Vitiligo

Overview

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Vitiligo is a skin condition characterized by the loss of pigment cells, leading to white patches on the skin. It can affect any part of the body and is caused by the destruction of melanocytes, the cells responsible for skin pigmentation.

It can affect any part of the body and is caused by the destruction of melanocytes, the cells responsible for skin pigmentation.

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Symptoms
  • White Patches on the Skin: The primary symptom is depigmented patches, often on areas exposed to the sun (hands, face, arms, feet).
  • Premature Graying of Hair: Hair on the scalp, eyebrows, eyelashes, and beard may turn white or gray.
  • Change in Mucosal Coloration: Loss of color inside the mouth and nose may occur.
  • Retinal Discoloration: In rare cases, eye color may change.
Complications
  • Psychological Effects: Depression, anxiety, and low self-esteem due to altered appearance.
  • Sunburn: Increased sensitivity to sunburn in depigmented areas.
  • Eye Problems: Uveitis (inflammation of the middle layer of the eye) is rare but possible.
  • Hearing Loss: Some cases have linked vitiligo to hearing abnormalities.
  • Autoimmune Disorders: An increased risk of other autoimmune conditions, such as thyroid disease, type 1 diabetes, and alopecia areata.
Causes
  • Autoimmune Response: The body’s immune system mistakenly attacks and destroys melanocytes.
  • Genetics: Family history can increase susceptibility.
  • Environmental Triggers: Sunburn, stress, or chemical exposure might contribute to the onset of vitiligo.
  • Oxidative Stress: Imbalance between free radicals and antioxidants may damage skin cells.
  • Neurogenic Factors: A connection between the nervous system and the depigmentation process has been proposed.
Prevention

There is No Guaranteed Prevention for Vitiligo, but Some Strategies may Help

  • Avoid Skin Trauma: Cuts, scrapes, and severe sunburns might trigger vitiligo in some cases.
  • Manage Stress: Since stress may play a role in triggering or worsening vitiligo, stress management techniques (meditation, yoga, therapy) are important.
  • Sun Protection: Use sunscreen to protect affected areas from sunburn."
Risk Factors
  • Family History: Those with a family history of vitiligo or other autoimmune conditions are at higher risk.
  • Autoimmune Diseases: People with other autoimmune disorders, like lupus or Hashimoto's thyroiditis, are more likely to develop vitiligo.
  • Skin Trauma or Damage: Physical damage to the skin (cuts, burns) may trigger vitiligo.
  • Genetics: Certain genes are linked to an increased risk.
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How is it Treated?

  • Topical Corticosteroids: Reduce inflammation and may restore skin color.
  • Immunomodulators: Tacrolimus or pimecrolimus are non-steroidal creams used to treat areas where steroid use is less desirable (face, neck).
  • Phototherapy (UVB): Narrowband ultraviolet B (NB-UVB) therapy helps stimulate melanocytes to restore pigment.
  • Excimer Laser: A targeted form of light therapy that can be used on smaller areas.
  • Depigmentation: For extensive cases, the remaining skin may be depigmented to match the lighter patches.
  • Surgical Treatments: Skin grafting or melanocyte transplants are options when other treatments are ineffective.
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How is it Diagnosed?

Vitiligo is diagnosed clinically through the presence of depigmented, milky-white macules or patches on the skin, often with well-defined borders. These lesions are typically symmetrical and may appear on the face, hands, arms, feet, and around body orifices. The diagnosis begins with a detailed medical history, including family history of autoimmune diseases.

A Wood’s lamp examination helps confirm depigmentation by accentuating the contrast between vitiliginous and normal skin under ultraviolet light. Skin biopsy, though rarely needed, may be performed to confirm loss of melanocytes. Blood tests may be ordered to detect associated autoimmune conditions, such as thyroid function tests, vitamin B12 levels, and ANA.

Differential diagnoses like tinea versicolor, post-inflammatory hypopigmentation, and leprosy must be excluded based on clinical presentation and fungal scraping when appropriate. Early and accurate diagnosis allows timely intervention to slow progression.

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FAQs

No, Vitiligo is Not Contagious. It Cannot be Spread From Person to Person.

There is No Cure For Vitiligo, but Treatments are Available to Help Manage and Reduce the Appearance of the Condition.

While no specific diet has been proven to cure vitiligo, a balanced diet rich in antioxidants may help support overall skin health.

Vitiligo is generally not painful, but the affected skin may be more sensitive to sunburn.

Yes, vitiligo can occur at any age, including in childhood.

Vitiligo is a chronic condition. Some people experience slow progression, while others may see more rapid changes in skin pigmentation.

Stress is considered a potential trigger or aggravator of vitiligo symptoms, although the exact relationship is not fully understood.

Yes, Vitiligo can cause hair to lose color, resulting in patches of white or gray hair.

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