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

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...

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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.

Treatment

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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Vitiligo
From Gale Encyclopedia of Medicine, 4/6/01 by Dorothy Elinor Stonely

Definition

Vitiligo is a condition in which a loss of cells that give color to the skin (melanocytes) results in smooth, white patches in the midst of normally pigmented skin.

Description

Vitiligo is a common, often inherited disorder characterized by areas of well-defined, milky white skin. People with vitiligo may have eye abnormalities and also have a higher incidence of thyroid disease, diabetes mellitus, and pernicious anemia. Vitiligo affects about 1-2% of the world's population. It is more easily observed in sun-exposed areas of the body and in darker skin types, but it affects any area of the body and all races. Vitiligo seems to affect men and women equally, although women more frequently seek treatment for the disorder.

Vitiligo may appear as one or two well-defined white patches or it may appear over large portions of the body. Typical sites for generalized vitiligo are areas surrounding body openings, bony areas, fingers, and toes. It can begin at any age but about 50% of the time it starts before the age of 20.

Causes & symptoms

Vitiligo is a disorder with complex causes. People with vitiligo seem to inherit a genetic predisposition for the disorder, and the appearance of disorder can be brought on by a variety of precipitating causes. Many people report that their vitiligo first appeared following a traumatic or stressful event, such as an accident, job loss, death of a family member, severe sunburn, or serious illness. There are at least three theories about the underlying mechanism of vitiligo. One theory says nerve endings in the skin release a chemical that is toxic to the melanocytes. A second theory states that the melanocytes simply self-destruct. The third explanation is that vitiligo is a type of autoimmune disease in which the immune system targets the body's own cells and tissues.

The primary symptom of vitiligo is the loss of skin color. Hair growing from the affected skin areas also lacks color. In addition, people with vitiligo may have pigment abnormalities of the retina or iris of the eyes. A minority of patients also may have inflammation of the retina or iris, but vision is not usually impaired.

Diagnosis

The diagnosis of vitiligo is usually made by observation. Progressive, white areas found at typical sites point to a diagnosis of vitiligo. If the diagnosis is not certain, the doctor will test for other conditions which can mimic vitiligo, such as chemical leukoderma or systemic lupus erythematosus. If the tests rule out other conditions, vitiligo is confirmed.

Treatment

Vitiligo cannot be cured, but it can be managed. Cosmetics can be used to improve the appearance of the white areas not covered by clothing. Sunscreens prevent burning of the affected areas and also prevent the normal skin around the patches from becoming darker. Skin creams and oral medications are available for severe cases, but they have side effects that may make them undesirable. Autologous transplantation of skin is an option for those who are severely affected. Bleaching or depigmentation of the normal skin is another option.

In addition to treating the skin, attention should be paid to the psychological well-being of the individual. Extreme cases of vitiligo can be unattractive and may affect a person's outlook and social interactions.

Prognosis

The condition is usually gradually progressive. Sometimes the patches grow rapidly over a short period, and then the condition remains stable for many years.

Prevention

No measures are currently known to prevent vitiligo.

Key Terms

Autoimmune disease
A condition in which something triggers the immune system to react against and attack the body's own tissues.
Autologous transplantation
A procedure wherein the person donates blood or tissue to themselves.
Iris
The colored part of the eye.
Pernicious anemia
A disease in which red blood cells are abnormally formed due to the body's inability to absorb vitamin B.
Retina
The innermost layer of the eye, it contains the rods and cones, specialized light-sensitive cells.

Further Reading

For Your Information

    Books

  • Fitzpatrick, Thomas B., et al, eds. Dermatology in General Medicine. 4th ed. New York: McGraw-Hill, 1993.
  • Professional Guide to Diseases. 5th ed. Springhouse, PA: Springhouse Corp., 1995.

    Organizations

  • Frontier's International Vitiligo Foundation. 4 Rozina Court, Owings Mills, MD 21117. (301) 594-0958.
  • National Foundation for Vitiligo and Pigment Disorders. 9032 South Normandy Drive, Centerville, OH 45459. (513) 885-5739.
  • National Vitiligo Foundation. P.O. Box 6337, Tyler, TX 75703. (903) 531-9767, e-mail: 73071.33@compuserve.com

Gale Encyclopedia of Medicine. Gale Research, 1999.

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