Vitiligo

summary about vitiligo

Vitiligo is a skin disease that causes white spots (depigmentation) associated with a decrease or absence of melanocytes in these regions. Melanocytes are the skin cells responsible for producing melanin, which is the substance that gives skin its color. Vitiligo usually starts on the hands, forearms, feet, and face1 .
The disease occurs at any age, it can begin in childhood or in adulthood. It often occurs after a psychological trauma (divorce, death) or illness (gastroenteritis).

The cause of vitiligo is not known, but there are several theories, such as genetic cause, autoimmune process, action of free radicals, intrinsic abnormality of melanocytes, emotional disturbances, among others. Contrary to what many people think, sun exposure is unrelated to the appearance of vitiligo, but it can show the spots of people with fair skin. We also know that stress plays a key role in the onset and treatment of disease.

It is not a contagious disease and does not cause other health problems besides affecting the psychological due to aesthetic changes.

The white spots are usually surrounded by a hyperpigmented border, they can be isolated or scattered over the body. The most affected areas are the face, joints, extremities of the hands and feet.

The diagnosis is usually made through the clinical analysis performed by the doctor. Other causes of white spots must be excluded, such as mycoses. Biopsy may be required to differentiate from other diseases.

Treatments
The most used treatment is repigmentation, which can be done using topical products such as corticoids and calcineirin inhibitors, through phototherapy or surgery. People who have more than 50% (sometimes 80%) of their skin affected can undergo healthy skin depigmentation. The use of sunscreen is also essential, as the absence of melanin makes the affected areas more sensitive to the harmful effects of sunlight. In addition to physical treatment, psychological follow-up is very important.

Definition

Vitiligo is a skin disorder characterized by white patches (or skin depigmentation). This occurs due to a lack of melanocytes – cells that give color to the skin, responsible for the production of melanin, the skin pigment (see photo in symptoms).

This disease is not contagious and does not cause any damage to health other than stains and emotional problems linked to aesthetics.

Statistics

– Vitiligo affects about 1% of the population.

– Despite affecting people of all races, the disease becomes more evident in blacks.

Age
– The appearance of the disease is not related to any age, but outbreaks seem to be concentrated between the 20s and 30s2 . Vitiligo often occurs after a psychological trauma (divorce, death) or illness (gastroenteritis).

Causes

The causes of this skin condition are not fully understood. Here are some possible theories to explain the origin of vitiligo, as well as the risk factors:

In general, when one family member has vitiligo, other family members are at a higher risk of having it as well. Around 20 to 30% of people who develop this disease have a family history of the disease.

There are indications that the disease involves an autoimmune process against melanocytes, based on the fact that melanocytes are not found in the affected areas and the concomitant occurrence of other autoimmune diseases in people with vitiligo. The most common autoimmune diseases in people with vitiligo are: thyroid disease , pernicious anemia , lupus and Addison’s disease.

Stress can trigger the appearance of white patches on the skin, good stress management is essential for vitiligo prevention and therapy.

To explain the disease in people without a family history of the disease or autoimmune diseases, there are other theories that include: intrinsic abnormality of melanocytes, increased local catecholamine release, inadequate defense against free radicals and cytomegalovirus infection. But neither theory has really been proven.

Some external factors may be involved in triggering the disease, such as stress and exposure to certain industrial chemicals. Although new patches of vitiligo can appear in areas of trauma such as sunburn, there is no causal link between sun exposure and vitiligo. But people with vitiligo should avoid sun exposure, as they are more sensitive to sunlight due to the absence of melanin. For example, sunburn can sometimes trigger vitiligo.

Groups of risk

Vitiligo affects both men and women of all races. However, it is much more visible in dark-skinned people.

People with blue eyes have a lower risk of developing vitiligo, according to a study published 5/8/2012 in the online version of the journal Nature Genetics . Nearly 3,000 people with vitiligo of non-Hispanic origin and European descent were studied by the Colorado Medical University in the United States.

Although not related to any age, the peak of the disease tends to be concentrated between the ages of 20 and 30.

Symptoms

Vitiligo is characterized by white patches surrounded by a hyper-pigmented border. The edges of the patches are sharp and have a smooth surface. You should know that vitiligo is not painful, at least not directly. The skin can be painful, for example after a sunburn . Some people with vitiligo have reported having itchy skin a few times, even before the onset of depigmentation.

White hair and vitiligo
If a person has vitiligo in a place where there is hair, it may also turn white.

Progression
Vitiligo usually starts out as a few small white patches that can gradually spread across the body over several months. Sometimes the larger spots continue to enlarge and spread, but they usually remain in the same place for years.

Location
In generalized vitiligo, the spots usually appear in the armpits, on the back of the hands, on the face (generally around the mouth, eyes, nose), joints (knees, elbows, knuckles,…) and genitals. They can also appear in areas with injuries, especially in areas of friction such as the neck, shoulders and wrists. Vitiligo usually starts on the hands, forearms, feet and face[Cleveland Clinic (Health Library) article on vitiligo, dated 01.13.2020, accessed by Create health.com.br on 09.21.2022[/efn_note].

Extent
The extent of white spots varies from person to person: sometimes they are small and isolated, but they can cover a large part of the body.

Types of Vitiligo
Vitiligo can be:
– Generalized, which is the most common type, when patches 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 the mucous membranes of the mouth and/or genitals.
– Focal, which is a rare type where the macules are in a small area and do not spread in a certain pattern within one to two years.
– Trichome , which means there is a white or colorless center, then an area of ​​lighter pigmentation, then an area of ​​normally colored skin.
– Universal, another rare type of vitiligo, and one in which more than 80% of the skin on the body lacks pigment.

Vitiligo Reversal
Approximately 10 to 20% of people with vitiligo experience spontaneous repigmentation of some areas.

Diagnosis

The diagnosis of vitiligo is made by a doctor, through clinical analysis: appearance of the white spots. Using a special lamp can be helpful for examining difficult areas.

Biopsy may be required to differentiate vitiligo from other diseases.

Due to the possible link with autoimmune diseases, it is recommended that you be screened for some of these.

Complications

Vitiligo is neither contagious nor dangerous. Its main complication is of an aesthetic nature, which can affect the person’s self-esteem, generating great psychological impacts. That’s why psychological follow-up is essential.

Vitiligo does not evolve in a predictable way, the spots appear in outbreaks.

Sun exposure without sunscreen can cause skin cancer . It is important to know that the white spots of vitiligo are more susceptible to the harmful effects of the sun.

Treatments

The choice of treatment depends on your age, how much skin is affected and where it is located, how fast the disease progresses and how it affects your life, according to the Mayo Clinic.

Vitiligo treatment should be done as soon as possible, as the disease can be physically and emotionally disfiguring.

Treatment can take a long time and is usually associated with skin repigmentation (corticosteroids, calcineurin inhibitors, ultraviolet rays, surgery). Healthy skin depigmentation is considered in few cases of vitiligo in advanced stages, due to the total loss of sun protection, cultural factors and the permanent nature of the treatment.

– Application of corticoid-based cream. Generally used in cases where spots occupy up to 10% of the skin on the body and not used on the face. People using topical corticosteroids should see their doctor at least once a month to check for signs of corticosteroid-induced skin atrophy. Oral corticosteroids are used only in some cases.

– Topical calcineurin inhibitors (eg pimecrolimus, tacrolimus). There are few studies, but it has been shown to be a good alternative because it does not cause skin atrophy.

– Phototherapy (ultraviolet rays), to stimulate the production of melanin, with the use of psoralen, for example.

– Excimer laser, uses a light close to the UVB band. It can only be used in small areas, limiting its use. Despite having few studies, it has been shown to be more effective than ultraviolet rays.

– Topical vitamin D analogues.

– Surgery, skin grafting (transplantation) from healthy cells in place of cells affected by vitiligo. This alternative treatment is apparently more practiced in the United States. The surgery is known as melanocyte-keratinocyte transplantation (MKTP). Patients with stabilized vitiligo who have small, localized patches (vitiligo) may better benefit from this alternative treatment (according to the American Academy of Dermatology). In patients with well-localized spots and dark skin, it seems to be particularly effective.
In 2010, researchers at the Henry Ford Hospital in Detroit (USA) performed skin transplants on 32 patients. After 6 months, there was a rate of repigmentation ranging from 52% to 74% of the natural skin color.
In July 2017, a study also conducted by researchers at the Henry Ford Hospital in Detroit showed that the skin transplant operation had long-term (5 years) benefits in restoring skin pigmentation. In a so-called retrospective study, researchers found that most areas of skin treated in vitiligo patients with transplant surgery still had “very good to excellent” color pigmentation five years after the operation. This study was published in July 2017 in the Journal of the American Academy of Dermatology(Journal of the American Academy of Dermatology). For more information, consult your dermatologist.

– Depigmentation of healthy skin with hydroquinone-based creams, when vitiligo is very widespread. The desired effect is a homogeneous appearance of the skin in dark-skinned people. In general, people with more than 50% (some sources, more than 80%) of the body affected by vitiligo can undergo total skin depigmentation. However, it is necessary to pay attention to the risk of complications from such a method.

– Correction thanks to cosmetics (disguise of lesions, through cosmetics).

– Indispensable sun protection.

– Micropigmentation: A type of tattoo that is usually applied to the lips of people affected by vitiligo.

In addition to physical treatment, it is very important that people affected by vitiligo have psychological follow-up, as most suffer emotionally and that emotional factors can aggravate the appearance and evolution of lesions.

Tips

– In case of vitiligo, it is necessary to protect yourself from the sun, use adequate sunscreen, to avoid tanning and reduce the contrast. In addition to protecting itself from the harmful effects of sunlight, the skin is left unprotected without melanin.

– The use of makeup can help to disguise the stains.

– It is not necessary to avoid contact, as it is not a contagious disease.

– Aesthetic problems can affect emotionally, so psychological follow-up is important.

– Screening tests for autoimmune diseases are recommended.

– Stress can trigger the appearance of white spots on the skin, good stress management is essential for vitiligo prevention and therapy.

 

Jeanne Kenney
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I’m a stylist trainer, a content creator, and an entrepreneur passion. Virgo sign and Pisces ascendant, I move easily between my dreams, the crazy world I want, and my feet on the ground to carry out my projects.

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