Vitiligo is a medical condition in which the patient develops white patches. These patches can develop anywhere on the body and are often scattered in multiple places. It is a fairly common condition and affects almost 1 in a hundred people.
Vitiligo, also known as white spot disease, is an acquired chronic disease in which there is a patchy loss of the pigment melanin (responsible for the color of skin, hair, and eyes) and thus the original skin color. The inhibition or destruction of the melanin-producing cells or melanocytes is responsible for this pigment loss. The white spots can appear anywhere on the skin and also affect mucous membranes, hair, or eyes. Sometimes the spots disappear spontaneously, but more often they grow together into larger areas or spread over several areas of the body
In the following, we will look into the possible Vitiligo causes, symptoms, and how you might prevent it from developing.
- 1 How You Might Detect Vitiligo
- 2 What are the Vitiligo Causes?
- 3 Diagnosis (examination) of Vitiligo
- 4 Treating Vitiligo
- 5 How to Cope with Vitiligo?
- 6 Conclusion
- 7 Recommended Reading if You Want to Know More
How You Might Detect Vitiligo
The most prominent and common symptom of Vitiligo is the white patches. But you may also detect it by the onset of gray hair on the scalp, eyelash, or eyebrows. Vitiligo also causes the retina to change color. There are even some cases of severe Vitiligo that cause a loss in the color of the membrane inside the mouth.
The main symptom of Vitiligo are typically chalk-white or milky-white spots that are several millimeters to centimeters in size, rounded, and sharply demarcated. The edge can rarely be darker in color or reddish. The skin itself remains intact.
Vitiligo most often begins on sun-exposed skin areas such as the face, especially in the area around the eyes and mouth, hands, forearms, and feet. The course is unpredictable. Occasionally the Vitiligo spots disappear spontaneously. More often they grow together to form larger areas or affect several areas of the body or even the entire surface of the skin.
The skin areas around natural body orifices such as lips, eyes, nose, nipples, genitals or navel as well as the armpit or groin are also preferred areas for white spot disease. The white spots are also often found in areas where the skin stretches over bony protrusions, such as on the elbows, wrists, or knuckles.
Vitiligo spots often develop in previously healthy areas of the skin after specific trauma, which is known as the Koebner phenomenon or isomorphic stimulus effect. Various factors or mechanisms can lead to this effect, for example, injuries to the skin, e.g. through cuts or scratches, or burns or chemicals, in areas of chronic friction or at pressure points (e.g. from clothing) or in areas with heavy use (e.g. elbows, knees).
In affected areas, the hair may gray or whiten early (in places or entirely), and on the face also the eyebrows, eyelashes, and whiskers. Infestation of the mucous membranes is possible, as is a loss of pigment in the retina.
What are the Vitiligo Causes?
Even after so many technological advances, scientists are still confused about what are Vitiligo causes. Several theories have been gathered by Vitiligo patients and tests.
The most accepted Vitiligo cause is the loss of melanin. Melanin is the basic factor or pigment that gives the skin its color. The pigment is lost due to the destruction of special pigment-forming cells which are called melanocytes. However, the reason for the loss of pigment and destruction of cells is still unsure. There are a few theories to support this fact too.
There is an autoimmune hypothesis that states that the immune system attacks the melanocytes. Also, a neural theory is present that states that a certain chemical named norepinephrine is toxic to melanocytes and thus destroys them.
Other Vitiligo causes are seen in patients. Heredity may be blamed for Vitiligo but there are no solid researches to support this. It is also seen that patients of Vitiligo are deficient in certain minerals and vitamins. This may be due to Vitiligo caused by this deficiency or Vitiligo may be causing these deficiencies. In any case, the patient is advised to have a stable and healthy diet.
Stress and trauma have also been linked with one of the Vitiligo causes. It is often seen that the first onset of Vitiligo is during some stressful event or trauma. This may be your body’s way of reacting in an autoimmune reaction due to the stress.
In Vitiligo, skin discoloration occurs when the melanin-forming cells or melanocytes no longer produce melanin, due to the inhibition or destruction of these melanocytes. The exact reason for this is not yet known. A hereditary predisposition is likely, however, as approximately 30% of Vitiligo cases are familial.
Various mechanisms are assumed which, individually or in combination, influence the melanocytes and thus lead to the development of the pigment disorder:
In the autoimmune hypothesis, it is assumed that the body’s defense system incorrectly recognizes its melanin-producing cells as foreign and dangerous, forms antibodies against them, so-called autoantibodies, and thus initiates their destruction. In addition, certain immune cells are supposed to attack the body’s melanocytes.
Self-destruction hypothesis (auto aggression hypothesis)
In the self-destruction hypothesis or auto-aggression hypothesis, an imbalance in the cell metabolism of the melanin-producing cells is said to cause them to self-destruct.
Certain substances released by the skin nerves are believed to be responsible for the destruction of melanocytes.
This could also be related to statements made by patients in whom Vitiligo was triggered or worsened after psychological stress, stress, skin injuries, or severe sunburns.
Radical hypothesis and oxidative stress
It is assumed that free radicals accumulate in the melanocytes because the antioxidant protective mechanisms fail. This accelerates cell aging and promotes the destruction of melanocytes.
Diagnosis (examination) of Vitiligo
The diagnosis of vitiligo is usually made clinically, which includes a thorough review of the patient’s and family history and a thorough physical exam. Blood tests and, if necessary, a tissue sample (biopsy) help rule out other causes for the skin changes or any accompanying diseases (such as autoimmune diseases).
Important points of the patient survey
- How long have the skin changes existed and are they stable or progressive?
- Under what circumstances did the skin changes occur? For example, after previous inflammation, irritation, or rashes on the affected skin; after skin injuries; after severe sunburn; after emotionally stressful events, or physical illnesses.
- Koebner phenomenon
- Known vitiligo in family members
- In the person affected or in his family known (autoimmune) concomitant diseases: e.g. thyroid diseases, type 1 diabetes, premature graying of hair (before the age of 30), alopecia areata ( circular hair loss ), pernicious anemia (vitamin B12 deficiency anemia), connective tissue diseases, etc.
- Medicines or contact with certain chemical substances.
- Examination of the skin with the Wood lamp to better visualize the white spots
- Description of the number, distribution, and extent of skin changes (classification of vitiligo)
- Examination by an ophthalmologist (40% of Vitiligo patients also have unnoticed changes to the retina)
For the exclusion or detection of, for example, thyroid diseases or diabetes mellitus and other concomitant diseases.
A tissue sample (biopsy)
To rule out other causes of the skin changes such as pigment loss as a result of melanoma (black skin cancer).
The reliable diagnosis of Vitiligo is crucial for the further course of action and the start of treatment. Many diseases also cause white spots, so-called leukoderma, or a reduction in skin pigmentation, but require a completely different therapy or approach than white spot disease. In contrast to Vitiligo, some are curable (e.g. infectious diseases).
According to your diagnosed cause of Vitiligo, the doctor will select a line of action. A 100% cure for Vitiligo is not available but with the right treatment, it can be controlled a great deal. Most common treatment procedures include application of cosmetics and makeup, UV therapy, corticosteroid creams, skin grafting, and even de-pigmentation of un-affected skin.
Vitiligo Repigmentation is achieved by stimulating melanocytes. In most Vitiligo patients there are remaining pigment cells in the hair root area, which can be stimulated to growth and immigration into the skin. Individual melanocytes remaining in the Vitiligo spots or located in the edge of the spots serve as additional sources.
Sun protection is one of the most important measures for Vitiligo. With the loss of pigment, the natural protection of the skin has also been lost. With adequate sunscreen and covering clothing, you protect the unpigmented skin areas from sunburn and normal skin from excessive tanning (so the color difference to the white spots is not greater). Severe sunburns can also worsen the condition of Vitiligo.
The white Vitiligo spots represent a serious aesthetic problem for many sufferers. The following are available for cosmetic coverage:
- Camouflage: that is, waterproof, special high-coverage make-up products can cover up the skin changes. Instruction by trained cosmetic staff is recommended.
- Self-tanner: However, this cannot be washed off (the effect lasts 3 to 5 days) and a regular result is more difficult to achieve.
- Cosmetic tattoos: can be used, for example, in the area of the lips (especially for dark-skinned people) or nipples, but caution is advised in other areas due to the unpredictability of Vitiligo.
Depending on the extent of the disease and the level of suffering of those affected, cosmetic measures may be sufficient for Vitiligo patients.
Medicines for external use
Corticosteroids as a cream or ointment:
- Medium-strength corticosteroids are recommended as the therapy of the first choice for use in children and adults with limited, extensive vitiligo (less than 2-3% of the body surface) outside the face. Duration: 3 to 6 months, depending on the therapy scheme.
- Not applicable in the long term due to side effects. Possible side effects are thinning of the skin (atrophy), permanently enlarged superficial blood vessels (telangiectasia), increased hairiness (hypertrichosis), or acne-like skin changes.
- Most effective when used on sun-exposed skin, dark skin, and fresh skin changes.
- When used over a longer period, on a large area, on thin skin, or in children, newer corticosteroids with negligible systemic side effects should be used due to (systemic) side effects affecting the entire organism.
Calcineurin inhibitors as a cream or ointment:
- These are so-called immunomodulators, ie they influence processes in the immune system.
- Studies confirm its effectiveness in terms of repigmentation, especially in the head and neck area.
- Are better tolerated than corticosteroids.
- Can be used as an alternative to corticosteroids in children and adults for new vitiligo spots on thin skin. Due to the lack of data available for other areas of the body, the use of calcineurin inhibitors should be restricted to the head area and neck area.
- Duration of therapy: 6 months, extension possible if successful.
- During the therapy, the treated areas of the skin should be exposed to sunlight in moderation, but daily.
- So far only as off-label use, as the authorities currently only approved for neurodermatitis.
Other active ingredients that affect the immune system are still being researched.
Medicines for internal (systemic) use
- Use as oral mini pulse therapy (OMP), ie taking medium doses at certain intervals, in the case of rapidly progressing (progressive) Vitiligo or lack of stabilization after light therapy: stabilizes the disease and promotes repigmentation.
- Not suitable for stable Vitiligo.
Other drugs that affect the immune system are still being researched. However, the currently insufficient data and side effects do not justify their use in Vitiligo.
During phototherapy or light treatment, areas of the skin affected by vitiligo are irradiated with ultraviolet light (UV). This can stimulate remaining melanocytes to grow and form new pigments. Skin areas on the face or trunk usually respond well to this treatment.
Phototherapy can be combined with medication (corticosteroids, calcineurin inhibitors). Various combinations with other substances such as antioxidant gels (pseudo catalase) or antioxidant food supplements have shown some positive results. However, these must be confirmed in further studies.
Narrowband UVB light therapy
- Currently considered the treatment of the first choice for generalized vitiligo.
- Irradiation with a certain narrow spectrum of UVB rays in radiation cabins or utilizing partial body devices.
- Whole-body irradiation if more than 15-20% of the body surface is affected.
Targeted UVB light therapy
- Excimer laser, excimer lamp: irradiation with UVB light of a certain wavelength (monochromatic light).
- Micro-phototherapy: Narrowband UVB with a focused light beam
- High-energy flash lamp
- Affected areas can be irradiated in a targeted manner without affecting the surrounding healthy skin. Particularly useful for areas that are otherwise difficult to access, such as skin folds.
- Indicated for localized forms of Vitiligo, especially for small new spots and in childhood.
There is still no agreement on what the optimal duration of treatment for targeted or narrowband UVB light therapy is. The light therapy is usually used for at least 3 months and, if successful, continued as long as repigmentation can be detected, for a maximum of 1 to 2 years.
Combination of special active ingredients that increase the skin’s sensitivity to light with irradiation of the skin with UVA light:
- PUVA: As a light-sensitizing agent, psoralen is applied topically (cream, ointment, or as a bath) or internally before radiation. Particularly effective for dark skin types. Has been replaced by the better tolerated and more efficient narrowband UVB light therapy as the treatment of the first choice for generalized vitiligo. As a long-term side effect, there is an increased risk of skin cancer.
- KUVA: Khellin as a light sensitizing agent before UVA radiation. Internal ingestion is no longer used because of its liver-damaging effect. Topical application as a cream or gel can be used in certain cases. However, there is largely a lack of data to prove the effectiveness of this application.
Pieces of skin or pigment cells are taken from healthy skin areas of the person affected and transplanted into pathologically altered skin areas after the upper layer of skin has been removed there. Various surgical procedures are available that can be performed under local anesthesia or, under certain circumstances, under general anesthesia.
- Surgical procedures are primarily used for segmental vitiligo and other localized forms when medicinal and physical measures have not shown any success.
- The prerequisite is a disease that has become stable. The segmental Vitiligo and localized Vitiligo forms are therefore best suited.
- In certain circumstances, patients with stable nonsegmental vitiligo can also be treated surgically, but the risk of relapse is increased.
- During depigmentation, remaining healthy skin islands are bleached with chemical substances and/or laser treatment to achieve an adaptation to the affected skin.
- Only in the case of extensive (more than 50% of the body surface), disfiguring Vitiligo that does not respond to other treatment options.
- Subsequently, there is an extreme sensitivity to sunlight.
How to Cope with Vitiligo?
If you have been detected with Vitiligo, then the next important thing is to find out what caused it. This way you might be able to find a better solution to the problem. Even though this is a painless condition, it has a lot of psychological impacts on the body.
Patients with Vitiligo should be more positive and optimistic. You can use the Natural Vitiligo Treatment system that will claim to restore your skin color to 100% original. It even helps your mood and self-esteem grow.
Vitiligo is a painless yet disturbing skin condition in which the patient develops white patches all over the body. Many Vitiligo causes are still under research. It cannot be prevented but there are ways of reducing its effects. It is important to find your exact Vitiligo cause so that it can be treated appropriately and without the risk of getting any unwanted side effects.
The Natural Vitiligo Treatment System is developed by the biomedical researcher and nutritionist Michael Dawson which has been suffering from Vitiligo himself but has come up with different methods you can use to treat Vitiligo. If you want to learn more then click on the link below to get started.
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