Vitiligo

Symptoms Of Vitiligo

The main sign of vitiligo is patchy loss of skin color. Usually, the discoloration first shows on sun-exposed areas, such as the hands, feet, arms, face and lips.

Vitiligo signs include:

• Patchy loss of skin color
• Premature whitening or graying of the hair on your scalp, eyelashes, eyebrows or beard
• Loss of color in the tissues that line the inside of your mouth and nose (mucous membranes)
• Loss of or change in color of the inner layer of the eyeball (retina)

Vitiligo can start at any age, but often appears before age 20.

Depending on the type of vitiligo you have, the discolored patches may cover:

• Many parts of your body. With this most common type, called generalized vitiligo, the discolored patches often progress similarly on corresponding body parts (symmetrically).
• Only one side or part of your body. This type, called segmental vitiligo, tends to occur at a younger age, progress for a year or two, then stop.
• One or only a few areas of your body. This type is called localized (focal) vitiligo.

It's difficult to predict how your disease will progress. Sometimes the patches stop forming without treatment. In most cases, pigment loss spreads and eventually involves most of your skin. Rarely, the skin gets its color back.

Causes

Vitiligo occurs when pigment-producing cells (melanocytes) die or stop producing melanin — the pigment that gives your skin, hair and eyes color. The involved patches of skin become lighter or white. Doctors don't know why the cells fail or die. It may be related to:

• A disorder in which your immune system attacks and destroys the melanocytes in the skin
• Family history (heredity)
• A trigger event, such as sunburn, stress or exposure to industrial chemicals.

Treatment Of Vitiligo

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.

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. And 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.

Medications

No drug can stop the process of vitiligo — the loss of pigment cells (melanocytes). But some drugs, used alone or with light therapy, can help restore some skin tone.

• Creams that control inflammation. Applying a corticosteroid cream to affected skin may help return color, particularly if you start using it early in the disease. You may not see a change in your skin's color for several months.
  This type of cream is effective and easy to use. But it can cause side effects, such as skin thinning or the appearance of streaks or lines on your skin.
  Milder forms of the drug may be prescribed for children and for people who have large areas of discolored skin.
• Medications that affect the immune system. Ointments containing tacrolimus or pimecrolimus (calcineurin inhibitors) may be effective for people with small areas of depigmentation, especially on the face and neck.
  This treatment may have fewer side effects than corticosteroids and can be used with ultraviolet B (UVB) light. However, the Food and Drug Administration has warned about a possible link between these drugs and lymphoma and skin cancer.

Therapies

• Combining psoralen and light therapy. This treatment combines a plant-derived substance called psoralen with light therapy (photochemotherapy) to return color to the light patches. After you take psoralen by mouth or apply it to the affected skin, you're exposed to ultraviolet A (UVA), UVB light or excimer light. These approaches tend to have better results than just medication or just light. You may need to repeat treatments up to three times a week for six to 12 months.
• Removing the remaining color (depigmentation). This therapy may be an option if your vitiligo is widespread and other treatments haven't worked. A depigmenting agent is applied to unaffected areas of skin. This gradually lightens it so that it blends with the discolored areas. The therapy is done once or twice a day for nine months or longer.
  Side effects can include redness, swelling, itching and dry skin. Depigmentation is permanent, and you'll always be extremely sensitive to sunlight.

Surgery

Surgery may be an option for you if light therapy doesn't work. Surgery can also be used with those therapies. The goal of the following techniques is to even out your skin tone by restoring color.

• 
  Skin grafting. In this procedure, your doctor removes very small sections of your normal, pigmented skin and attaches them to areas that have lost pigment. This procedure is sometimes used if you have small patches of vitiligo.
  Possible risks include infection, scarring, a cobblestone appearance, spotty color and failure of the area to recolor.
• Blister grafting. In this procedure, your doctor creates blisters on your pigmented skin, usually with suction. He or she then removes the tops of the blisters and transplants them to an area of discolored skin.
  Possible risks include scarring, a cobblestone appearance and failure of the area to recolor. And the skin damage caused by suctioning may trigger another patch of vitiligo.
• Tattooing (micropigmentation). In this technique, your doctor uses a special surgical instrument to implant pigment into your skin. It's most effective in and around the lips in people with darker complexions.
  Drawbacks include difficulty matching the skin color and potential for the tattooing to trigger another patch of vitiligo.

Potential future treatments

Treatments being studied include:

• A drug to stimulate color-producing cells (melanocytes). Called afamelanotide, this potential treatment is implanted under the skin to promote the growth of melanocytes.
• A drug that helps control melanoctyes. Prostaglandin E2 is being tested as a way to restore skin color in people with localized vitiligo that isn't spreading. It's applied to the skin as a gel.
• A drug that reverses loss of color. Tofacitinib, an oral drug typically used to treat rheumatoid arthritis, has shown some potential as a treatment for vitiligo.