Vitiligo is an autoimmune disease that destroys the pigment cells in the skin and affects 1-3% of the population. While it is not a dangerous or painful condition, it can have a serious impact on patients since it is a visible condition. The affected areas of the skin turn white, as the pigment becomes lost, and this can be disturbing for many patients.
Vitiligo Basics
Vitiligo is a disease that causes the loss of skin color and affects up to 2% of people worldwide.1 The color loss usually forms in patches and can vary in pattern, and in some cases, can be progressive, eventually affecting the entire body. Vitiligo can start at any age, but it often starts before the age of 20.
The most visible and obvious sign of vitiligo is the loss of color of the skin, which contrasts with the surrounding skin. Vitiligo can also affect the hair and the inside of the mouth. There are three general patterns of vitiligo:
- Affecting small areas of the body
- Affecting all areas of the body
- Affecting one side of the body
Vitiligo is most noticeable in those with dark skin due to contrast with the unaffected skin, but vitiligo can affect anyone.
The immediate cause of the loss of color is the destruction of melanocytes, which produce melanin (color pigment). Similar to many skin diseases, we don’t know the precise mechanisms, but the major factors that are involved include:
- Autoimmunity – The body attacks its melanocyte cells
- Genetics – Family history
- Triggers – Stress, sunburn, exposure to certain substances
Quality of Life
Vitiligo is not an infectious disease, and it does not cause itch or pain. It has no other significant health impacts, except for a small increase in susceptibility to other skin diseases. Vitiligo is primarily a cosmetic concern, but like many skin conditions, it can significantly impact the patient’s quality of life. Visible skin conditions can lead to considerable social stigma and discrimination, loss of self-confidence, and body image issues, affecting a person’s social life or even employment prospects.
In particular, vitiligo impacts people with darker skin tones more significantly due to the contrast with unaffected skin those with genital area involvement.2 Women also tend to have worse outcomes. The larger extent of vitiligo (VASI), facial involvement, or upper extremity involvement are correlated to a worse quality of life. Facial or involvement on the hands has the greatest negative impact on the quality of life due to its visibility. Finally, in some cultures, vitiligo has been attributed to “divine punishment” or “white leprosy.” These superstitions have always followed visible skin conditions and frequently exacerbate social stigma in communities where these beliefs are prevalent.3
Treatment and Lifestyle
There is currently no cure for vitiligo. There isn’t a treatment that can reliably prevent or reverse the loss of pigment cells. Generally, these treatments focus on reducing inflammation or influence immune response if the affected area is small. Light therapies like PUVA may be used as well. Overall, the prognosis for treatments that seek to reverse the effects of vitiligo is poor. Another more aggressive approach is to camouflage the skin affected by vitiligo to darken it or depigment the surrounding skin to better match the patches of vitiligo. Medical tattoos and grafting of skin are also possibilities as well for some cases.
Sun protection is crucial for people with vitiligo. First, skin darkened by a tan contrasts with the vitiligo-affected areas more, making the condition more visible. More importantly, sunburns or any injury can worsen vitiligo or even start new vitiligo areas that were previously unaffected. Avoiding injuries, in general, is also important for the same reason. Called the Koebner phenomenon, vitiligo may start at a site of injury, and for this reason, tattoos are also not recommended.4
1https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4897932/
2https://www.ncbi.nlm.nih.gov/pubmed/28456327
3https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4897932/
4https://onlinelibrary.wiley.com/doi/full/10.1111/j.1755-148X.2011.00838.x
