I Have Vitiligo
Vitiligo can dramatically change your skin color and cause some anxiety. Before you panic, read on to find answers to all the questions you want to ask but don't know who to ask.
Vitiligo is primarily caused by the progressive death of melanocytes.
Melanocytes are the skin cells responsible for producing melanin, the skin pigment. They are found at the bottom of the top layer of the skin. When sunlight penetrates the skin, it activates the melanocytes to produce melanin.
However, when these cells die out faster than they are replaced, the skin loses its color and slowly turns white. Therefore, vitiligo is most apparent in people with dark skins.
Because vitiligo significantly changes the appearance of the skin, it can be psychologically distressing and many sufferers are stigmatized and feel depressed. Still, the condition can be well managed if you understand it well and know what to do.
This article is written to provide the best answers to your burning questions.
The exact cause of vitiligo is still up for debate.
Although there are many theories put forward to explain how vitiligo occurs, most clinicians believe vitiligo is an autoimmune disease. This means that it is caused because the body attacks itself. More specifically, vitiligo is caused by the attempts of the immune cells to rid the body of melanocytes.
Why this occurs is not exactly clear but studies have shown that vitiligo has a genetic component and that it is sometimes linked to other autoimmune disease.
However, none of these links can be used to predict who gets vitiligo or when. For example, only one-third of vitiligo patients have other members of their families with the same skin disorder and direct inheritance of the disease from one’s parent is only estimated at 5 – 7% of vitiligo patients.
Even then, genes are believed to play a strong role in the development of vitiligo.
Other proposed causes of vitiligo include defective melanocytes, oxidative stress (harmful free radicals killing melanocytes), neural changes (some people develop vitiligo after sustaining nerve injuries), toxic chemicals and viruses.
No, vitiligo is not contagious.
In fact, it produces no pain or any other changes in the affected skin except in color. If another family member develops vitiligo, it is not because it is contagious but because it is an inheritable skin disorder.
There are a few ways to classify vitiligo but the simplest classification is by the amount of area covered by the white patches.
Therefore, vitiligo can either be generalized or segmental.
Segmental vitiligo affects limited areas of the skin. The white patches only appear in one or a few parts of the body. Generalized vitiligo is more extensive; it affects multiple parts of the body and it can also be symmetrical (appear on the same part of the two arms or legs).
However, both types of vitiligo are found in most vitiligo patients.
There is no definite way to know if the first white spots or patches seen during the initial phase of vitiligo will spread.
For some people, these patches grow rapidly as more areas of the skin get depigmented.
However, for some people the first few patches may lay dormant for many years. It is also possible to slow down and even stop the expansion of vitiligo patches with the right treatment.
Besides the change in skin color, vitiligo has no symptoms.
In fact, the only quality of the skin that changes after a vitiligo breakout is the skin color. The tone and other aspects of the skin remain the same in both the tan/white areas and the areas with normal skin color.
However, the hair growing out of the vitiligo patches will also turn white. Furthermore, depigmented skins are more susceptible to sunburn. Since the skin is stripped of one of its defenses, it is easily affected by sunlight. This may also cause itching in a few people.
Very rarely does vitiligo affect eye color and vision.
Phenols are the most important chemical cause of vitiligo. Unfortunately, this class of compound is found in a variety of household and industrial chemicals.
Therefore, you should avoid hair dyes and bleaches as well as photography chemicals containing phenolic compounds.
Vitiligo is often experienced along with other autoimmune and inflammatory diseases.
Therefore, diseases associated with vitiligo include alopecia areata, pernicious anemia, lupus, psoriasis, inflammatory bowel disease, hyperthyroidism, adrenocortical insufficiency and diabetes mellitus.
While there is still some disagreement among medical scientists, the prevailing opinion is that there is no increased risk of skin cancer among vitiligo patients.
Vitiligo may actually lower the risk of certain types of skin cancer in vitiligo patients. For example, the same genetic link that makes melanocytes susceptible to destruction by immune cells also protects the skin from malignant melanoma.
Even though ultraviolet lights (UVA and UVB) are used in the treatment of vitiligo, the doses received by patients should not increase the risk of skin cancers. In fact, narrowband UVB, which is newer and currently the preferred of the ultraviolet lights used for treating vitiligo, is safer than UVA.
There are various treatment options for vitiligo. Some of the important ones are discussed below.
PUVA is also called psoralen and ultraviolet A therapy. It is a photochemotherapy option that includes the use of a drug, psoralen, and ultraviolet A light.
Psoralen is a photosensitizing drug. It can be taken orally or topically. Topical PUVA is used when the vitiligo patches are found in less than 20% of the body surface and concentrated in a few parts of the body.
The drug, psoralen, is taken well before the ultraviolet irradiation. When UVA is shone on the affected areas of the skin with special lamps, the white patches progressively turn pink. With repeated treatment, these depigmented areas are darkened by the photo-activated psoralen.
PUVA is time-consuming. The usual course of treatment takes 2 years before the skin can regain its original color.
Narrowband UVB is newer than PUVA and it is now even more popular.
It involves exposing the vitiligo patches to a narrow band of UVB radiation (311 – 312 nm). UVB delivers better results with far fewer side effects. Since the skin is not exposed to all the unneeded radiation in ultraviolet range, the risk of burning and photodamage to the skin is much lower.
In addition, UVB treatment does not require photosensitizing drugs such as psoralen. Therefore, all the side effects of psoralen is avoided in UVB therapy.
Lastly, UVB treatment can be done at home with special home UV lamps.
Excimer laser is a new treatment option and very expensive too.
It is simply the use of focused, monochromatic ultraviolet rays at 308 nm. Excimer laser is safe and effective especially when the vitiligo patches cover no more than 30% of the skin surface.
The effectiveness of excimer laser can be improved by combining it with tacrolimus ointment.
Topical steroids make the simplest vitiligo treatment option but they may not be as effective as other treatments. These corticosteroids are supplied as creams and ointments and they are most effective at the early stages of the skin disorder.
If used early, topical steroids can revive melanocytes and increase the production of melanin.
They must be used for at least 3 months before their efficacies can be determined. However, topical steroids do have their side effects including causing the shrinking and thinning of the skin as well as stretch marks.
Immunomodulators work by suppressing the autoimmune attack that kills off melanocytes. This allows more melanocytes to grow over time and for the skin to repigment.
Protopic or tacrolimus is the most popular of this class of drugs. It can be used in children.
A related drug is pimecrolimus which is also an immunomodulator. However, long-term safety studies are still lacking for both drugs, and they currently carry a black box warning regarding disputed risks of skin cancers.
Pseudocatalase is a relatively uncommon vitiligo drug. It is meant to mop up the hydrogen peroxide released in the skin which is one of the compounds that increases the oxidative stress known to kill off melanocytes.
In fact, the antioxidant enzyme, catalase, is naturally produced in healthy skins but vitiligo patients are known to have low levels of this enzyme. Therefore, pseudocatalase serves as a replacement that provides the same function and protection for melanocytes.
V-Tar, on the other hand, is a water-soluble coal tar product that contains anti-inflammatory and antioxidant agents. It is used to treat different skin pigmentation diseases including vitiligo.
Surgery is also an option for treating vitiligo. Vitiligo surgeries are essentially transplants.
Skin grafting involves taking some normal, pigmented skin and transferring them to areas of the skin affected by vitiligo. The skin graft is taken from and given to the same person. Therefore, since the donor and recipient of the graft is the same person, it is called autologous skin graft.
Autologous melanocyte transplant is a newer, experimental technique. Here, instead of direct skin transplant, the donor skin is taken and cultured in the laboratory. This allows the melanocytes to multiply before they are then transplanted to the areas of the skin covered by white patches.
Depigmentation involves turning the rest of the skin to the same color as the depigmented area.
It involves fading the pigmented areas of the skin with monobenzone. Depigmentation is the recommended treatment when vitiligo covers more than 50% of the body area.
Depigmentation is permanent and patients must understand what it means as well as be counseled during and after treatment. Depigmentation also increases the sensitivity of the skin to sunlight.
Natural supplements and herbal extracts can also be used to treat vitiligo. These supplements are safe and they serve to complement conventional vitiligo treatments.
A prime example of such natural remedies is callumae. Callumae contains B vitamins such as folic acid, pyridoxine and cyanocobalamin. It also contains herbal extracts with antioxidant and immunomodulatory activities.
The length of treatment varies from one individual to another. It depends on how quickly the vitiligo repigments.
The usual vitiligo treatment takes 3 – 6 months for the first positive signs to be seen. However, treatment may go on for as long as 2 years to complete the repigmentation of the skin and to reduce the chances of relapse and treatment failure.
Some vitiligo treatments work faster than others. For example, immunomodulators have been known to start repigmenting the skin in some individuals within the first 2 months of treatment.
Dermatologists believe that UVA and UVB lamps and even natural sunlight are better than tanning beds. This is because tanning beds emit a broad range of ultraviolet light (unlike UVA and UVB lamps) which is concentrated (unlike sunlight).
Some drugs may pass through the placenta to the fetus. Therefore, you should tell your doctor if you are pregnant. Ultraviolet light may also affect the fetus; therefore, adequate precautions should be taken.
The hands and feet are particularly difficult to treat but they can be repigmented with relentless treatment.
The eyes and genitals are especially sensitive and vitiligo at those spots should be carefully treated.
Makeups and sunless tanners are used to camouflage the skin. These are available in every skin color and most of them are waterproof.
However, finding the perfect color match can be difficult. Therefore, you should make your own camouflage if you are unsatisfied with the result from makeups and sunless tanning creams.
All you need to make your own vitiligo camouflage are rubbing alcohol and food colorings. By mixing these in different amounts, it is possible to find the perfect ratio to produce a color to match your skin color.
There are currently multiple studies being done in different areas of vitiligo treatment. The current treatments may not be surefire or even perfect but it is quite possible that a cure could happen in some years.
Therefore, it is important to keep treating your vitiligo. These treatments may only restore some pigmentation back to the skin but they are definitely better than leaving the white spots to spread. The more melanocytes left on your skin, the better a cure will work when it is found.
Vitiligo can cause psychological distress as well as affect your social and work interaction. Stigmatization is also quite commonly reported.
To deal with vitiligo, you should first learn as much about it as possible. Then you should see a dermatologist. Tell your doctor if you ever get depressed. Also, you should also talk to a therapist and get some counseling.
Also consider joining a local and/or online support group where vitiligo patients come together to discuss and cope with the skin condition.
Teenagers are the ones most affected by the psychological distress of vitiligo. They may withdraw and refuse to acknowledge offers of help but they do need it and their parents should provide such.
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*Callumae is a Vitiligo Remedy designed to help get rid of white spots on your skin. Use in conjunction with light therapy (or natural sun light) to help get the most repigmentation to your skin.