- What is vitiligo
- Prevalence and Visibility
- What are the symptoms of vitiligo?
- Types of Vitiligo
- Causes of Vitiligo
- Detachment or Destruction of Melanocytes
- Genetic Predisposition
- What are the risk factors?
- Is vitiligo contagious?
- Clinical Signs of Vitiligo
- Treatments for Vitiligo
- Psychological Care in Vitiligo
- Skin Care for Vitiligo
- Conclusion
What is vitiligo
Vitiligo is a skin condition characterized by a progressive loss of pigmentation, resulting in the appearance of white spots on the skin. These pigmentary disorders can manifest anywhere on the body, but they typically appear first on the face, hands, and trunk. In some cases, vitiligo symptoms can also affect mucous membranes and the retina. The hair in the affected areas may turn white, impacting the hair, eyebrows, or even the beard.
Prevalence and Visibility
This disease affects between 0.5% and 2% of the population, regardless of sex or skin color. However, due to the contrast between depigmented and unaffected skin, vitiligo is more visible on darker skin. Although vitiligo can appear at any time, it is more likely to develop before the age of 20 in 50% of cases.
What are the symptoms of vitiligo?
The initial lesion of vitiligo is a whitish-colored depigmented spot with a darker or reddish border. The tone of the stain will also depend on the initial tone of the skin.
This lesion can appear in any region of the body, although some areas are more common:
- Hands
- Elbows
- Knees
- Armpits
- Around orifices (like the eyes or mouth)
- Groin folds
- Navel
Types of Vitiligo
Segmental Vitiligo
Segmental vitiligo is commonly found in children, accounting for around 41% of cases before the age of 10. It is localized to one side of the body with well-demarcated white spots. This form appears and progresses rapidly over a few months and then tends to stabilize.
Non-Segmental Vitiligo
This is the most common form of vitiligo. It begins by affecting the face and extremities and generally progresses to the rest of the body bilaterally and symmetrically. It is not uncommon for itching to herald the appearance of new spots. Unlike segmental vitiligo, this form has a slow progression. Vitiligo universalis (affecting the entire body), mucosal, and follicular are considered subtypes of non-segmental vitiligo.
Mixed Vitiligo
Mixed vitiligo starts as segmental vitiligo but evolves into non-segmental vitiligo approximately six months after the onset of the disease.
Generalized or vulgar
The most common, where the discolored spots affect any part of the body, often bilaterally and symmetrically;
Universalis
Similar to the generalized type, vitiligo however covers more than 80% of the body’s surface
Localized
Depigmentation affects a small area of the skin and does not spread.
Causes of Vitiligo
The exact causes of vitiligo remain mysterious. The disease is characterized by the disappearance of melanocytes, the cells responsible for melanin production. Two main hypotheses are put forward:
Detachment or Destruction of Melanocytes
This involves disturbances in the immune system, where antibodies produced by the body attack and destroy its cells, specifically melanocytes. This mechanism classifies vitiligo as an autoimmune disease.
Genetic Predisposition
Genetics plays a crucial role in vitiligo. Approximately 20% of people with vitiligo have a first-degree relative with the disease. However, the genetic factor alone is insufficient to cause depigmentation. Environmental factors, such as stress and injury, often trigger or exacerbate the disease.
Additionally, vitiligo is commonly associated with other autoimmune diseases. In 15% to 20% of cases, it is linked with autoimmune thyroid disease (hypothyroidism or hyperthyroidism). Some patients also have type 1 diabetes or other dermatological conditions such as psoriasis or atopic dermatitis.
What are the risk factors?
The course of vitiligo is unpredictable. Indeed, it is impossible to predict in advance the number and extent of depigmentation spots. It can notably evolve in phases and, in certain rarer cases, disappear spontaneously. If it is not the main cause of the development of vitiligo, stress can promote its appearance or worsen, whether psychological or physiological (linked to a pathological condition).
Is vitiligo contagious?
Vitiligo is neither contagious nor painful. However, the psychosocial consequences can be devastating in the adolescent population and patients with depigmented spots on visible areas of the body.
Clinical Signs of Vitiligo
The main clinical sign of vitiligo is the appearance of white spots or depigmentation on the skin. These spots can vary in shape and size and tend to enlarge over time. Vitiligo can also affect the beard and body hair, a condition known as leukotrichia.
Due to the loss of melanin, the skin of people with vitiligo is more susceptible to sunburn. Melanin helps protect the skin against the sun’s effects. Therefore, people with vitiligo should avoid prolonged sun exposure, which can cause new spots to appear. Interestingly, people with vitiligo have a lower risk of developing skin cancers, even after UV phototherapy treatments.
Treatments for Vitiligo
Currently, there is no cure for vitiligo. However, several treatments can slow down or interrupt the discoloration process:
Repigmentation Treatments
These treatments aim to stimulate the multiplication of existing melanocytes. Repigmentation can be achieved through phototherapy or topical treatments. Often, these methods are combined to maximize the chances of success. Treatment duration can range from six to 24 months.
Depigmentation Treatments
These treatments aim to permanently depigment the entire skin for a uniform appearance. This option is considered when vitiligo covers most of the body, as in vitiligo universalis where 90% of the body surface is depigmented.
Skin Grafts
In some cases, particularly when the hair is also depigmented, skin grafts may be offered. These autologous transplants are taken from unaffected areas of the patient’s body and are suitable for individuals with non-progressing segmental vitiligo.
Cosmetics
Some patients may resort to cosmetics to camouflage depigmented regions:
- Correctors: Temporary cover-up for white spots.
- Foundations: Temporary but effective coverage.
- Self-tanners: Semi-permanent solution to even out skin tone.
New and Experimental Treatments
Research into vitiligo treatments is ongoing, and several promising options are being explored:
- JAK Inhibitors: These medications target the immune system and have shown promise in repigmenting skin in clinical trials.
- Topical Prostaglandins: Used in combination with light therapy, these have shown some efficacy in stimulating repigmentation.
- Stem Cell Therapy: Research is ongoing to explore how stem cells can be used to treat vitiligo.
Psychological Care in Vitiligo
The skin plays a crucial role in social interactions, and any visible change can significantly impact a person’s psychosocial well-being. Vitiligo can lead to stigmatization, isolation, and depression, particularly in adolescents. Nearly 50% of people with vitiligo report significantly impacting their quality of life. The psychological effects should not be minimized, and medical professionals should offer psychological care to address patients’ distress.
Skin Care for Vitiligo
Skin affected by vitiligo does not differ much from normal skin but requires special care to prevent damage:
Skin without pigment is not much different from skin with melanin. Due to this, it does not require any special care. However, some indications providing certain substances with cosmetic products contribute to better therapeutic effects in the treatment of vitiligo.
For this reason, cosmetics available on the market for vitiligo are characterized by a selection of active substances with multi-pronged effects, which accurately fit into the accepted hypotheses regarding the mechanisms of the development of this disease.
Antioxidation
Oxidative stress plays a key role in the development of vitiligo. Antioxidants such as coenzyme Q10, vitamin C, and vitamin E can help protect pigment cells. PHA acids like lactobionic acid and gluconolactone are also effective anti-radical agents.
Sun Protection
High photoprotection is crucial for vitiligo care. The pigment-deprived skin easily absorbs UVB radiation, which can worsen the disease and cause sunburn. Sunscreens with at least SPF 30 are necessary to prevent damage. Reapplying sunscreen every two to three hours, especially after water exposure, sweating, or towel drying, is important. Solariums are contraindicated due to the high risk of severe burns.
Cosmetic Camouflage
Camouflaging makeup techniques can effectively conceal vitiligo lesions, especially on the face and exposed body parts. Strong coverage foundations and self-tanners can even out skin tone and provide mental comfort.
Coping Strategies and Support
Living with vitiligo can be challenging, but various strategies and support systems can help individuals manage the condition effectively:
Education and Awareness
Understanding vitiligo and its causes can reduce fear and anxiety. Educating friends and family about the condition can foster a supportive environment.
Support Groups
Joining a support group, either in person or online, can provide a sense of community and shared experiences. Connecting with others who understand the challenges of vitiligo can be comforting.
Professional Counseling
Seeking help from a psychologist or counselor can be beneficial in dealing with the emotional impact of vitiligo. Cognitive-behavioral therapy (CBT) has been particularly effective in helping individuals cope with the stress and self-esteem issues associated with vitiligo.
Patient Stories and Experiences
Sharing personal stories can be a powerful way to raise awareness and provide support to those affected by vitiligo. Here are a few experiences from individuals living with vitiligo:
- Rita’s Story: “When I was diagnosed with vitiligo at 15, I felt like my world was falling apart. The white patches on my skin made me self-conscious, and I was bullied at school. It took years, but with the support of my family and a great therapist, I learned to embrace my unique appearance. Today, I advocate for vitiligo awareness and help others find their confidence.”
- Pauls’ Experience: “I developed vitiligo in my late 20s. It started with a small patch on my hand and gradually spread. The hardest part was explaining to people that it’s not contagious. Joining a support group helped me find a community that understands my struggles. We share tips on skincare and support each other through the ups and downs.”
Ongoing Research and Future Directions
The field of vitiligo research is dynamic, with continuous advancements aimed at improving understanding and treatment options:
- Genetic Studies: Research into the genetic factors contributing to vitiligo is ongoing. Identifying specific genes associated with the condition can lead to targeted therapies and personalized treatment plans.
- Immunotherapy: Investigating the role of the immune system in vitiligo has opened new avenues for treatment. Immunotherapy, which modulates the immune response, shows promise in repigmentation and disease management.
- Advanced Phototherapy: Innovations in phototherapy, including targeted UVB treatments and combination therapies, are enhancing the effectiveness of this treatment modality.
- Stem Cell Research: Exploring the potential of stem cells to regenerate melanocytes offers hope for future breakthroughs in vitiligo treatment.
Conclusion
Vitiligo is a complex and often misunderstood condition. It is not life-threatening but can significantly impact a person’s quality of life. Understanding its types, causes, and treatments is essential for managing the disease. While there is no cure, various treatments and skin care practices can help manage symptoms and improve the appearance of the affected skin.
Living with vitiligo requires resilience and a proactive approach to self-care and mental health. With ongoing research and advancements in treatment, there is hope for more effective therapies in the future. By fostering a supportive community and raising awareness, we can help individuals with vitiligo lead fulfilling lives and celebrate their unique identities.
