Vitiligo - Western SummaryWestern Medicine Summary

Western Medicine

Western Summary

Vitiligo is a chronic skin condition characterized by areas of the skin that have lost their natural color. About 1% of people worldwide have the condition.[1] Vitiligo affects all races and skin colors equally, but it is more noticeable in people with darker skin.

Symptoms

The affected skin is typically white and appears lighter than the unaffected skin. Though vitiligo mainly affects the skin, it can develop anywhere in the body that contains color. Some examples include hair (extending to eyebrows, eyelashes and beards), areas inside the mouth, genitals, or even the eye can lose color. Vitiligo does not cause many symptoms, but occasionally people can feel itch or pain. Though vitiligo is not life threatening and cannot be spread from person to person, its appearance can cause significant stress and worsen one's quality of life.[2,3]

There are two types of vitiligo: segmental and non-segmental.[4] 

  1. Segmental vitiligo appears on one part of the body, such as the face, arm, leg or one side of the trunk. This type of vitiligo begins at an early age and typically continues for a few years before it stops spreading.
  2. Non-segmental vitiligo is more common, and often starts at the hands/feet, around the eyes or mouth, and affects both sides of the body symmetrically. Unlike segmental vitiligo, non-segmental vitiligo starts later in life and can continue to spread throughout one's lifetime.[4] 

Causes

Vitiligo occurs when the cells that produce color in the skin and hair called melanocytes either die or stop working.[5] Scientists and researchers have not pinpointed the exact cause for why this happens, but it appears that there are several reasons. One reason is that a person's immune system may be overactive and falsely attacking and destroying one's own melanocytes.[6] Vitiligo can appear along with other diseases caused by an overactive immune system, such as thyroid diseases, type I diabetes, lupus, rheumatoid arthritis, and alopecia areata (a type of hair loss). Genetics may also play a role, as patients with vitiligo are more likely to have a close relative who is also affected by it.[7] 

Treatments

There is no cure for vitiligo, but several treatments are available to slow down or reverse pigment loss. 

  • Anti-inflammatory medications: The most commonly used treatments are topical anti-inflammatory medications such as steroids and calcineurin inhibitors.
  • Phototherapy: Ultraviolet light treatment is called phototherapy. Phototherapy can improve vitiligo in several ways: it can reduce the immune system from attacking the melanocytes (also known as the pigment producing cells in the skin),[8,9] and it can simulate existing melanocytes to make more pigment.[10] Phototherapy can be combined with topical steroids or calcineurin inhibitors. A second kind of phototherapy is known as psoralen phototherapy (PUVA). It involves taking a medication called psoralen by mouth or in a soaking solution in combination with UVA light treatment. Psoralen makes the skin more sensitive to ultraviolet light and in turn makes phototherapy more effective.[11] PUVA therapy is typically used for the hands and feet, although it could be used for the entire body too.
  • Laser: The use of the excimer laser (308 nm) has been shown to be helpful in the treatment of vitiligo.[12] 
  • Minigrafiting: Vitiligo can also be treated by minigrafting, where small pieces of the patient's own normal skin are harvested and grafted onto the areas of skin that have lost color.[13] 
  • Skin bleaching: In people with a large surface area involvement (typically over 80%), permanent skin depigmentation using topical chemicals such as monobenzone and hydroquinone may be considered.[10]
  • Cosmetic camouflage: When the affected body surface area is limited, skin camouflage using cosmetic makeup or artificial tanning can make the depigmented areas less noticeable.

1.    Whitton M, Pinart M, Batchelor JM, et al. Evidence-Based Management of vitiligo: summary of a Cochrane systematic review. Br J Dermatol.2015;10.1111/bjd.14356PMID: 26686510.

2.    Amer AA, Gao XH. Quality of life in patients with vitiligo: an analysis of the dermatology life quality index outcome over the past two decades. Int J Dermatol.2016;10.1111/ijd.13198PMID: 26749040.

3.    Bonotis K, Pantelis K, Karaoulanis S, et al. Investigation of factors associated with health-related quality of life and psychological distress in vitiligo. J Dtsch Dermatol Ges.2016;14(1):45-48; PMID: 26713637.

4.    Mazereeuw-Hautier J, Bezio S, Mahe E, et al. Segmental and nonsegmental childhood vitiligo has distinct clinical characteristics: a prospective observational study. J Am Acad Dermatol.2010;62(6):945-949; PMID: 20466172.

5.    Mohammed GF, Gomaa AH, Al-Dhubaibi MS. Highlights in pathogenesis of vitiligo. World J Clin Cases.2015;3(3):221-230; PMID: 25789295.

6.    Iannella G, Greco A, Didona D, et al. Vitiligo: Pathogenesis, clinical variants and treatment approaches. Autoimmun Rev.2015;10.1016/j.autrev.2015.12.006PMID: 26724277.

7.    Majumder PP, Nordlund JJ, Nath SK. Pattern of familial aggregation of vitiligo. Arch Dermatol.1993;129(8):994-998; PMID: 8352624.

8.    Dang YP, Li Q, Shi F, et al. Effect of topical calcineurin inhibitors as monotherapy or combined with phototherapy for vitiligo treatment: a meta-analysis. Dermatol Ther.2015;10.1111/dth.12295PMID: 26460804.

9.    Whitton ME, Pinart M, Batchelor J, et al. Interventions for vitiligo. Cochrane Database Syst Rev.2015;2:CD003263; PMID: 25710794.

10.    Bulat V, Situm M, Dediol I, et al. The mechanisms of action of phototherapy in the treatment of the most common dermatoses. Coll Antropol.2011;35 Suppl 2:147-151; PMID: 22220423.

11.    Maverakis E, Miyamura Y, Bowen MP, et al. Light, including ultraviolet. J Autoimmun.2010;34(3):J247-257; PMID: 20018479.

12.    Spencer JM, Nossa R, Ajmeri J. Treatment of vitiligo with the 308-nm excimer laser: A pilot study. Journal of the American Academy of Dermatology.2002;46(5):727-731; PMID.

13.    Njoo MD, Westerhof W, Bos JD, et al. A systematic review of autologous transplantation methods in vitiligo. Arch Dermatol.1998;134(12):1543-1549; PMID: 9875191.