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Vitiligo

Vitiligo (vit-ill-EYE-go) is a pigmentation disorder in which melanocytes (the cells that make pigment) in the skin, the mucous membranes (tissues that line the inside of the mouth and nose and genital and rectal areas), and the retina (inner layer of the eyeball) are destroyed. As a result, white patches of skin appear on different parts of the body. The hair that grows in areas affected by vitiligo usually turns white.

Vitiligo shows no racial preference, but the distinctive patches are most prominent in blacks. Vitiligo doesn't favor one sex; however, women tend to seek treatment more often than men. Repigmentation therapy, which is widely used in treating vitiligo, may necessitate several summers of exposure to sunlight; the effects of this treatment may not be permanent.

Causes

Vitiligo is now believed to be an autoimmune disorder. An autoantibody to tyrosinase, the enzyme responsible for melanin synthesis, has been found in most patients.

Some link exists between vitiligo and other autoimmune disorders that it often accompanies - autoimmune thyroiditis, pernicious anemia, Addison's disease, and alopecia areata.

Signs and symptoms

Vitiligo produces depigmented or stark white patches on the skin; on fair­skinned Whites, these are almost imperceptible. Lesions are usually bilaterally symmetric with sharp borders, which occasionally are hyperpigmented.

These unique patches generally appear over bony prominences, around orifices (such as the eyes and mouth), within body folds, and at sites of trauma. The hair within these lesions may also turn white. Because hair follicles and certain parts of the eyes also contain pigment cells, vitiligo may be associated with premature gray hair and ocular pigmentary changes.

Diagnosis

Diagnosing vitiligo requires accurate history of onset and of associated illnesses, family history, and observation of characteristic lesions. Other skin disorders, such as tinea versicolor, must be ruled out.

In fair-skinned patients, Wood's light examination in a darkened room detects vitiliginous patches; depigmented skin reflects the light, and pigmented skin absorbs it. If autoimmune or endocrine disturbances are suspected, laboratory studies (thyroid indexes, for example) are appropriate.

Treatment

• Patients with vitiligo should take a B-complex multivitamin each day.  Also take Folic Acid 1 mg, Vitamin E 600 - 800 IU, and ascorbic acid 1000 mg a day. All of these nutrients can be found in a specialty supplement such as Total Balance .
• Calcineurin inhibitors such as topical pimecrolimus and tacrolimus have recently been shown to be safe and effective, and is especially useful on the face and neck where strong steroid creams may cause skin thinning.
• Vitamin D ointment by prescription can help some people with vitiligo.
• Narrowband UVB phototherapy has recently also been shown to be helpful in some patients, particularly in combination with calcipotriol cream (usually used in psoriasis ).
• Surgical treatment. Experimentally some centres are removing the top layer of skin by various techniques and replacing it with skin with normal pigmentation from another site. Some researchers have used the patient's own melanocytes grown in tissue culture. Good results are reported, especially if the vitiligo is stable.

Coping skills

The change in appearance caused by vitiligo can affect your emotional and psychological well-being. You may experience emotional stress, particularly if vitiligo develops on visible areas of you body, such as your face, hands, arms or feet. You may feel embarrassed, ashamed, depressed or worried about how others will react. Certain strategies may help you cope with vitiligo. Consider these tips:

• Find a doctor who's knowledgeable about vitiligo. A dermatologist is a doctor who specializes in the care of skin.
• Let your doctor know if you're feeling depressed. He or she can refer you to mental health professionals who specialize in helping people deal with depression.
• Find out as much as you can about vitiligo and its treatment options so you can participate in making important decisions about your health care.