Vitiligo (vit-ih-LIE-go) is a skin condition that individuals have and do not even know they have it. As common as it is, much about this condition still remains misunderstood by many individuals – and even some health professionals. It is a not contagious and not an infectious condition, but still some patients with this condition are stigmatised and suffer many psychological disorders.
What is Vitiligo?
Vitiligo is a disease that causes loss of skin colour in patches. The discoloured areas usually get bigger with time. The condition can affect the skin on any part of the body. It can also affect hair and the inside of the mouth. Vitiligo affects people of all skin types, but it may be more noticeable in people with darker skin.
Although vitiligo is typically a lifelong condition, those who have it are not born with this depigmentation. Rather, the patches of colour loss develop later on and usually set in before age 20. In addition to this change of skin colour, other signs of vitiligo include premature graying of the hair (on eyelashes and eyebrows, too), and loss of tissue colour inside the mouth, nose, and inner layer of the eyeball (retina). This lightening of the skin and mucous membranes is usually the only symptom although, in very rare cases, vitiligo can also potentially cause hearing loss and changes in vision.
Types of vitiligo
There are different types of vitiligo, all of which share the same underlying symptom of skin discolouration which manifests in various ways. Vitiligo comes in many varieties ranging from localised to universal depigmentation. The most common form, generalised vitiligo, refers to discoloured patches that present themselves symmetrically (matching spots on left and right arms, for example) and occur on many different body parts. Segmental vitiligo occurs on only one side of the body, and the localised variety tends to contain itself in just one or a few small areas.
What causes vitiligo?
Vitiligo occurs when pigment-producing cells (melanocytes) die or stop producing melanin — the pigment that gives your skin, hair and eyes colour. The involved patches of skin become lighter or white. It is unclear exactly what causes these pigment cells to fail or die. It may be related to:
• A disorder of the immune system (autoimmune condition)
• Family history (heredity)
• A trigger event, such as stress, severe sunburn or skin trauma such as contact with a chemical
When to see a doctor
See your doctor if areas of your skin, hair or mucous membranes lose colouring. Vitiligo has no cure, but treatment might stop or slow the discolouring process and return some colour to your skin.
Making the diagnosis
Your doctor will take a history and carry out a full examination. Your evaluation might include a skin biopsy and a number of blood tests.
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 is affecting the person’s life.
Medications and light-based therapies are available to help restore skin colour or even out skin tone, though results vary and are unpredictable.
If you and your doctor decide to treat your condition with a drug, surgery or therapy, the process may take many months to judge its effectiveness. 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 doctor might recommend a medication applied to the skin as maintenance therapy to help prevent relapse. 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 skin tone.
The change in the individual’s appearance caused by vitiligo might make them feel stressed, self-conscious or sad – and often psychological support is required.
Can vitiligo cause other complications?
Vitiligo is not life-threatening. In rare cases, it can present other complications, including loss of hearing or changes in vision.
Sadly, however, perhaps the most common side effect is psychological. Our appearances can affect our self-esteem, our moods and emotions, and the way we interact with others. The psychological toll of vitiligo can be high, even in mild cases of skin discolouration. Issues of self-esteem and self-confidence are common, and there may be a major impact on quality of life.
Another complication of vitiligo is an increased risk of sunburn. This is because the melanocytes in our skin typically help provide some UV protection—and therefore when they become deficient or depleted, the skin is more prone to damage and burning.
Conclusion
Vitiligo is a skin condition that is not life-threatening or contagious but can result in many psychological problems. The loss of skin colour on various parts of the body can lead to much stigmatisation by the general public. There is no cure for this disorder at this time, and treatment options are limited. Greater public awareness and understanding of vitiligo is crucial if we are going to minimise the psychological problems associated with this skin disorder.
Ask Your Dr is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge MB BS DGO MRCOG is an obstetrician/Gynaecologist and Family Doctor with over thirty-eight years in clinical practice. Dr Brett Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 497 5828).
