Vitiligo: A Comprehensive Guide

Vitiligo is an acquired pigmentary disorder in which there is a loss of melanocytes from the skin, leading to areas of abnormal skin color. Vitiligo is a skin condition characterized by white patches on the skin. The skin surrounding these patches lacks pigment. These changes in skin color can occur anywhere on the body, but most commonly, they affect exposed areas such as hands, feet, arms, face, and lips. Vitiligo affects people of all backgrounds; however, it most often appears in adolescence or early adulthood. Although it may begin at any age, some reports indicate that white spots appear from infancy to early childhood.

What causes vitiligo?

1. Autoimmune destruction of melanocytes:

Vitiligo is an autoimmune disease. It results from the body’s destruction of melanocytes (cells that make pigment) in the skin. The exact cause of vitiligo is unknown, but it may be related to several factors, including genetic predisposition, environmental factors, and neurogenic factors.

2. Neurogenic factors:

Many researchers believe that there are neurological components to this process, including inflammation within the nervous system seen on positron emission tomography scans or biopsy evidence of neural damage with loss of melanocytes in tiny nerve endings near hair follicles. This condition occurs most often in epilepsy, diabetes mellitus, Addison’s Disease, and thyroid disorders, especially Hashimoto thyroiditis.

3. Genetic factors:

In most cases, vitiligo is a non-discriminatory disorder that can affect anyone from infancy to adulthood with no preference for race or sex. It is believed that the genetic susceptibility may be inherited as an autosomal recessive trait, and it appears to have a strong association with human leukocyte antigen (HLA)-coding on chromosome 6p21. There are no known risk factors aside from autoimmune disease in some cases; however, several studies suggest that there might be environmental triggers that increase the likelihood of developing vitiligo in persons who already possess the genes associated with this disease. These triggers include sunburns, trauma, certain medications, stress, and autoimmune diseases.

4. Stress:

Stress may play a role in triggering the disease in susceptible people. Stressful events, such as physical trauma or emotional stress that produces extreme fright, can cause vitiligo to develop in some individuals.

5. Several Medications:

Vitiligo has been reported following the use of several medications, including beta-blockers, interferon, isotretinoin (Accutane), levodopa, thiouracil, tricyclic antidepressants, naproxen sodium (Aleve), and bleomycin sulfate. However, many patients on these medications do not develop vitiligo, while others develop it while taking the drug but have no family history of vitiligo.

6. Chemical Exposure:

The use of chemicals such as silver nitrate, mercury compounds, and some hair dyes may cause vitiligo to develop in some individuals.

7. Chronic infections:

Other factors associated with vitiligo include chronic infections due to either viral or bacterial agents that can be present without causing symptoms. These infected persons have a higher incidence of the above-mentioned autoimmune disorders, including thyroid disease. This suggests that there may be some connection between chronic infections and autoimmune diseases, including vitiligo.

What are the different types of vitiligo?

Vitiligo is characterized by the appearance of white patches on different parts of the skin. The degree and extent can vary from a few small spots to most of the body surface area (more than 50%) in some cases. There are three major categories:

1. Non-segmental vitiligo: 

This type usually begins in adolescence or young adulthood and involves patches on both sides of the body, such as both hands, arms, legs, feet, and so forth.

2. Segmental vitiligo: 

This type occurs mainly in children and teenagers who have it on one side only of the body with no involvement on the other side, i.e., unilateral segmental vitiligo. This form of vitiligo can also affect the face in children.

3. Mucosal vitiligo:

This type can occur as a chalky white discoloration of the mucous membranes lining the insides of the mouth, nose, vagina, and rectum.

4. Focal Vitiligo:

It involves one or more small areas on the body, such as an isolated spot on the arm or leg. It can also occur in patches that resemble a ringworm infection (circular).

5. Universal Vitiligo:

It is characterized by the involvement of more than 80% of the body. In most cases, it starts in childhood and continues into adulthood. It affects males and females equally with no preference for race or sex.

What are the symptoms?

The common signs of vitiligo include:

• Patches of light-coloured skin on different body parts, particularly on sun-exposed areas such as hands, arms, face, feet, and lips.
• The depigmented patches are usually oval or round with sharply defined edges.
• Slowly but progressively, the color of the skin turns white due to loss of pigment.
• There may be some black or gray discoloration called a “salt and pepper” appearance.
• Itchiness is rare in vitiligo patients.
• A few cases of stinging or local pain are reported in some patients.
• Vitiligo can develop within 2-3 months after exposure to certain medications such as beta-blockers, interferon, isotretinoin (Accutane), levodopa, thiouracil, tricyclic antidepressants, naproxen sodium (Aleve), and bleomycin sulfate.
• The color tends to fade away slowly over several months or years, even after it has started disappearing. It can also sometimes spread quickly over a few weeks.

Hence, there can be different courses for this disease that affects each person differently. For some people, it may stabilize, while for others, it will continue to spread further on the body surface area.

Who gets vitiligo?

About one percent of people worldwide have vitiligo. Although it can occur at any age group, both genders are equally affected but more common among whites than Asians or African Americans. Vitiligo affects almost 1 to 2 percent of the world’s population.

What are the risk factors?

Some possible risk factors for developing this condition are listed below:

• The most potent risk factor is family history since people having a parent or sibling with vitiligo have an increased chance of getting this disease. However, less than 20% of affected individuals have a family member that has also been diagnosed with vitiligo. People who live in the same house as another person who has vitiligo increase the chances four times over those residing in non-affected families, i.e., 12% compared to 3%.
• It can develop after exposure to certain medications such as beta-blockers, isotretinoin (Accutane), levodopa, thiouracil, tricyclic antidepressants, naproxen sodium (Aleve), and bleomycin sulfate.
• It is also associated with other autoimmune diseases such as thyroiditis Hashimoto’s thyroiditis, and Grave’s disease. It can also occur with alopecia areata, which is a form of patchy hair loss.
• Vitiligo patients with a close family member affected by the disease have a greater risk of developing this condition than individuals without a family history.
• Having facial vitiligo increases the chance of finding it on other areas in the body, too, i.e., 60%, while having an upper extremity lesion only raises it to 30%.

How does vitiligo progress?

The color gradually fades away, leaving white patches on the skin. It can recur in some cases, but it is unlikely that new pigment will develop. Vitiligo usually spreads slowly on different areas of the body over many years or decades, even after it has started disappearing. There can be sudden appearance changes, such as more extensive hair loss (alopecia), formation of pearly depigmented patches, and rapid spread within a few weeks or months to other parts of the body surface area.

How common is vitiligo?

Vitiligo occurs in 1% to 2% of the population worldwide and is more common among Whites than other races. It has been estimated that approximately one percent of the global population (40 million people) has vitiligo. The number of people with this disease may be as high as two percent.

Can you inherit vitiligo?

Vitiligo may run in families, but most individuals with this condition do not have a family history of vitiligo. Only two to three percent of affected individuals have a first-degree relative (parent or sibling) with the disease.

Is vitiligo contagious?

No, vitiligo is not contagious. It is not an infection and cannot be transmitted from one person to another via casual contact.

How is vitiligo diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for vitiligo may include:

• Determination of levels of certain chemicals in the blood called autoantibodies that can be associated with autoimmune diseases such as thyroid disease or pernicious anaemia
• A skin biopsy is often taken during an office visit to allow your dermatologist to examine your skin under a microscope.

What are the treatment options for vitiligo?

• The first line of treatment is topical steroids on the depigmented areas to encourage repigmentation.
• Phototherapy using ultraviolet light that helps stimulate the production of melanin pigment on previously depigmented skin can be used along with topical corticosteroids or as a single modality if there has been no response to topical steroids. In some instances, oral psoralen and UVA therapy may also be prescribed with significant inflammation of the facial skin treated with photochemotherapy or PUVA therapy.
• Some medications have been reported to work, but further studies are needed to support their use, such as calcineurin inhibitors cyclosporine and tacrolimus, and other medications such as Benoquin and oral Gilenya (fingolimod).
• Cosmetic camouflage is sometimes used if depigmented skin is present in an exposed or visible area.

What does the future hold for patients with vitiligo?

The prognosis for people with this condition is life-long. Although some improvement may occur spontaneously over time, so far, there is no cure for vitiligo.

People with low self-esteem due to these hypopigmented patches can seek treatment from a dermatologist who specializes in treating conditions of the skin and pigment cells called a dermatopathologist.

Treatment can help restore normal pigmentation and improve appearance and psychological well-being, also known as cosmetically camouflaging the affected skin.

What are the natural treatment options for vitiligo?

There is no permanent cure for vitiligo. However, there are natural treatment options available for people with vitiligo to slow down the depigmentation of the skin. Here are some natural ways of treating vitiligo:

Vitamins and Supplements 

A balanced diet can help maintain a healthy lifestyle to boost your body’s immune system. A daily intake of vitamin D3 supplements may help improve the pigmentation of skin cells in Vitiligo patients. Foods’s rich in antioxidants such as green vegetables, berries, oily fish like salmon or sardines can also help improve your condition. Honey has been known to have antibacterial properties, which can help heal the wounds on the patches of Vitiligo.

Skin Care

The use of sunscreen creams, lotions, or other forms of sun protection should be applied to your skin every two hours during the daytime, mainly if you have been prescribed phototherapy treatment for vitiligo. If you are exposed to direct sunlight, you should take precautions, such as wearing sunglasses and wide-brimmed hats so that your skin won’t get burned due to overexposure.

Home Remedies

• The application of fresh aloe vera juice to affected areas several times a day can help promote the regeneration of skin cells in Vitiligo patients.
• Another natural home remedy is the application of castor oil on depigmented skin areas to accelerate melanin production.
• You may also try using fresh or dried marigold flowers as they can help stimulate melanin pigmentation in your skin cells.
• The use of sunscreen and sunblock is recommended if you are exposed to direct sunlight as it helps protect against the harmful ultraviolet (UV) rays. UV rays from natural sunlight or artificial sources such as tanning beds cause Vitiligo patches to become lighter in color.
• Homeopathic treatment for vitiligo
  It is also one of the best and natural treatments available if you are looking for natural alternative medicine. Homeopathic treatment for vitiligo works by stimulating the body’s immune system to slow down vitiligo development while also reducing the patchy appearance of white skin areas. Homeopathy doctors treat vitiligo by the root cause and ensure there is no recurrence of the disease in the future.

Homeopathic treatment is a popular form of treatment for Vitiligo patients. It can help stimulate melanin production without exposing you to harmful effects from other treatments such as topical creams or contact with chemicals. The areas affected by depigmentation will then become lighter or return to normal pigmentation levels given time. For more information and proper treatment, you can book an appointment through OHO Homeopathy now!