Vitiligo

What is vitiligo?

Vitiligo is a long-term skin condition where patches of the skin lose their pigment due to the loss or malfunction of melanocytes, the cells responsible for producing skin pigment. These patches often become stark white, contrasting sharply with the surrounding skin. This condition is especially prominent in individuals with darker skin tones but can affect people of all races. It's important to differentiate vitiligo from conditions like tinea versicolor, which has a different cause and presentation.

What causes vitiligo?

Vitiligo is thought to involve immune-system activity against melanocytes, along with genetic and environmental factors. Some patients have a family history of vitiligo or other autoimmune disease.

The condition can sometimes appear after skin injury, sunburn, or periods of stress, though not every patient identifies a clear trigger.

What are the symptoms of vitiligo?

Vitiligo is identified by well-defined patches of skin that lack pigment. These patches can manifest on various parts of the body, with common areas being the face, neck, extremities, body folds, nipples, navel, and genitalia.

Symptoms can include:

• White or very light patches of skin

• Involvement of the face, hands, arms, feet, or around body openings

• Whitening of hair in affected areas in some patients

• Changes that may be more noticeable after sun exposure because surrounding skin tans while vitiligo patches do not

Vitiligo can look different depending on skin tone, but it is often especially noticeable in patients with darker skin because of the contrast.

How is vitiligo treated?

Managing vitiligo varies in effectiveness based on the location and duration of the patches. Recent patches are generally more receptive to treatment than older ones, with areas like the hands and feet being particularly challenging. When repigmentation occurs, it often starts around hair follicles. Treatment avenues comprise:

• Topical corticosteroids (limited use is advised to avoid long-term side effects)

• Topical immunomodulators like pimecrolimus or tacrolimus

• Topical JAK inhibitors, such as ruxolitinib or tofacitinib

• UVB phototherapy

• Cosmetic options like makeup or tattooing to camouflage the patches

• Oral medications, which might include JAK inhibitors, corticosteroids, methotrexate, cyclosporin, or mycophenolate mofetil

• For extensive vitiligo, depigmentation of the unaffected skin is an option, though it necessitates lifelong vigilant sun protection

What else is important in vitiligo care?

Sun protection is important because vitiligo patches are more vulnerable to sunburn. Patients may also benefit from screening for associated autoimmune conditions when clinically appropriate.

Because vitiligo can affect confidence and quality of life, treatment goals often include both pigment improvement and emotional support.