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Vitiligo is a long-term condition where pale white patches develop on the skin. It's caused by the lack of melanin, a pigment in the skin.

What is vitiligo?

Vitiligo is an acquired depigmenting disorder of the skin, in which pigment cells (melanocytes) are lost. It presents with well-defined milky-white patches of skin (leukoderma). Vitiligo can be cosmetically very disabling, particularly in people with dark skin.

Vitiligo can affect any area of skin, but most commonly occurs on the face, neck and hands, and in skin creases.

Who gets vitiligo?

Vitiligo affects 0.5–1% of the population, and occurs in all races. It may be more common in India than elsewhere, with reports of up to 8.8% of the population affected. In 50% of sufferers, pigment loss begins before the age of 20, and in about 80% it begins before the age of 30 years. In 20%, other family members also have vitiligo. Males and females are equally affected.

Even though most people with vitiligo are in good general health, they face a greater risk of having autoimmune diseases such as diabetes, thyroid disease (in 20% of patients over 20 years with vitiligo), pernicious anaemia (B12 deficiency), Addison disease (adrenal gland disease), systemic lupus erythematosus, rheumatoid arthritis, psoriasis, and alopecia areata (round patches of hair loss).

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Types of vitiligo

There are two main types of vitiligo:

  • non-segmental vitiligo
  • segmental vitiligo
  • Small, red, individual spots (more common in children and young adults)

In rare cases, it's possible for vitiligo to affect your whole body. This is known as universal or complete vitiligo.

Non-segmental vitiligo

In non-segmental vitiligo (also called bilateral or generalised vitiligo), the symptoms often appear on both sides of your body as symmetrical white patches. Symmetrical patches can appear on the:

  • non-segmental vitiligo
  • backs of your hands
  • arms
  • skin around body openings, such as the eyes
  • knees
  • elbows
  • feet

Non-segmental vitiligo is the most common type of vitiligo, affecting around nine out of 10 people with the condition.

Segmental vitiligo

In segmental vitiligo (also known as unilateral or localised vitiligo), the white patches only affect one area of your body.

Segmental vitiligo is less common than non-segmental vitiligo, although it's more common in children. It usually starts earlier and affects three in 10 children with vitiligo.

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What causes vitiligo?

Vitiligo is due to loss or destruction of melanocytes, which are the cells that produce melanin. Melanin determines the colour of skin, hair, and eyes. If melanocytes cannot form melanin or if their number decreases, skin colour becomes progressively lighter.

The exact cause of vitiligo is unknown. It is thought to be a systemic autoimmune disorder, associated with deregulated innate immune response, although this has been disputed for segmental vitiligo. There is a genetic susceptibility and vitiligo is a component of some rare syndromes. The gene encoding the melanocyte enzyme tyrosinase, TYR, is likely involved.

There are three theories on the cause of vitiligo:

  • The pigment cells are injured by abnormally functioning nerve cells.
  • There may be an autoimmune reaction against the pigment cells.
  • Autotoxic theory – the pigment cells self-destruct.

A vitiligo-like leukoderma may occur in patients with metastatic melanoma. It can also be induced by certain drugs, such as immune checkpoint inhibitors (pembrolizumab, nivolumab) and BRAF inhibitors (vemurafenib, dabrafenib) used to treat metastatic melanoma.

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Risk factors for vitiligo

You may be at increased risk of developing non-segmental vitiligo if:

  • other members of your family have it
  • there's a family history of other autoimmune conditions – for example, if one of your parents has pernicious anaemia (an autoimmune condition that affects the stomach)
  • you have another autoimmune condition
  • you have melanoma (a type of skin cancer) or cutaneous T-cell lymphoma (cancer of the lymphatic system)
  • you have particular changes in your genes that are known to be linked to non-segmental vitiligo

Triggers

It's possible that vitiligo may be triggered by particular events, such as:

  • stressful events, like childbirth
  • skin damage, such as severe sunburn or cuts (this is known as the Koebner response)
  • exposure to certain chemicals – for example, at work
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Symptoms of vitiligo

The most obvious sign or symptom of vitiligo is loss of pigment on the skin, resulting in milky-white, irregularly-shaped patches on the skin.

Typically occurs first on sun-exposed areas (face, hands, feet, arms, legs).

Less common signs include pigment loss or graying of hair on scalp, eyebrows, eyelashes or other affected areas.

May also experience loss of pigment on the tissues that line the inside of the mouth (mucous membranes) and the retina of the eye.

Some of those affected by vitiligo experience intense itching at the site of depigmentation during active stages.

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What are the clinical features of vitiligo

Vitiligo can affect any part of the body. Complete loss of pigment can affect a single patch of skin or it may affect multiple patches. Small patches or macules are sometimes described as confetti-like.

  • Common sites are exposed areas (face, neck, eyelids, nostrils, finger tips and toes), body folds (armpits, groin), nipples, navel, lips and genitalia.
  • Vitiligo also favours sites of injury (cuts, scrapes, thermal burns and sunburn). This is called the Koebner phenomenon.
  • New-onset vitiligo also sometimes follows emotional stress.
  • Vitiligo may occasionally start as multiple halo naevi.
  • Loss of colour may also affect the hair on the scalp, eyebrows, eyelashes and body. White hair is called 'leukotrichia' or 'poliosis'.
  • The retina at the back of the eye may also be affected. However, the colour of the iris does not change.

The colour of the edge of the white patch can vary.

  • It is usually the colour of unaffected skin, but sometimes it is hyperpigmented or hypopigmented.
  • The term trichrome vitiligo is used to describe 3 shades of skin colour. Very rarely, there are 4 shades of pigment (white, pale brown, dark brown and normal skin).
  • Occasionally, each patch of vitiligo has an inflamed red border.

The severity of vitiligo differs with each individual. There is no way to predict how much pigment an individual will lose or how fast it will be lost.

  • Vitiligo appears more obvious in patients with naturally dark skin.
  • Extension of vitiligo can occur over a few months, then it stabilises.
  • Some spontaneous repigmentation may occur. Brown spots arise from the hair follicles and the overall size of white patch may reduce.
  • At some time in the future, the vitiligo begins to extend again.
  • Cycles of pigment loss followed by periods of stability may continue indefinitely.
  • Light skinned people usually notice the pigment loss during the summer as the contrast between the affected skin and suntanned skin becomes more distinct.
  • Pigment has occasionally been reported to be lost from the entire skin surface.

Vitiligo Pictures

  • Mucosal vitiligo

  • Acral vitiligo

  • Segmental vitiligo

  • Poliosis

  • Koebnerised vitiligo

  • Trichrome vitiligo

  • Red border

  • Follicular repigmentation

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Diagnosing vitiligo

Medical history and exam

If your doctor suspects you have vitiligo, he or she will ask about your medical history, examine you and try to rule out other medical problems, such as dermatitis or psoriasis. He or she may use a special lamp to shine ultraviolet light onto the skin to determine whether you have vitiligo.

Skin biopsy and blood draw

In addition to gathering your personal and family medical history and examining your skin, your doctor may:

  • Take a small sample (biopsy) of the affected skin
  • Draw blood for lab tests
  • Skin CT

Other exams

Your doctor may recommend that you see an eye specialist (ophthalmologist), who may check for inflammation in your eye (uveitis). Your doctor may also suggest that you see a hearing specialist (audiologist) to undergo a hearing evaluation because people with vitiligo may have an increased risk of hearing loss.

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Complications of vitiligo

Vitiligo can sometimes cause other problems.

Because of a lack of melanin, your skin will be more vulnerable to the effects of the sun. Make sure you use a strong sunscreen to avoid sunburn.

Vitiligo may also be associated with problems with your eyes, such as inflammation of the iris (iritis), and a partial loss of hearing (hypoacusis).

Problems with confidence and self-esteem are common in people with vitiligo, particularly if it affects areas of skin that are frequently exposed.

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How Is Vitiligo Treated?

Many treatments are available to help restore skin color or even out skin tone. Results vary and are unpredictable. Some treatments have serious side effects. So your doctor may suggest that you first try improving the appearance of your skin by applying self-tanning products or makeup.

UM-D Diagnosis System

Acupuncture

Chinese Medicine Fumigation

Traditional Chinese Medicine

Anti-Free Radicals Therapy

Epidermal Grafting

Light Therapy

308 Laser

NBUVB

UM-D

Skin CT

Trace Elements Examination

Best cure Vitiligo

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