Today, June 25th, marks World Vitiligo Day, aimed at raising awareness about the disease. Vitiligo affects roughly 100 million people worldwide and almost 2 million in the US. It’s not contagious or fatal, but scientists are unsure of what causes it.
What is Vitiligo
Vitiligo is a patchy loss of skin coloring (pigmentation). The average age of onset of vitiligo is in the mid-twenties, but it can appear at any age. 95 percent of people with vitiligo have been diagnosed before reaching age forty. It tends to progress over time, with larger areas of the skin losing pigment. Some people with vitiligo also have patches of pigment loss affecting the hair on their scalp or body.
Myths VS Facts
Myth 1: Vitiligo is an outcome of the wrong combination of foods, for instance, milk consumption shortly after eating fish can bring on the disorder.
Fact: Vitiligo has no apparent link with the diet. It is irrational to deprive patients of healthy foods they enjoy in the hope of declining the possibility of the disease.
Myth 2: Vitiligo is a kind of leprosy and is communicable.
Fact: Though often referred to those who do not understand the disease as “white leprosy”, vitiligo is in no way linked to leprosy. It is not infectious or contagious and, hence, cannot pass on from one person to another.
Myth 3: Vitiligo is connected to serious skin diseases, such as skin cancer and albinism.
Fact: There are clear dissimilarities among each of these syndromes, and not of them are linked to Vitiligo.
Myth 4: There are no effective treatments for vitiligo.
Fact: Medications like steroids, Ultraviolet A, immunomodulator drugs and the newer narrowband Ultraviolet B are accessible, along with several surgical options.
Types of Vitiligo
Generalized vitiligo, also called non-segmental vitiligo, is the most common form. It involves loss of pigment (depigmentation) in patches of skin all over the body. Depigmentation typically occurs on the face, neck, and scalp, and around body openings such as the mouth and genitals. Sometimes pigment is lost in mucous membranes, such as the lips. Loss of pigmentation is also frequently seen in areas that tend to experience rubbing, impact, or other trauma, such as the hands, arms, and places where bones are close to the skin surface (bony prominences).
Segmental vitiligo is associated with smaller patches of depigmented skin that appear on one side of the body in a limited area; this occurs in about 10 percent of affected individuals.
What causes Vitiligo?
Vitiligo is generally considered to be an autoimmune disorder. Autoimmune disorders occur when the immune system attacks the body’s own tissues and organs. In people with vitiligo the immune system appears to attack the pigment cells (melanocytes) in the skin. About 15 to 25 percent of people with vitiligo are also affected by at least one other autoimmune disorder, particularly autoimmune thyroid disease, rheumatoid arthritis, type 1 diabetes, psoriasis, pernicious anemia, Addison disease, or systemic lupus erythematosus.
In the absence of other autoimmune conditions, vitiligo does not affect general health or physical functioning. However, concerns about appearance and ethnic identity are significant issues for many affected individuals.
Some researchers think that the melanocytes destroy themselves. Others think that a single event such as sunburn or emotional distress can trigger vitiligo. But these events have not been proven to cause vitiligo.
Role of Genetic Changes
Variations in over 30 genes, occurring in different combinations, have been associated with an increased risk of developing vitiligo. Two of these genes are NLRP1 and PTPN22.
The NLRP1 gene provides instructions for making a protein that is involved in the immune system, helping to regulate the process of inflammation. Inflammation occurs when the immune system sends signaling molecules and white blood cells to a site of injury or disease to fight microbial invaders and facilitate tissue repair. The body then stops (inhibits) the inflammatory response to prevent damage to its own cells and tissues.
The PTPN22 gene provides instructions for making a protein involved in signaling that helps control the activity of immune system cells called T cells. T cells identify foreign substances and defend the body against infection.
The variations in the NLRP1 and PTPN22 genes that are associated with an increased risk of developing vitiligo likely affect the activity of the NLRP1 and PTPN22 proteins, making it more difficult for the body to control inflammation and prevent the immune system from attacking its own tissues.
Studies indicate that variations in a number of other genes also affect the risk of vitiligo. Many of these genes are also involved in immune system function or melanocyte biology, and variations in each likely make only a small contribution to vitiligo risk. Some of the gene changes associated with an increased risk of vitiligo have also been associated with an increased risk of other autoimmune conditions.
It is unclear what specific circumstances trigger the immune system to attack melanocytes in the skin. Research suggests that the immune system of affected individuals may react abnormally to melanocytes that are stressed by factors such as chemicals or ultraviolet radiation. In addition, the melanocytes of people with vitiligo may be more susceptible to stress than those of the general population and therefore may be more likely to be attacked by the immune system. The condition probably results from a combination of genetic and environmental factors, most of which have not been identified.
What are the symptoms of Vitiligo?
White patches on the skin are the main sign of vitiligo. These patches are more common in areas where the skin is exposed to the sun. The patches may be on the hands, feet, arms, face, and lips. Other common areas for white patches are:
- The armpits and groin (where the leg meets the body)
- Around the mouth
- Rectal areas.
People with vitiligo often have hair that turns gray early. Those with dark skin may notice a loss of color inside their mouths.
Will the white patches spread?
There is no way to tell if vitiligo will spread. For some people, the white patches do not spread. But often the white patches will spread to other areas of the body. For some people, vitiligo spreads slowly, over many years. For other people, spreading occurs quickly. Some people have reported more white patches after physical or emotional stress.
How is vitiligo diagnosed?
A doctor will use family and medical history, physical exam, and tests to diagnose vitiligo. The doctor may ask questions such as:
- Do you have family members with vitiligo?
- Do you or family members have any autoimmune diseases?
- Did you have a rash, sunburn, or other skin problem before the white patches appeared?
- Did you have some type of stress or physical illness?
- Did your hair turn gray before age 35?
- Are you sensitive to the sun?
A physical exam will be completed to rule out other medical problems.
Tests might include:
- Taking a small sample (biopsy) of the affected skin to be examined
- Blood tests
- An eye exam.
How is vitiligo treated?
Treatment may help make the skin look more even. The choice of treatment depends on:
- The number of white patches
- How widespread the patches are
- The treatment the person prefers to use.
Some treatments are not right for everyone. Many treatments can have unwanted side effects. Treatments can take a long time, and sometimes they don’t work.
Current treatment options for vitiligo include medical, surgical, and other treatments. Most are aimed at restoring color to the white patches of skin.
Medical treatments include:
- Medicines (such as creams) that you put on the skin
- Medicines that you take by mouth
- A treatment that uses medicine plus ultraviolet A (UVA) light (PUVA)
- Removing the color from other areas so they match the white patches.
Surgical treatments include:
- Skin grafts from a person’s own tissues. The doctor takes skin from one area of a patient’s body and attaches it to another area. This is sometimes used for people with small patches of vitiligo.
- Tattooing small areas of skin.
Other treatments include:
- Cosmetics, such as makeup or dye, to cover the white patches
- Counseling and support.
Vitiligo does not develop into other diseases, but people with the condition are more likely to experience:
- painful sunburn
- hearing loss
- changes to vision and tear production
Overcoming social challenges
If the skin patches are visible, the social stigma of vitiligo can be difficult to cope with. Embarrassment can lead to problems with self-esteem, and in some cases, anxiety and depression can result. 75% of those with vitiligo report having social anxiety in some from as a result of the changes to their skin.
People with darker skin are more likely to experience difficulties, because the contrast is greater. In some countries, vitiligo is known as “white leprosy.”
Increasing awareness about vitiligo, for example, by talking to friends about it, can help people with the condition to overcome these difficulties. Connecting with others who have vitiligo may also help.
Anyone with this condition who experiences symptoms of anxiety and depression should ask their dermatologist to recommend someone who can help.
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Medical News Today.com