All About Vitiligo: Diagnosis and Treatment

What is Vitiligo?

Vitiligo is a chronic skin condition characterized by the loss of color in patches of the skin. This occurs due to damage to melanin, the pigment responsible for the color of skin, hair, and eyes.

Vitiligo often appears on the face, hands, and genitals but can affect any part of the body, including hair. The skin pigmentation changes are typically symmetrical, showing up as similar or identical patches on both sides of the body.

It is estimated that up to 2% of the population has vitiligo. It can occur in individuals of any age or sex, though it most commonly presents before the age of 20. Vitiligo can develop in people of any skin color but may be more noticeable in those with darker complexions. While the change in appearance can cause stress and anxiety, vitiligo is neither dangerous nor contagious.

Vitiligo and Eczema: How Are They Linked?

Causes of Vitiligo

Vitiligo is an autoimmune disease where the immune system attacks certain parts of the body. In this case, it targets the cells that produce melanin (melanocytes), leading to their destruction and resulting in the loss of skin pigment.

The exact trigger for this immune response is unclear, but genetics play a significant role, with about one-third of cases having a family history of the condition.

Certain factors can increase the risk of developing vitiligo, including:

• Having family members with vitiligo
• Having another autoimmune condition (e.g., lupus, rheumatoid arthritis, Crohn’s disease)
• Having certain types of cancer (e.g., melanoma, non-Hodgkin lymphoma)

Additionally, factors like severe sunburns and skin injuries can trigger flare-ups in individuals with vitiligo.

Symptoms

The primary symptom of vitiligo is the sudden loss of pigment in patches of skin, which appear as milky-white, irregularly shaped areas. These patches often occur on the face, hands, and genitals and can spread over time, varying greatly from person to person. The extent of skin affected is unpredictable, ranging from small areas to most of the body.

Vitiligo can affect any part of the body, including the inside of the mouth. It can also cause early whitening of hair on the scalp, eyelashes, eyebrows, and facial hair.

Diagnosis

Diagnosing vitiligo involves a healthcare provider examining the skin. This may include a skin biopsy and/or blood tests to rule out other conditions. The provider will also inquire about your family history and the progression of your symptoms to make a comprehensive diagnosis.

Treatment for Vitiligo

Treating vitiligo is a personal choice since the condition is not dangerous. Some individuals may opt not to seek treatment, while others may feel unhappy with their changing appearance and choose to cover the patches with makeup or seek medical treatment.

While the white patches are generally permanent, some products can help reduce their appearance and restore some pigment to the skin. Treatment for vitiligo typically aims to:

• Restore the original color to white patches of skin, and/or
• Slow the progression of the condition (prevent patches from getting larger)

It's important to note that vitiligo has no cure. Treatment may improve discoloration, but the effects are not permanent and may fade over time.

Medication Options for Insomnia

When lifestyle changes aren't enough to manage insomnia, various over-the-counter (OTC) and prescription medications can help. Consult a healthcare provider before starting any new medication to ensure it's safe and appropriate for you.

Non-Medication Treatment

Light Therapy

Light therapy (phototherapy) aims to restore lost pigment to the skin. It is most effective when combined with other therapies, such as topical medications. This treatment involves exposing the skin to narrow-band ultraviolet (UV) light, specifically UVB, usually 2-3 times per week over several months.

Sometimes, a healthcare provider may prescribe the medication psoralen in addition to light therapy. Psoralen increases the amount of UV light the skin absorbs, enhancing the effectiveness of the treatment.

Common side effects of light therapy are typically short-lived and may include:

• Skin irritation
• Redness of the skin

There is also an increased risk of skin cancer with UVA light exposure, though this risk is lower with UVB.

Surgery (Skin Grafting)

Surgery is the most invasive treatment option for vitiligo and is typically reserved for cases that are no longer spreading and have not responded to other treatments. Surgical treatment usually involves skin grafting, where healthy skin is transplanted to areas that have lost pigment.

Common side effects of light therapy are typically short-lived and may include:

• Infection
• Scarring
• Irregular appearance of the skin

Depigmentation

Depigmentation is a unique treatment option that removes any remaining pigment from healthy skin rather than restoring pigment. This treatment is uncommon and is only an option for individuals who have already lost most of their original skin color.

Depigmentation is usually done with a topical product applied to areas with the original skin color. Over time, this removes the remaining melanin, resulting in an even skin tone. This approach is time-consuming and may take several years to achieve the desired effect.

Side effects of depigmentation may include:

• Irritation
• Dryness
• Redness of the skin

This treatment is considered permanent, as any removed pigment will not return.

Medication Treatment

There are various medications available to help manage vitiligo. Although only one FDA-approved treatment exists, there are several over-the-counter (OTC) and prescription medications available.

Topical Corticosteroids

Topical steroids are a common anti-inflammatory treatment for various skin conditions, including vitiligo. These products come in different strengths and formulations, such as creams and ointments. Lower strength products (0.5-1% hydrocortisone) are available OTC, while higher strength products require a prescription.

Topical steroids are typically used early in the condition before it has widely spread. They are applied to areas of skin that have lost pigment to slow its spread and potentially restore some original skin color. While they may show effects sooner than other products, it can still take several months to see benefits.

Long-term use of these medications comes with certain risks, so it's important to discuss treatment with a healthcare provider. Side effects may include:

• Burning/stinging of the skin
• Thinning of the skin
• Topical steroid withdrawal

Calcineurin Inhibitors

Calcineurin inhibitors are prescription-only products usually prescribed for skin conditions like eczema. Although not FDA-approved for vitiligo, Protopic (tacrolimus) and Elidel (pimecrolimus) are often prescribed to treat the condition.

These inhibitors work by reducing immune system activity, which helps prevent further loss of pigment and potentially restores some lost color. They are considered a good option early in the disease progression with small patches of lost pigment.

Common side effects include:

• Burning/irritation of the skin
• Increased sensitivity to the sun
• Skin irritation/redness when drinking alcohol

Unlike topical steroids, calcineurin inhibitors do not cause skin thinning and can be used long-term.

Opzelura (ruxolitinib)

Opzelura is the only FDA-approved medication for vitiligo. This prescription-only cream is approved for individuals aged 12+ and can be applied to up to 10% of the body’s surface area.

Opzelura is a JAK inhibitor that interferes with inflammation to calm the immune response. Applied to areas of skin that have lost pigment, it may help restore the original color over several weeks. While JAK inhibitors are relatively safe, they may increase the risk of certain infections.

Living with Vitiligo

Although vitiligo is not dangerous, there are considerations for managing the progressive loss of pigment. The affected skin becomes more sensitive to the environment, and there are psychological implications to the changing appearance. Here are some important considerations:

Sun Protection

Skin that has lost pigment becomes extra sensitive to the sun. It's crucial to protect your skin from sunburn by applying sunscreen with a high sun protection factor (SPF) and wearing clothes that cover your skin.

Vitamin D Supplementation

Most people get some of their required vitamin D from the sun. Covering your skin reduces vitamin D absorption, potentially leading to a deficiency. Healthcare providers often recommend daily vitamin D supplements or increasing vitamin D-rich foods in your diet.

Counseling and Support

Many individuals with vitiligo feel isolated and struggle with their changing appearance. Joining support groups to speak with others experiencing similar challenges can be helpful. Additionally, talk therapy can assist in coming to terms with the diagnosis and gaining comfort with the changing appearance.