Unknown: Vitiligo

Definition
Description
Demographics
Causes and Symptoms
Diagnosis
Treatment
Prognosis
Prevention
The Future
For more information

Definition

Vitiligo (pronounced vittle-EYE-go) is a skin disorder in which patches of skin—most commonly on parts of the body that are exposed to sunlight— lose their pigmentation. The patches of depigmented tissue may involve the soft tissues that line the nose and mouth.

Description

Vitiligo is a skin disorder in which patches of skin, soft tissues lining the nose and mouth, and/or hair gradually lose their color. This loss of color takes place when melanin, a dark brown or reddish pigment produced by cells in the skin called melanocytes, is either destroyed or not produced in the first place. The patches of depigmented skin may grow, shrink, or stay the same size. They usually appear first on the parts of the body that are exposed to the sun, such as the hands, feet, face, lips, and arms. They may spread later to the armpits, genitals, groin area, and the soft tissues that line the nose and mouth. In some cases the white patches may eventually cover the patient's entire body.

Doctors classify vitiligo into three types according to the pattern of the skin patches:

• Focal. The areas of depigmented skin are limited to one or a few parts of the body.
• Segmental. The loss of color occurs on only one part of the body.
• Generalized. There are many patches of white skin on many different parts of the body. This is the most common of the three patterns.

Demographics

Vitiligo is thought to affect between 0.5 and 2 percent of people around the world, as many as 65 million adults. There are between 1 and 2 million people in the United States with the disorder.

Vitiligo can start at any age, but roughly half of patients develop it before age twenty and most patients before age forty. It affects men and women equally, although women are more likely to notice the disorder at an earlier age than men. It also affects people of all races equally;

however, the depigmented areas of skin are more noticeable on people with darker skin.

In addition to humans, vitiligo is found in some animals, particularly certain breeds of dogs and horses.

Causes and Symptoms

The causes of vitiligo are not completely understood. One reason some researchers think that genetic factors may be involved is that about 30 percent of cases run in families. Another theory is that vitiligo is either an autoimmune disorder or caused by one. Still other researchers think that vitiligo may be stress-related, because some people develop their first symptoms of it following a severe case of sunburn or an emotional shock. None of these theories have been proved so far, however.

In addition to the patches of depigmented skin, the symptoms of itiligo may include:

• Premature graying (before age thirty) of scalp hair, pubic hair, and eyebrows.
• Uveitis. This is an inflammation of the interior of the eye.
• Depigmented areas on the soft tissues lining the mouth and nose.
• Change in color of the retina of the eye.

• Itching of the affected skin. This symptom is usually limited to the early stages of the disorder.
• Increased sensitivity to sun exposure.

Although vitiligo is a skin disorder and not a psychiatric condition, many patients do have strong psychological reactions to the impact of the disorder on their appearance, particularly if the face is affected. In some cultures, people with vitiligo are thought to be evil or infected with leprosy and may be rejected by other members of the community. Many people with vitiligo in the United States become depressed or socially isolated because they are afraid of being stared at or teased.

Diagnosis

The diagnosis of vitiligo is based on the patient's history, including a family history of vitiligo. The doctor will also ask about autoimmune disorders, recent sunburns or other injuries to the skin, unusual sensitivity to the sun, or a history of diabetes.

In most cases the doctor can diagnose vitiligo by looking at the patient's skin with a Wood lamp, a special device that uses ultraviolet light to diagnose skin infections and other abnormalities. Another diagnostic technique that can be used is the skin biopsy. To perform a biopsy, the doctor removes a small piece of the affected skin to examine under a microscope. If the patient has vitiligo, the skin sample will usually show a complete absence of melanocytes.

In the Public Eye: A Television Reporter's Story

Lee Thomas, a television anchor in Detroit, first noticed his vitiligo in 1992, when he was 25 and working for a news station in Louisville, Kentucky. After a haircut he noticed a white spot about the size of a quarter on one side of his scalp. Looking closely, he found other patches on the other side of the scalp, one hand, and inside his mouth. He immediately went to a doctor and was told he had vitiligo. He decided not to let the disease interfere with his goals, though his career depends in part on appearance. On camera, he wears makeup to even out the different colors of his facial skin. “I'm a black man turning white on television and people can see it…If you've watched me over the years, you've seen my hands completely change from brown to white.”

Thomas no longer wears makeup outside the studio, a decision made partly for the sake of patients with vitiligo who fear rude or unkind reactions from the public. He admits that he himself went through “times when I would not come out of the house. I call it a mental war. It was me saying, ‘I don't want to deal with it today.'” Thomas wrote a book about his experiences and credits the disease with strengthening his inner qualities: “Having this disease forces me to focus on what I am: kind, caring, honest. There are [other] people who have diseases that will kill them.”

Treatment

There is no cure for vitiligo. Medical or surgical treatment is not necessary; some people choose to manage the condition with special cosmetics that cover the white areas and even out the person's skin tone. Even patients who choose medical or surgical therapies may wish to use

camouflage cosmetics during their treatment, as it takes between six to eighteen months to complete treatment.

No treatment that is presently available for vitiligo will work for all patients. The choice of treatment depends partly on the number, size, and location of the white patches. Medical treatments for vitiligo are aimed at reducing the contrast between the pigmented and depigmented areas of skin. They include:

• Corticosteroids. These medications are applied directly to the depigmented skin; they work by restoring the color to the white areas. They take about three months for the skin to show improvement.
• PUVA (psoralen/ultraviolet A) therapy. In this type of treatment, the patient takes a drug called psoralen either by mouth or by applying it to the skin as a cream. The patient is then exposed to carefully timed ultraviolet light in the doctor's office. Psoralen reacts with ultraviolet light to darken the skin. Major drawbacks of PUVA therapy are its side effects (chiefly sunburn and too much darkening of the skin) and an increased risk of skin cancer.
• Depigmentation. A drug called Benoquin is applied twice a day to the pigmented areas of the body to lighten them to match the areas that are already white. Depigmentation may be the best choice for people who have vitiligo on more than 50 percent of the body. Its chief drawback is that the person's skin will always be unusually sensitive to sunlight afterward. In addition, this form of treatment is irreversible.

Surgical treatments for vitiligo include:

• Skin grafts. The surgeon removes skin from pigmented areas of the patient's body and places it on depigmented areas. This procedure has a number of drawbacks: it is time-consuming, expensive, painful, and carries some risk of scarring and infection.
• Micropigmentation (tattooing). In this procedure, the doctor implants pigment into the skin with a special surgical instrument. It is usually used only in the area around the lips. One drawback is that it is usually difficult to match the patient's natural skin color.
• Autologous melanocyte transplantation. This procedure is still considered experimental. The doctor removes a sample of the patient's normal pigmented skin and places it in a special culture medium to grow melanocytes. After the melanocytes have

multiplied, the doctor transplants them into the areas of depigmented skin. As of 2008, this treatment was very expensive and impractical for most people with vitiligo.

Patients with vitiligo are encouraged to join support groups or seek counseling in order to cope with the emotional effects of the disease.

Prognosis

It is very difficult to predict the spread of vitiligo on any patient's body or the outcome of any specific type of treatment.

Prevention

There is no known way to prevent vitiligo, because the causes of the disorder are not yet understood.

The Future

It is not likely that vitiligo will become either more or less common in the general population than it is at present. Research into the disorder is focused on looking for specific genes that may be related to vitiligo and examining the role of stress in triggering the onset of the disorder. Some evidence has been recently found of a link between vitiligo and variants of a gene called FOXD3.

SEE ALSO Stress; Sunburn

WORDS TO KNOW

Melanin: A brownish or dark reddish pigment that is the primary determinant of skin, hair, and eye color in humans.

Melanocyte: A type of skin cell that produces melanin.

Retina: The layer of light-sensitive cells at the back of the eyeball.

Uveitis: Inflammation of the interior of the eye.

Wood lamp: A special lamp that uses ultraviolet light to detect certain types of skin infections and other disorders, including vitiligo.

For more information

BOOKS

Thomas, Lee. Turning White: A Memoir of Change. Troy, MI: Momentum Books, 2007.

PERIODICALS

Associated Press. “Fox TV Reporter Refuses to Give In to Skin Disorder Turning Him White.” Fox News, December 17, 2007. Available online at http://www.foxnews.com/story/0,2933,317065,00.html (cited June 15, 2008).

WEB SITES

American Vitiligo Research Foundation. Vitiligo Facts. Available online at http://www.avrf.org/facts/facts.htm (accessed June 15, 2008).

Mayo Clinic. Vitiligo. Available online at http://www.mayoclinic.com/health/vitiligo/DS00586 (updated April 20, 2007; accessed June 15, 2008).

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Questions and Answers about Vitiligo. Available online at http://www.niams.nih.gov/Health_Info/Vitiligo/default.asp (updated October 2006; accessed June 15, 2008).

National Vitiligo Foundation (NVF). Vitiligo Patient Handbook. Available online at http://www.nvfi.org/pages/info_patient_handbook.php (updated February 2008; accessed June 15, 2008).