Vitiligo
A common disease in which the skin loses pigment due to the destruction of pigment cells so that the skin becomes white, especially in areas such as the groin or armpits, around body openings, and on exposed areas like the face or hands. The unpigmented areas are extremely sensitive to ultraviolet radiation and are especially obvious in dark-skinned people. Most children who have vitiligo are in good health and suffer no symptoms other than areas of pigment loss.
Vitiligo may spread to other areas, but there is no way of predicting whether or where it will spread. In many cases, initial pigment loss will occur; then after several months, the number and size of the light areas become stable and may remain so for a long time. Episodes of pigment loss may appear again later on. Many vitiligo patients report that initial or later episodes of pigment loss followed by periods of physical or emotional stress, seem to trigger further depigmentation in those who are predisposed. Sometimes depigmented areas may spontaneously repigment.
About half of the people who develop this skin disorder experience some pigment loss before the age of 20, and about one-third of all vitiligo patients say that other family members also have this condition.
When vitiligo begins and how severe the pigment loss will be differs with each patient, but illness and stress can result in more pigment loss. Light-skinned people usually notice the pigment loss during the summer as the contrast between the vitiliginous skin and the suntanned skin becomes distinct. People with dark skin may observe the onset of vitiligo at any time.
In severe cases, the pigment loss extends over the entire body surface. The degree of pigment loss can also vary within each vitiligo patch, and a border of abnormally dark skin may encircle a patch of depigmented skin.
Vitiligo often starts with a rapid loss of pigment, which may be followed by a lengthy period when the skin color does not change. Later, the pigment loss may resume, especially if the patient has suffered physical trauma or stress. The loss of color may continue until for unknown reasons it suddenly stops. Cycles of pigment loss, followed by periods of stability, may continue indefinitely. However, it is rare for a patient with vitiligo to regain skin color. Most patients who say that they no longer have vitiligo may actually have become totally depigmented and are no longer bothered by contrasting skin color. While such patients appear to be “cured,” they really are not. People who have vitiligo all over their bodies do not look like albinos because the color of their hair and eyes may not change.
Cause
Medical researchers are not sure what causes vitiligo. Some researchers think the body may develop an allergy to its pigment cells; others believe that the cells may destroy themselves during the process of pigment production. Melanin is the substance that normally determines the color of skin, hair, and eyes. This pigment is produced in cells called melanocytes. If melanocytes cannot form melanin or if their number decreases, skin color will become lighter or completely white as in vitiligo.
A combination of genetic and immunologic factors is of major importance in most cases. In more than half the cases, there is a family history of vitiligo or early graying of hair. Many patients do not realize that anyone in the family has had vitiligo, either because they do not know that premature gray hair is a sign of vitiligo or because the affected area is hidden by clothing. In many cases of vitiligo, there is no family history of the disorder, and many vitiligo patients do not have either children or grandchildren with symptoms of pigment loss.
Many people report pigment loss shortly after a severe sunburn. Others relate the onset of vitiligo to emotional trauma associated with an accident, death in the family, or divorce. Patients with vitiligo appear to have normal pigment cells. An increase in something such as nitric oxide may be toxic for pigment cells or there may be a lack of growth factors that are required for normal pigment cells to be viable.
Treatment
There is no cure for this disease, but the symptoms can be treated, although treatment may not be completely satisfactory. There are two basic methods: to try to restore the normal pigment (repigment), or to try to destroy the remaining pigment cells (depigment).
The most common method of repigmenting is a combination of a drug called psoralen (applied to the skin or taken orally) and regulated doses of sunlight. Some clinics use psoralen and indoor ultraviolet light treatments. When psoralen drugs are activated by UVA, they stimulate repigmentation by increasing the availability of color-producing cells at the skin’s surface. The response varies among patients and body sites. The psoralen treatment is not always successful, but many patients find that it can help restore some degree of pigmentation to areas of the skin. About 75 percent of the patients who undergo psoralen and UVA light therapy respond to some extent, but complete repigmentation rarely occurs.
The psoralen drugs used for repigmentation therapy are trimethylpsoralen and 8-methyoxypsoralen. A patient takes the prescribed dose by mouth two hours before lying in the sun or under artificial ultraviolet (UVA) light. The ideal time for natural sunlight is between 11 A.M. and 1 P.M. when the sun is highest. Treatment every other day is recommended. Too much ultraviolet light can be harmful. Treatment schedules can be adjusted for each patient. If the day is cloudy or if sun exposure is not possible on a scheduled treatment day, then the patient does not take any medication because the drug does not work without appropriate sunlight.
In the northern United States, patients usually begin therapy in May and continue until September. Moderate repigmentation should take place during this time. Treatment is usually discontinued during the winter. Although artificial sources of UVA light can be used throughout the year, patients should consult a dermatologist to determine whether such treatments are desirable. UVA light systems for home use are expensive and treatment can be time-consuming. Ordinary sunlamps are not effective with the psoralen medications, since only UVA light produces the desired interaction.
After the initial two to three weeks of exposure to sunlight, patients will look worse since the contrast between light and tanned skin increases. With time, however, repigmentation will begin, and the appearance of the skin improves. If patients stop the therapy in winter, most will retain at least half of the color they achieved during the summer months.
A dermatologist’s supervision is required during all aspects of repigmentation therapy. Patients with vitiligo should always protect their skin against excessive sun exposure by wearing protective clothing, staying out of the sun at peak periods except during treatment time, and applying sunscreen lotions and creams. Patients with vitiligo should use a sunscreen with a sun protection factor (SPF) of 15 or higher, except during the hours of treatment. During treatment, an SPF of eight to 10 protects against sunburn but does not block the UVA needed for treatment. Sunscreens should be reapplied after swimming or perspiring. To prevent potential damage to the eyes, special sunglasses with protective lenses should be worn during sunlight exposure and for the remainder of the day on which the psoralen drug is taken.
Another method of psoralen treatment, used occasionally for patients with small, scattered vitiligo patches, involves the application of a solution of the drug directly to the affected skin, which is then exposed to sunlight. However, such topical treatment makes a person very susceptible to severe burn and blisters with too much sun exposure.
Hydrocortisone-type compounds applied to the skin slow the process of depigmentation and sometimes even enhance repigmentation. However, the cortisones that are sold without a prescription (such as 0.5 percent hyrocortisone) are too weak to help. On the other hand, very potent cortisones when used daily for a long time produce side effects, such as thinning of the skin. Under the care of a dermatologist it is usually possible to adjust the treatment with topical hydrocortisones so that side effects are at a minimum.
Not everyone is a good candidate for repigmentation. The ideal person should have lost pigment no more than five years earlier. In general, children and young adults respond better than older people, but patients should be at least 10 years old. While treatment is safe for younger children, the method is tedious, and better results are achieved when the child is interested in treatment. In addition, patients should be healthy, and no one with a sensitivity or allergy to sunlight can be treated.
Depigmentation
Children with vitiligo over more than half of the exposed areas of the body are not candidates for repigmentation. Instead, they may want to try removing the pigmentation of the remaining skin so the patient is an even color. However, total depigmentation is tried only in very severe cases of vitiligo.
The drug for depigmentation is monobenzylether of hydroquinone. Many patients with vitiligo are at first apprehensive about the idea of depigmentation and reluctant to go ahead, but those who achieve complete depigmentation are usually satisfied with the end results. Unfortunately, some people become allergic to the medication and must discontinue therapy.
Cosmetics
Most patients, even if they are responding well to treatment, would like to make the vitiligo less obvious. Many find that a combination of cosmetics can de-emphasize the skin disorder. Cosmetics are not just for girls, nor are they only for the face. Anyone can wear them anywhere on their body. Over-the-counter cosmetics exist in a wide range of skin tones; many are waterproof and don’t rub off. There are also special dermatological cosmetics that patients even with severe vitiligo find useful. Patients who are interested in dyes and stains should consult a dermatologist for the names of suitable commercial products.
In the Future
Research on pigment cells and vitiligo has increased since the 1990s. Some studies are trying to stop vitiligo by the use of hydrocortisone compounds applied to the skin. Others are studying the possibility of melanocyte transplants, in which pigment cells from an unexposed normally pigmented patch of skin are grown in culture and returned into a white patch.
Vitiligo may spread to other areas, but there is no way of predicting whether or where it will spread. In many cases, initial pigment loss will occur; then after several months, the number and size of the light areas become stable and may remain so for a long time. Episodes of pigment loss may appear again later on. Many vitiligo patients report that initial or later episodes of pigment loss followed by periods of physical or emotional stress, seem to trigger further depigmentation in those who are predisposed. Sometimes depigmented areas may spontaneously repigment.
About half of the people who develop this skin disorder experience some pigment loss before the age of 20, and about one-third of all vitiligo patients say that other family members also have this condition.
When vitiligo begins and how severe the pigment loss will be differs with each patient, but illness and stress can result in more pigment loss. Light-skinned people usually notice the pigment loss during the summer as the contrast between the vitiliginous skin and the suntanned skin becomes distinct. People with dark skin may observe the onset of vitiligo at any time.
In severe cases, the pigment loss extends over the entire body surface. The degree of pigment loss can also vary within each vitiligo patch, and a border of abnormally dark skin may encircle a patch of depigmented skin.
Vitiligo often starts with a rapid loss of pigment, which may be followed by a lengthy period when the skin color does not change. Later, the pigment loss may resume, especially if the patient has suffered physical trauma or stress. The loss of color may continue until for unknown reasons it suddenly stops. Cycles of pigment loss, followed by periods of stability, may continue indefinitely. However, it is rare for a patient with vitiligo to regain skin color. Most patients who say that they no longer have vitiligo may actually have become totally depigmented and are no longer bothered by contrasting skin color. While such patients appear to be “cured,” they really are not. People who have vitiligo all over their bodies do not look like albinos because the color of their hair and eyes may not change.
Cause
Medical researchers are not sure what causes vitiligo. Some researchers think the body may develop an allergy to its pigment cells; others believe that the cells may destroy themselves during the process of pigment production. Melanin is the substance that normally determines the color of skin, hair, and eyes. This pigment is produced in cells called melanocytes. If melanocytes cannot form melanin or if their number decreases, skin color will become lighter or completely white as in vitiligo.
A combination of genetic and immunologic factors is of major importance in most cases. In more than half the cases, there is a family history of vitiligo or early graying of hair. Many patients do not realize that anyone in the family has had vitiligo, either because they do not know that premature gray hair is a sign of vitiligo or because the affected area is hidden by clothing. In many cases of vitiligo, there is no family history of the disorder, and many vitiligo patients do not have either children or grandchildren with symptoms of pigment loss.
Many people report pigment loss shortly after a severe sunburn. Others relate the onset of vitiligo to emotional trauma associated with an accident, death in the family, or divorce. Patients with vitiligo appear to have normal pigment cells. An increase in something such as nitric oxide may be toxic for pigment cells or there may be a lack of growth factors that are required for normal pigment cells to be viable.
Treatment
There is no cure for this disease, but the symptoms can be treated, although treatment may not be completely satisfactory. There are two basic methods: to try to restore the normal pigment (repigment), or to try to destroy the remaining pigment cells (depigment).
The most common method of repigmenting is a combination of a drug called psoralen (applied to the skin or taken orally) and regulated doses of sunlight. Some clinics use psoralen and indoor ultraviolet light treatments. When psoralen drugs are activated by UVA, they stimulate repigmentation by increasing the availability of color-producing cells at the skin’s surface. The response varies among patients and body sites. The psoralen treatment is not always successful, but many patients find that it can help restore some degree of pigmentation to areas of the skin. About 75 percent of the patients who undergo psoralen and UVA light therapy respond to some extent, but complete repigmentation rarely occurs.
The psoralen drugs used for repigmentation therapy are trimethylpsoralen and 8-methyoxypsoralen. A patient takes the prescribed dose by mouth two hours before lying in the sun or under artificial ultraviolet (UVA) light. The ideal time for natural sunlight is between 11 A.M. and 1 P.M. when the sun is highest. Treatment every other day is recommended. Too much ultraviolet light can be harmful. Treatment schedules can be adjusted for each patient. If the day is cloudy or if sun exposure is not possible on a scheduled treatment day, then the patient does not take any medication because the drug does not work without appropriate sunlight.
In the northern United States, patients usually begin therapy in May and continue until September. Moderate repigmentation should take place during this time. Treatment is usually discontinued during the winter. Although artificial sources of UVA light can be used throughout the year, patients should consult a dermatologist to determine whether such treatments are desirable. UVA light systems for home use are expensive and treatment can be time-consuming. Ordinary sunlamps are not effective with the psoralen medications, since only UVA light produces the desired interaction.
After the initial two to three weeks of exposure to sunlight, patients will look worse since the contrast between light and tanned skin increases. With time, however, repigmentation will begin, and the appearance of the skin improves. If patients stop the therapy in winter, most will retain at least half of the color they achieved during the summer months.
A dermatologist’s supervision is required during all aspects of repigmentation therapy. Patients with vitiligo should always protect their skin against excessive sun exposure by wearing protective clothing, staying out of the sun at peak periods except during treatment time, and applying sunscreen lotions and creams. Patients with vitiligo should use a sunscreen with a sun protection factor (SPF) of 15 or higher, except during the hours of treatment. During treatment, an SPF of eight to 10 protects against sunburn but does not block the UVA needed for treatment. Sunscreens should be reapplied after swimming or perspiring. To prevent potential damage to the eyes, special sunglasses with protective lenses should be worn during sunlight exposure and for the remainder of the day on which the psoralen drug is taken.
Another method of psoralen treatment, used occasionally for patients with small, scattered vitiligo patches, involves the application of a solution of the drug directly to the affected skin, which is then exposed to sunlight. However, such topical treatment makes a person very susceptible to severe burn and blisters with too much sun exposure.
Hydrocortisone-type compounds applied to the skin slow the process of depigmentation and sometimes even enhance repigmentation. However, the cortisones that are sold without a prescription (such as 0.5 percent hyrocortisone) are too weak to help. On the other hand, very potent cortisones when used daily for a long time produce side effects, such as thinning of the skin. Under the care of a dermatologist it is usually possible to adjust the treatment with topical hydrocortisones so that side effects are at a minimum.
Not everyone is a good candidate for repigmentation. The ideal person should have lost pigment no more than five years earlier. In general, children and young adults respond better than older people, but patients should be at least 10 years old. While treatment is safe for younger children, the method is tedious, and better results are achieved when the child is interested in treatment. In addition, patients should be healthy, and no one with a sensitivity or allergy to sunlight can be treated.
Depigmentation
Children with vitiligo over more than half of the exposed areas of the body are not candidates for repigmentation. Instead, they may want to try removing the pigmentation of the remaining skin so the patient is an even color. However, total depigmentation is tried only in very severe cases of vitiligo.
The drug for depigmentation is monobenzylether of hydroquinone. Many patients with vitiligo are at first apprehensive about the idea of depigmentation and reluctant to go ahead, but those who achieve complete depigmentation are usually satisfied with the end results. Unfortunately, some people become allergic to the medication and must discontinue therapy.
Cosmetics
Most patients, even if they are responding well to treatment, would like to make the vitiligo less obvious. Many find that a combination of cosmetics can de-emphasize the skin disorder. Cosmetics are not just for girls, nor are they only for the face. Anyone can wear them anywhere on their body. Over-the-counter cosmetics exist in a wide range of skin tones; many are waterproof and don’t rub off. There are also special dermatological cosmetics that patients even with severe vitiligo find useful. Patients who are interested in dyes and stains should consult a dermatologist for the names of suitable commercial products.
In the Future
Research on pigment cells and vitiligo has increased since the 1990s. Some studies are trying to stop vitiligo by the use of hydrocortisone compounds applied to the skin. Others are studying the possibility of melanocyte transplants, in which pigment cells from an unexposed normally pigmented patch of skin are grown in culture and returned into a white patch.
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Comments (1)
Thank you for your introduction, there is no way suffering from this disease cured.
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