What is Vitiligo? Causes, Symptoms, UV Treatment

What is Vitiligo?

Vitiligo is a disease that causes loss of skin color in patches. The discolored areas usually get bigger with time. The condition can affect the skin on any part of the body. It can also affect hair and the inside of the mouth.

Vitiligo is a chronic dermatological condition marked by the loss of skin pigmentation, resulting in distinct white patches. This depigmentation occurs when melanocytes, the cells responsible for producing the skin pigment melanin, are destroyed or cease to function. While the condition can manifest on any part of the body, it often starts on sun-exposed areas such as the face, hands, and feet. Over time, these patches may expand and vitiligo can develop on other parts of the body, including the mucous membranes and hair.

The prevalence of vitiligo varies globally, but it is estimated to affect between 0.5% to 2% of the population worldwide (Ezzedine, Eleftheriadou, Whitton, & van Geel, 2015). It can affect individuals of any age, gender, or ethnicity, though the visibility of the patches may vary depending on skin tone.

Symptoms and Signs of Vitiligo

Vitiligo is primarily recognized by the presence of well-demarcated, depigmented white patches on the skin. These patches are due to the loss of functioning melanocytes. The condition is notably unpredictable, with some individuals experiencing a rapid loss of pigmentation, while others have a slower, gradual change. Vitiligo can affect any area of the skin, but it typically appears on areas frequently exposed to the sun, such as the hands, face, and feet (National Institute of Arthritis and Musculoskeletal and Skin Diseases [NIAMS], 2021).

The symptoms of vitiligo extend beyond the skin, potentially leading to premature graying of the hair on the scalp, eyebrows, eyelashes, or beard. The mucous membranes and the retina may also lose pigmentation, and in some cases, individuals with vitiligo experience alterations in their hearing and vision (NIAMS, 2021).

The most apparent symptom of vitiligo is the appearance of white patches on the skin. These patches are more common on sun-exposed areas, including the hands, feet, arms, face, and lips. Other signs include:

• Premature whitening or graying of hair on the scalp, eyebrows, eyelashes, or beard.
• Loss of skin color in the mucous membranes inside the mouth and nose.
• Discoloration in the retina or color part of the eye.
• Some individuals may experience depigmentation of hair or experience hearing loss if the condition affects melanocytes in the inner ear.

Vitiligo can begin at any age but often manifests before the age of 30. It can progress, causing more extensive skin depigmentation over time, although some people may experience periods of stability without progression.

Types and Patterns of Vitiligo

Vitiligo presents in various forms and patterns, each with its own progression and distribution across the body. The classification of the condition is based on these patterns:

• Generalized Vitiligo: This is the most prevalent form, where individuals observe symmetrical depigmented patches on both sides of the body. The progression can be gradual or rapid and often involves areas like the hands, knees, elbows, and face (Gauthier & Benzekri, 2020).
• Segmental Vitiligo: Less common and typically occurs at a younger age. It affects only one side of the body and may cease spreading after a year or two.
• Universal Vitiligo: A rare form involving widespread depigmentation, covering most of the body.
• Localized Vitiligo: Characterized by a few patches in a single area; also known as focal vitiligo.
• Acrofacial Vitiligo: Primarily affects areas away from the body’s center, such as the face and hands, as well as around body openings.

The progression of vitiligo is highly individualized, and while some may experience a stabilization of symptoms without any intervention, others may see a gradual spread over many years (Taïeb & Picardo, 2009).

Causes and Triggers of Vitiligo

The etiology of vitiligo is multifactorial, involving a combination of genetic, autoimmune, and environmental factors. The destruction or malfunction of melanocytes, which leads to the hallmark white patches, is believed to be primarily autoimmune in nature (Spritz, 2013). Individuals with certain genetic profiles are more predisposed to developing vitiligo, particularly when combined with environmental triggers such as:

• Autoimmune Conditions: The presence of other autoimmune diseases can increase the likelihood of developing vitiligo.
• Family History: Genetics play a crucial role, with a higher prevalence observed in individuals with a family history of the condition.
• Trigger Events: Physical trauma, sunburn, or stress can precipitate the onset of vitiligo in susceptible individuals (Rodrigues, Ezzedine, Hamzavi, Pandya, & Harris, 2017).

Despite extensive research, the exact mechanisms leading to the onset of vitiligo remain a subject of ongoing investigation.

Treatment Options for Vitiligo

While there is no definitive cure for vitiligo, various treatments aim to restore pigmentation or even out skin tone. Treatment efficacy varies among individuals and may depend on the type and extent of vitiligo:

• Topical Therapies: Corticosteroid creams and calcineurin inhibitors can be effective, especially for small areas of depigmentation (National Institute of Arthritis and Musculoskeletal and Skin Diseases [NIAMS], 2021).
• Phototherapy: Controlled exposure to ultraviolet light, often in combination with topical treatments, can help restore some color to the white patches (Ezzedine et al., 2015).
• Surgical Options: In certain cases, skin grafting and melanocyte transplants are considered, particularly when topical treatments and light therapy are ineffective.
• Camouflage Therapy: Cosmetic options like makeup or self-tanners can mask depigmentation, improving appearance and boosting self-esteem.