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World Vitiligo Day - June 25, 2022

World Vitiligo Day aims to celebrate the community of vitiligo patients and their advocates across the world. Vitiligo is a condition that causes white patches of skin to appear on different parts of the body, affecting an estimated 1% of the population worldwide.

Around the world, those with vitiligo, their families, and advocates use the day to raise awareness and celebrate their own stories and experiences with the condition.

 

What is Vitiligo?

Vitiligo is a disease that causes loss of skin color in patches. The discolored areas usually get bigger with time. The condition can affect the skin on any part of the body. It can also affect hair and the inside of the mouth.

Normally, the color of hair and skin is determined by melanin. Vitiligo occurs when cells that produce melanin die or stop functioning. Vitiligo affects people of all skin types, but it may be more noticeable in people with brown or Black skin. The condition is not life-threatening or contagious. It can be stressful or make you feel bad about yourself.

Treatment for vitiligo may restore color to the affected skin. But it doesn't prevent continued loss of skin color or a recurrence.

 

Symptoms

The symptoms include patchy loss of skin color, which usually first appear on the hands, face, and areas around the body openings and the genitals. Signs also include the premature whitening or graying of the hair on your scalp, eyelashes, eyebrows, or beard, and the loss of color in the tissues that line the inside of the mouth and nose (mucous membranes).

Vitiligo can start at any age but usually appears before age 30. Depending on the type of vitiligo, it may affect:

  • Nearly all skin surfaces. With this type, called universal vitiligo, the discoloration affects nearly all skin surfaces.
  • Many parts of the body. With this most common type, called generalized vitiligo, the discolored patches often progress similarly on corresponding body parts (symmetrically).
  • Only one side or part of the body. This type, called segmental vitiligo, tends to occur at a younger age, progress for a year or two, then stop.
  • One or only a few areas of the body. This type is called localized (focal) vitiligo.
  • The face and hands. With this type, called acrofacial vitiligo, the affected skin is on the face and hands, and around body openings, such as the eyes, nose and ears.

It is difficult to predict how this disease will progress. Sometimes the patches stop forming without treatment. In most cases, pigment loss spreads and eventually involves most of the skin. Occasionally, the skin gets its color back.

See your health care provider if areas of your skin, hair or mucous membranes lose coloring. Vitiligo has no cure. But treatment might stop or slow the discoloring process and return some color to your skin.

 

Causes

Vitiligo occurs when pigment-producing cells (melanocytes) die or stop producing melanin — the pigment that gives your skin, hair, and eye color. The involved patches of skin become lighter or white. It's unclear exactly what causes these pigment cells to fail or die. It may be related to:

  • A disorder of the immune system (an autoimmune condition)
  • Family history (heredity)
  • A trigger event, such as stress, severe sunburn, or skin trauma, such as contact with a chemical
  • Complications

People with vitiligo may be at increased risk of social or psychological distress, sunburn, eye problems, or hearing loss.

 

Prevalence

Worldwide prevalence estimates of vitiligo vary widely with prevalence estimates ranging from 0.004% to 2.28%. A 2021 study by Ghandi, et. al. concluded that the current US population-based prevalence estimate of overall (diagnosed and undiagnosed combined) vitiligo in adults is between 0.76% (1.9 million cases in 2020) and 1.11% (2.8 million cases in 2020). Additionally, the study also suggests that approximately 40% of adult vitiligo in the US may be undiagnosed. Future studies should be performed to confirm these findings.

 

Who Gets Vitiligo?

Vitiligo appears to affect at least 1% to 2% of the population, irrespective of sex, race, or age. Series have been reported from across the globe. The more dark-skinned a person is, the more their vitiligo stands out, because of the contrast between affected and unaffected areas of skin. This may account for the apparent higher prevalence of vitiligo in some countries with darker-skinned populations. Vitiligo has become a marked social stigma in countries such as India, where opportunities for social advancement or marriage among affected individuals are severely limited even today.

In half of all vitiligo cases, onset occurs between the ages of 10 and 30. There are a few reported cases of vitiligo present at birth. Onset in old age also rarely occurs. Over 30% of affected individuals may report a positive family history. Up to four loci are now considered responsible for vitiligo. Vitiligo in identical twins has been reported. The risk for children of affected individuals is unknown, but maybe less than 10%. People from families with an increased prevalence of thyroid disease, diabetes mellitus, and vitiligo appear to be at increased risk for the development of vitiligo.

Both predisposing (genetic) and precipitating (environmental) factors contribute to vitiligo. Many patients attribute the onset of their vitiligo to physical trauma, illness, or emotional stress. Onset following the death of a relative or after a severe physical injury is often mentioned. Even sunburn reactions may precipitate vitiligo.

 

Not All White Spots Are Vitiligo

The diagnosis of vitiligo can usually be made on clinical examination of a patient with progressive, acquired, chalk-white macules in typical sites. Few conditions are as patterned and symmetrical as vitiligo. Sometimes the spots match on both extremities in a mirror image.

Woods light examination is required to detect all the spots, especially in fair-skinned persons, including:

  • Lupus erythematosus (atypical distribution, positive immunofluorescence, serologic studies)
  • Pityriasis alba (slight scaling, fuzzy margins, off-white color)
  • Piebaldism (congenital, white forelock, stable, hyperpigmented macules in the center of white spots, different distribution than vitiligo)
  • Tinea versicolor (fine scales with greenish yellow fluorescence under Wood's light, positive KOH)
  • Chemical leukoderma (history of exposure to certain phenolic germicides, confetti macules)
  • Post-inflammatory hypomelanosis (off-white macules, history of psoriasis or eczema in the same area)

Diagnosis can usually be established on clinical grounds alone. In certain difficult cases, a skin biopsy may be required to exclude some of the above. A defining feature is that pigment cells in the skin are absent in vitiligo. Vitiligo is sometimes associated with general diseases.

 

Vitiligo may be associated with thyroid disease (up to 30%, especially women), diabetes mellitus (probably less than 5%), pernicious anemia (increased risk), Addison's Disease (increased risk), and multiple endocrinopathy syndrome. Associated cutaneous conditions include white hair and prematurely grey hair, alopecia areata, and halo nevi. There is no increased risk for malignancy. Skin cancers (all types) appear to be unusual.

Ophthalmologic (eye) examination may reveal evidence of healed chorioretinitis or iritis (probably less than 10%). Vision is unaffected. There are no important hearing changes. Laboratory studies for the detection of general diseases associated with vitiligo include:

  • Thyroid profile: especially TSH (radioimmunoassay)
  • Fasting blood sugar (to rule out diabetes)
  • Complete blood count with indices (to rule out pernicious anemia

 

Why Does Vitiligo Develop?

Vitiligo results from a number of factors, Autoimmune, neurotrophic (interaction of melanocytes and the nervous system), and toxic (substances formed as a part of normal melanin production actually being toxic to melanocytes) hypotheses have been advanced. The mechanism involves progressive destruction of selected melanocytes, probably by cytotoxic T-cell lymphocytes.

 

How Much Vitiligo Will You Develop?

Vitiligo is a chronic disease process. Its course is highly variable and unpredictable, but rapid onset followed by a period of stability or low progression is most characteristic. Up to 30% of vitiligo patients report some spontaneous repigmentation, particularly in sun-exposed areas, but this is almost never enough to be satisfactory to the patient

Treatment of vitiligo-associated disease (for example, thyroid disease) does not produce a return of pigment in areas discolored by vitiligo.

 

How Is Vitiligo Treated?

There is no cure for vitiligo. The goal of medical treatment is to create a uniform skin tone by either restoring color (repigmentation) or eliminating the remaining color (depigmentation). Common treatments include camouflage therapy, repigmentation therapy, light therapy and surgery. Counseling may also be recommended.

 

Camouflage therapy

  • Using sunscreen with an SPF of 30 or higher. Also, the sunscreen should shield ultraviolet B light and ultraviolet A light (UVB and UVA). Use of sunscreens minimizes tanning, thereby limiting the contrast between affected and normal skin.
  • Makeups help camouflage depigmented areas. One well-known brand is Dermablend®.
  • Hair dyes if vitiligo affects the hair.
  • Depigmentation therapy with the drug monobenzone can be used if the disease is extensive. This medication is applied to pigmented patches of skin and will turn them white to match the areas of vitiligo.

 

Repigmentation therapy

  • Corticosteroids can be taken orally (as a pill) or topically (as a cream put on the skin). Results may take up to 3 months. The doctor will monitor the patient for any side effects, which can include skin thinning or striae (stretch marks) used for a prolonged period.
  • Topical vitamin D analogs.
  • Topical immunomodulators such as calcineurin inhibitors.

 

Light therapy

  • Narrowband ultraviolet B (NB-UVB) requires two to three treatment sessions per week for several months.
  • Excimer lasers emit a wavelength of ultraviolet light close to that of narrow-band UVB. This is better for patients who do not have widespread or large lesions since it is delivered to small, targeted areas.
  • Combining oral psoralen and UVA (PUVA) is used to treat large areas of skin with vitiligo. This treatment is said to be very effective for people with vitiligo in the areas of the head, neck, trunk, upper arms, and legs.

 

Surgery

  • Autologous (from the patient) skin grafts: Skin is taken from one part of the patient and used to cover another part. Possible complications include scarring, infection, or a failure to repigment. This might also be called mini grafting.
  • Micropigmentation: A type of tattooing that is usually applied to the lips of people affected by vitiligo.

 

Counseling

Vitiligo can cause psychological distress and has the ability to affect a person’s outlook and social interactions. If this happens, your caregiver may suggest that you find a counselor or attend a support group.

 

Coping With Vitiligo

The change in appearance caused by vitiligo can affect your emotional and psychological well-being. You may experience emotional stress, particularly if vitiligo develops on visible areas of your body, such as your face, hands, arms, or feet. You may feel embarrassed, ashamed, depressed, or worried about how others will react. Young people, who are often particularly concerned about their appearance, can be devastated by widespread vitiligo.

  • Make a good connection. Find a doctor who's knowledgeable about vitiligo. A dermatologist is a doctor who specializes in the care of skin.
  • Learn all about it. Find out as much as you can about vitiligo and its treatment options so you can participate in making important decisions about your health care.
  • Communicate your feelings. Let your doctor know if you're feeling depressed. He or she can refer you to mental health professionals who specialize in helping people deal with depression.
  • Talk with others. Ask your doctor about support groups in your area for people who have vitiligo. Take your loved ones along with you.
  • Confide in loved ones. Seek understanding and support from your family and friends.

 

Resources For People With Vitiligo



Sources:

https://www.mayoclinic.org/diseases-conditions/vitiligo/symptoms-causes/syc-20355912

https://www.avrf.org/facts/frequently-asked-questions.html

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