Vitiligo

Vitiligo is a chronic skin condition which results in the development of large pale patches on the skin. These patches are white or pale coloured due to the absence of melanin, a pigment which determines your skin colour. Plus it helps to protect it against the sun.

Vitiligo is not infectious and cannot be transmitted to another person.

Who is affected by vitiligo?

It affects around 1 in 100 people and usually young people. But anyone can be affected. Men and women are equally affected.

But there are certain groups of people who are more at risk of developing vitiligo. These include:

  • People with a family history of vitiligo
  • People with a family history of auto-immune disorders
  • People who have an auto-immune disorder
  • People who have an alteration to their genes which predisposes them to vitiligo particularly non-segmental vitiligo.
  • People with malignant melanoma or cutaneous T-cell lymphoma (form of cancer of the lymphatic system).

An outbreak of vitiligo is triggered by stress, exposure to certain types of chemicals and skin damage, e.g. sunburn.

Causes of vitiligo

Your skin contains cells called melanocytes which produce melanin, a pigment that determines the colour of your skin, e.g. white or dark brown.

But a lack of melanocytes is the cause of vitiligo which results in these distinctive pale patches on your hair or skin. There are two types of vitiligo which are:

  • Non-segmental vitiligo
  • Segmental vitiligo

Non-segmental vitiligo

This is the most common form and is considered to be an auto-immune disorder. By that we mean a fault with your immune system which causes it to release antibodies that attack healthy cells such as melanocytes.

A normal functioning immune system protects you against disease and infection by producing antibodies which are designed to attack alien cells. These alien invaders carry bacteria and other germs which causes a range of diseases.

But if something goes wrong then the immune system turns on itself, attacking healthy tissue and cells.

Your immune system destroys these melanocytes which results in large, pale patches on your skin.

Segmental vitiligo

This is caused by the release of chemicals from nerve endings within the skin which are toxic to melanocytes.

Symptoms of vitiligo

The most obvious sign is a large, pale or white patch on your skin. You will develop several of these on your face, armpits, wrists, fingers, inside your mouth and around the genitals/groin area. It can also develop on your scalp or even your eyelids.

If it develops on your scalp then you may notice a small patch of grey or white hair as a result.

The process starts with the appearance of a single pale patch which is lighter than the rest of your skin and eventually turns white. It may have a pinkish colour if there are visible blood vessels beneath the skin.

These patches may have smooth or irregular shaped edges which are sore and inflamed. These may be itchy.

Vitiligo rash often develops after exposure to the sun which is known as ‘photosensitivity’.

Diagnosing vitiligo

Your GP will diagnose this rash simply by looking at the affected areas. Large pale or white patches are a distinctive sign of this condition.

He or she will also ask you about your medical and family history which includes questions about whether anyone has suffered from an autoimmune disorder. Other questions will be about your skin and sun exposure: do you burn or tan and have you experienced severe sunburn.

Another important factor is the effect vitiligo has on your confidence and well being. It can cause a great deal of upset and many people become depressed as a result. Tell your GP this if you have developed depression as a result.

Your GP may carry out a blood test to see if there are any problems with your thyroid gland. The reason for this is that non-segmental vitiligo is caused by an auto-immune disorder such as an overactive or underactive thyroid.

Treatment for vitiligo

Vitiligo cannot be cured but the symptoms can be managed with topical steroids, camouflage creams and several other treatment options. Your GP will suggest these to start with.

He/she will advise you to try these forms of treatment for at least a month and then return to the surgery after then so that he/she can check on your progress.

But you need to be aware that treatment for vitiligo is not always a success.

Mild cases of vitiligo

The treatment you have depends upon the extent of your vitiligo. A small patch can be treated by your GP who will prescribe topical corticosteroids which are applied to the affected areas of skin.

There are two types of topical corticosteroids: creams and ointments. Your GP will advise you about both, how to use them and the benefits and side effects.

He or she will also mention about skin camouflage: this is used to describe a range of specially coloured creams which are used to cover the affected area and match the natural colour of your skin.

Your GP will also advise you to avoid sunbeds or sunlamps and to use a sunscream with a high sun protection factor (SPF) in warm/hot weather. This is especially important as the insufficient levels of melanin in your skin mean that you are particularly vulnerable to sunburn. And sunburn occurs in people with low levels of melanin.

This particularly applies to people who are fair skinned as they are at greater risk.

Severe cases of vitiligo

If you have a severe form of vitiligo your GP will refer you to a dermatologist for further treatment. But you will also be referred if you are pregnant, severely distressed by your condition, have developed vitiligo on your face or current treatment by your GP is not working.

This also applies to parents of children with this condition. If your child has vitiligo then your GP will refer him/her to a dermatologist. You may be prescribed topical steroids in the meantime.

The dermatologist will recommend alternative forms of treatment such as phototherapy (treatment which uses light), de-pigmentation lotion or a skin graft. Other options include medication such as azathioprine (immune system suppressant) and laser therapy.

The aim of these is to reduce, conceal or remove the vitiligo patches.

Living with vitiligo

This condition is not curable and any changes incurred by treatment can be reversed. In other words, the pale patches of skin may return.

It is a good idea to protect your skin from the sun and cover up whenever you are out of doors.

If your condition is causing psychological distress then ask your GP about counselling or support groups.