Vitiligo

Overview

Vitiligo is a long-term condition where pale white patches develop on the skin. It's caused by the lack of melanin, which is the pigment in skin. Vitiligo can affect any area of skin, but it commonly happens on the face, neck and hands, and in skin creases.

Normally, the color of hair and skin is determined by melanin. Vitiligo occurs when cells that produce melanin die or stop functioning. Vitiligo affects people of all skin types, but it may be more noticeable in people with brown or Black skin. The condition is not life-threatening or contagious. It can be stressful or make you feel bad about yourself.

Treatment for vitiligo may restore color to the affected skin. But it doesn't prevent continued loss of skin color or a recurrence.

Symptoms

Vitiligo signs include:

Patchy loss of skin color, which usually first appears on the hands, face, and areas around body openings and the genitals

Premature whitening or graying of the hair on your scalp, eyelashes, eyebrows or beard

Loss of color in the tissues that line the inside of the mouth and nose (mucous membranes)

Vitiligo can start at any age, but usually appears before age 30.

Depending on the type of vitiligo you have, it may affect:

• Nearly all skin surfaces. With this type, called universal vitiligo, the discoloration affects nearly all skin surfaces.
• Many parts of the body. With this most common type, called generalized vitiligo, the discolored patches often progress similarly on corresponding body parts (symmetrically).
• Only one side or part of the body. This type, called segmental vitiligo, tends to occur at a younger age, progress for a year or two, then stop.
• One or only a few areas of the body. This type is called localized (focal) vitiligo.
• The face and hands. With this type, called acrofacial vitiligo, the affected skin is on the face and hands, and around body openings, such as the eyes, nose and ears.

It's difficult to predict how this disease will progress. Sometimes the patches stop forming without treatment. In most cases, pigment loss spreads and eventually involves most of the skin. Occasionally, the skin gets its color back.

When to see a doctor

See your health care provider if areas of your skin, hair or mucous membranes lose coloring. Vitiligo has no cure. But treatment might stop or slow the discoloring process and return some color to your skin.

Treatment

The choice of treatment depends on your age, how much skin is involved and where, how quickly the disease is progressing, and how it's affecting your life.

Medications and light-based therapies are available to help restore skin color or even out skin tone, though results vary and are unpredictable. And some treatments have serious side effects. So your health care provider might suggest that you first try changing the appearance of your skin by applying a self-tanning product or makeup.

If you and your health care provider decide to treat your condition with a drug, surgery or therapy, the process may take many months to judge its effectiveness. And you may have to try more than one approach or a combination of approaches before you find the treatment that works best for you.

Even if treatment is successful for a while, the results may not last or new patches may appear. Your health care provider might recommend a medication applied to the skin as maintenance therapy to help prevent relapse.

Medications

No drug can stop the process of vitiligo — the loss of pigment cells (melanocytes). But some drugs, used alone, in combination or with light therapy, can help restore some color.

• Drugs that control inflammation. Applying a corticosteroid cream to affected skin might return color. This is most effective when vitiligo is still in its early stages. This type of cream is effective and easy to use, but you might not see changes in your skin's color for several months. Possible side effects include skin thinning or the appearance of streaks or lines on your skin.
• Milder forms of the drug may be prescribed for children and for people who have large areas of discolored skin.
• Corticosteroid pills or injections might be an option for people whose condition is progressing rapidly.
• Medications that affect the immune system. Calcineurin inhibitor ointments, such as tacrolimus (Protopic) or pimecrolimus (Elidel) might be effective for people with small areas of depigmentation, especially on the face and neck. The U.S. Food and Drug Administration (FDA) has warned about a possible link between these drugs and lymphoma and skin cancer.

Therapies

Light therapy. Phototherapy with narrow band ultraviolet B (UVB) has been shown to stop or slow the progression of active vitiligo. It might be more effective when used with corticosteroids or calcineurin inhibitors. You'll need therapy two to three times a week. It could take 1 to 3 months before you notice any change, and it could take 6 months or longer to get the full effect.

Surgery

If light therapy and medications haven't worked, some people with stable disease may be candidates for surgery. The following techniques are intended to even out skin tone by restoring color:

• Skin grafting. In this procedure, your doctor transfers very small sections of your healthy, pigmented skin to areas that have lost pigment. This procedure is sometimes used if you have small patches of vitiligo.
• Possible risks include infection, scarring, a cobblestone appearance, spotty color and failure of the area to recolor.
• Blister grafting. In this procedure, your doctor creates blisters on your pigmented skin, usually with suction, and then transplants the tops of the blisters to discolored skin.
• Possible risks include scarring, a cobblestone appearance and failure of the area to recolor. And the skin damage caused by suctioning may trigger another patch of vitiligo.
• Cellular suspension transplant. In this procedure, your doctor takes some tissue on your pigmented skin, puts the cells into a solution and then transplants them onto the prepared affected area. The results of this repigmentation procedure start showing up within four weeks.
• Possible risks include scarring, infection and uneven skin tone.

Lifestyle and home remedies

If you have vitiligo, the following self-care tactics may help you care for your skin and improve its appearance:

• Protect your skin from the sun and artificial sources of UV light. Use a broad-spectrum, water-resistant sunscreen with an SPF of at least 30. Apply sunscreen generously and reapply every two hours — or more often if you're swimming or sweating.
• You can also seek shade and wear clothing that shields your skin from the sun. Don't use tanning beds and sunlamps.
•  Protecting your skin from the sun helps prevent sunburn of the discolored skin. Sunscreen also minimizes tanning, which accentuates the vitiligo patches.
• Conceal affected skin. Makeup and self-tanning products can help minimize the differences in skin color. You may need to try several brands of makeup or self-tanners to find one that blends well with your normal skin tone. The coloring of self-tanning products doesn't wash off, but it gradually fades over several days. If you use a self-tanner, select one that contains dihydroxyacetone, as it is approved by the U.S. Food and Drug Administration.
• Don't get a tattoo. Damage to your skin, such as that caused by a tattoo, may cause a new patch of vitiligo to appear within two weeks.

What you can do

• Review your family medical history. Find out if anyone in your family has vitiligo, a thyroid condition or a disease in which the immune system attacks healthy tissues in the body (autoimmune disease).
• List relevant personal information, such as recent major stressful events, life changes, sunburns and rashes.
• List any medications, vitamins and supplements you're taking, including doses.
• Make note of questions you'd like to ask your health care provider, which will help you make the most of your limited time together.

Some basic questions to consider include:

• What's the most likely cause of my symptoms?
• What are other possible causes?
• Do I need any tests?
• Is this condition temporary or long lasting?
• What treatments are available, and which do you recommend?
• What side effects can I expect from treatment?
• Can I do anything to help, such as avoid the sun at certain times or wear a specific sunscreen?
• Can you recommend a product to conceal the discolored patches?
• Do you have brochures or other printed material I can take home? What websites do you recommend?

How does vitiligo progress?

Vitiligo usually begins with a few small white patches that may gradually spread over the body over the course of several months. Vitiligo typically begins on the hands, forearms, feet, and face but can develop on any part of the body, including the mucous membranes (moist lining of the mouth, nose, genital, and rectal areas), the eyes, and inner ears.

Sometimes the larger patches continue to widen and spread, but usually they stay in the same place for years. The location of smaller macules shifts and changes over time, as certain areas of skin lose and regain their pigments. Vitiligo varies in the amount of skin affected, with some patients experiencing few depigmented areas and others with widespread loss of skin color.

What are the types of vitiligo?

Vitiligo can be:

• Generalized, which is the most common type, when macules appear in various places on the body.
• Segmental, which is restricted to one side of the body or one area, such as the hands or face.
• Mucosal, which affects mucous membranes of the mouth and/or the genitals.
• Focal, which is a rare type in which the macules are in a small area and do not spread in a certain pattern within one to two years.
• Trichome, which means that there is a white or colorless center, then an area of lighter pigmentation, and then an area of normally colored skin.
• Universal, another rare type of vitiligo, and one in which more than 80% of the skin of the body lacks pigment.

How do I stop vitiligo from spreading?

Topical steroids. Topical steroids come as a cream or ointment you apply to your skin. They can sometimes stop the spread of the white patches and may restore some of your original skin colour.

What should not eat in vitiligo?

Here are some of the top problem foods that some people with vitiligo cite:

• alcohol.
• blueberries.
• citrus.
• coffee.
• curds.
• fish.
• fruit juice.
• gooseberries.

What is best cream for vitiligo?

PAARDADI LAPE (ROOP CHANDANI) is a ayurvedic lape for leucoderma (vitiligo). This lape decreases the area of spot with in 3 to 20 weeks (depended on affected area). This lape gives your natural skin colour after removing the spot.