotide appears to be effective.

Tofacitinib citrate

An arthritis medication, tofacitinib citrate, has shown promise. Janus kinase, an enzyme that appears to be involved in the etiology of vitiligo, is inhibited.

Causes

The exact causes of vitiligo are not clear. Several factors can contribute.

These include:

  • an autoimmune disorder, in which the immune system becomes overactive and destroys melanocytes
  • a genetic imbalance of oxidative stress
  • a stressful event
  • skin damage from a burn or critical cut
  • exposure to some chemicals
  • a neural cause
  • inheritance as it can run in families
  • A virus

Vitiligo is not contagious. One person cannot catch it from another.

It can appear at any age, but studies suggest it is more likely to start around age 20.

symptom

The only symptom of vitiligo is the appearance of flat white spots or patches on the skin. The first white spot that is noticed is often in an area that tends to be exposed to the sun.

It starts out as a simple blemish, a little paler than the rest of the skin, but as time goes by, this blemish becomes paler until it turns white.

The patches are irregular in shape. Sometimes the edges can swell a bit with a slight shade of red, which sometimes causes itching.

Normally, however, it does not cause any discomfort, irritation, pain, or dry skin.

The effects of vitiligo vary from person to person. Some people may have only a handful of white dots that do not develop further, while others develop larger white patches that bind together and affect larger areas of the skin.

Types

There are two types of vitiligo, non-segmental and segmental.

Non-segmental vitiligo

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Vitiligo often appears in a semi-symmetrical pattern.

If the first white patches are symmetrical, this suggests a type of vitiligo known as non-segmental vitiligo. Development will be slower than if the patches are in one area of the body.

Non-segmental vitiligo is the most common type, accounting for up to 90 percent of cases.

The patches they often appear equally on both sides of the body, with some measure of symmetry. They often appear on skin that is commonly exposed to the sun, such as the face, neck, and hands.

Common areas include:

  • back of hands
  • arms
  • eyes
  • knees
  • elbows
  • feet
  • mouth
  • armpit and groin
  • nose
  • belly button
  • genitalia and rectal area

Non-segmental vitiligo is divided into subcategories:

  • Generalized : There is no specific area or patch size. This is the most common type.
  • Acro-facial - This occurs mainly on the fingers and toes.
  • Mucous membrane : appears mainly around the mucous membranes and lips.
  • Universal : Depigmentation covers most of the body. This is very extrange
  • Focal : One or more scattered white patches develop in a discrete area. It occurs more frequently in young children.

Segmental Vitiligo

Segmental vitiligo spreads more quickly but is considered more constant and stable and less erratic than the non-segmental type. It is much less common and affects only 10 percent of people with vitiligo. It is not symmetrical.

It is most noticeable in the early age groups, affecting approximately 30 percent of children diagnosed with vitiligo.

Segmental vitiligo generally affects areas of the skin attached to the nerves that arise in the dorsal roots of the spine. Responds well to topical treatments.

Complications

Vitiligo does not turn into other diseases, but people with the condition are more likely to experience:

  • painful sunburn
  • hearing loss
  • changes in vision and tear production

A person with vitiligo is more likely to have another autoimmune disorder, such as thyroid problems, Addison's disease, Hashimoto's thyroiditis, type 1 diabetes, or pernicious anemia. Most people with vitiligo do not have these conditions, but tests can be done to rule them out.

Overcoming social challenges

If the patches of skin are visible, the social stigma of vitiligo can be difficult to manage. Shame can lead to problems with self-esteem and, in some cases it can lead to anxiety and depression .

People with darker skin are more likely to experience difficulties because the contrast is higher. In India, vitiligo is known as "white leprosy."

Raising awareness about vitiligo, for example, by talking to friends about it, can help people on the condition of overcoming these difficulties. Connecting with others who have vitiligo can also help.

Anyone with this condition experiencing symptoms of anxiety and depression should ask their dermatologist to recommend someone who can help.


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