Young woman with VitiligoSharni Kaur, right, and her mother, Roop Singh. Sharni has suffered from vitiligo, which causes her skin to lighten, since she was nine years old.Singer/songwriter Michael Jackson suffers from vitiligo (see upper-arm)
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Vitiligo (IPA /ˌvɪtəˈlaɪgo/) or leukoderma is the patchy loss of skin pigmentation due to an auto-immune attack by the body's own immune system on skin melanocytes. It frequently begins in late adulthood, with patches of unpigmented skin appearing on extremities. The patches may grow or remain constant in size. Occasional small areas may repigment as they are recolonised by melanocytes. The population incidence is between 1% and 2%. more...

VACTERL association
Van der Woude syndrome
Van Goethem syndrome
Varicella Zoster
Variegate porphyria
Vasovagal syncope
VATER association
Velocardiofacial syndrome
Ventricular septal defect
Viral hemorrhagic fever
Vitamin B12 Deficiency
VLCAD deficiency
Von Gierke disease
Von Hippel-Lindau disease
Von Recklinghausen disease
Von Willebrand disease

Vitiligo is not contagious.

In some cases, mild trauma to an area of skin seems to cause new patches - for example around the ankles (caused by friction with shoes or sneakers). Vitiligo may also be caused by stress that affects the immune system, leading the body to react and start eliminating skin pigment.

The disease is not medically a problem, but it is mentally and socially to some people, other than the problem that the affected skin areas have no protection against sunlight - they burn but never tan. However, if the skin is naturally dark, the visual effect of the white patches may be considered disfiguring by some. (If the affected person is pale-skinned, the patches can be at least be made less visible by avoiding sunlight and the tanning of unaffected skin.) The location of vitiligo affected skin changes over time, with some patches re-pigmenting and others becoming affected. (Exposure to sunlight is always better; it helps the melanocytes regenerate to allow the pigmentation to come back to its original color.)

Vitiligo on the scalp may affect the colour of the hair (though not always), leaving white patches or streaks. It will similarly affect whiskers and body hair.

In some cultures there is a stigma attached to having vitiligo. Those affected with the condition are sometimes thought to be evil or diseased and are sometimes shunned by others in the community. People with vitiligo may feel depressed because of this stigma or because the way their skin looks is a dramatic change.


Steroids have been used to remove the white patches, but they are not very effective. Other more dramatic treatments include chemically treating the patient to remove all pigment from the skin to present a uniform skin tone. Current experimental treatments include exposure to narrow-band UV light, which seems to blur the edges of patches, and lightly freckling the affected areas. Immunomodulator creams are believed to cause repigmentation in some cases, but there is no scientific study yet to back this claim. All these treatments alter the appearance but do not address the underlying cause of vitiligo.

In late October of 2004, doctors successfully transplanted melanocytes to vitiligo affected areas, effectively repigmenting the region. The procedure involved taking a thin layer of normally pigmented skin from the patient's "gluteal region". Melanocytes were then separated out and used to make a cellular suspension. The area to be treated was then ablated with a laser, and the melanocyte graft applied. Three weeks later, the area was exposed to UV light repeatedly for two months. Between 73 and 84 percent of patients experienced nearly complete repigmentation of their skin. The longevity of the repigmentation differed from patient to patient.


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Skin care by the book
From Essence, 7/1/04 by Julia Chance

When it comes to darker skin tones, there has been a shortage of reliable information to tell us which products and procedures are best suited to our needs. Until now. Dermatologists Jeanine Downie, M.D., and Fran Cook-Bolden, M.D., with Emmy Award-winning reporter Barbara Nevins Taylor, have filled the void with their new book, Beautiful Skin of Color: A Comprehensive Guide to Asian, Olive, and Dark Skin (Regan Books). Written as an A-to-Z manual, it covers topics from acne and eczema to sun protection and vitiligo. The book also features letters from everyday women with their questions about skin care, as well as straightforward explanations, advice and product recommendations to help you attain healthy, beautiful skin. Here we take a sneak peek at what the good doctors have to say about skin discoloration.

Joint Darkness

'I have a light-brown complexion, but my knees and elbows are black," Tanika writes. "It's been like this since I was little. I never wear skirts and always wear long sleeves. Is there anything I can do?"

It's not unusual for people to have severe discoloration that they want to cover up. Skin of color, ranging from the palest Asian tone to olive and the darkest of dark skin, is prone to darkening in certain areas. But people are often too embarrassed to talk about it. Over-the-counter creams and lotions aren't likely to work if the problem is severe or genetic. But in many cases there are remedies.

Why It Happens

Some people are born with darker skin on their joints. If this is a genetic problem, it may be impossible to make a significant difference. But the darkness may be caused by friction and the way your skin has responded to it. You started banging your elbows and knees when you were very young. We're all born with extra skin at the joints so that we can bend and stretch. If you have skin of color, that extra skin darkens easily.

Melanocytes, the cells that give our skin color, are very active in Asian, olive and dark skin. The slightest bump, bruise, scrape or trauma of any kind activates the melanocytes. In the joint areas the extra color cells get trapped in the extra skin. So if you're doing housework or anything that involves repeated pressure on your knees and elbows for long periods of time, it's likely that the skin over those joints will darken. Similarly if you're doing work or playing a game or sport that's rough on the hands, your knuckles will likely be darker than the rest of your skin. The same is true for your toes. If you squeeze your feet into great-looking shoes that hurt and scrunch the toes, your toe joints are likely to darken.

Doctor's Guidance

A dermatologist will use a combination of therapies to even the skin tone. Hydroquinone, which blocks the enzyme that produces color in the melanocytes, is most effective when combined with retinoids like Retin-A Micro. This full strength retinoid evens skin tone as it speeds the shedding of dead-skin cells. It also stimulates natural collagen production and gives the skin good texture.

Some prescription medications, such as EpiQuin Micro, Glyquin XM and Alustra, contain all these ingredients and others, including vitamins C and E--antioxidants that fight the oxygen compounds known as free radicals, which cause aging.

If the skin is very thick and very dark, the doctor may prescribe Tri-Luma Cream, a medication combining a hydroquinone, a retinoid and a steroid. Use the cream for a limited time only, and be sure its use is monitored carefully by a doctor.


* In all situations, treat your skin gently. Think about your habits and the way your body moves and works. If you can eliminate some of the damaging action, you'll stop creating new dark-skin cells, which will be a step forward.

* Sunblock may not sound like an obvious solution, but it's important. Once the skin gets dark in an area, the sun will make it darker. We recommend a sunblock with UVA and UVB, Parsol 1789, and a sun-protection factor of at least 20. Apply the sunblock on every area exposed to the sun, paying particular attention to the joints.

* Lubricate dry areas. Because there's likely to be rough skin in these areas, it is a good idea to try to thin the skin a little bit with moisturizers containing lactic acid, such as AmLactin, LactiCare and Lac-Hydrin. They're available over the counter in most drugstores. Jergens Ash Relief, containing beta hydroxy acid, is an excellent moisturizer; Eucerin Alpha Hydroxy Moisturizer is also potent.

As you are thinning the skin, you also want to begin to try to slough off the dead dark-skin cells and fade what's left behind. That's where the vitamin A, or retinoid, products and other alpha and beta hydroxy acids come in. Over-the-counter products are a good way to begin to lighten skin color at the joints.

COPYRIGHT 2004 Essence Communications, Inc.
COPYRIGHT 2004 Gale Group

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