Vitiligo is a long term skin condition characterized by patches of the skin losing their pigment. The patches of skin affected become white and usually have sharp margins. The hair from the skin may also become white. Inside the mouth and nose may also be involved. Typically both sides of the body are affected. Often the patches begin on areas of skin that are exposed to the sun. It is more noticeable in people with dark skin. Vitiligo may result in psychological stress and those affected may be stigmatized.
|Non-segmental vitiligo of the hand|
|Symptoms||Patches of white skin|
|Risk factors||Family history, other autoimmune diseases|
|Diagnostic method||Tissue biopsy|
|Treatment||Sunscreen and makeup|
|Frequency||1% of people|
The cause is typically unknown. It is believed to be due to genetic susceptibility that is triggered by an environmental factor such that an autoimmune disease occurs. This results in the destruction of skin pigment cells. Risk factors include a family history of the condition or other autoimmune diseases, such as hyperthyroidism, alopecia areata, and pernicious anemia. It is not contagious. Vitiligo is classified into two main types: segmental and non-segmental. Most cases are non-segmental, meaning they affect both sides; and in these cases, the affected area of the skin typically expands with time. About 10% of cases are segmental, meaning they mostly involve one side of the body; and in these cases, the affected area of the skin typically does not expand with time. Diagnosis can be confirmed by tissue biopsy.
There is no known cure for vitiligo. For those with light skin, sunscreen and makeup are all that is typically recommended. Other treatment options may include steroid creams or phototherapy to darken the light patches. Alternatively, efforts to lighten the unaffected skin, such as with hydroquinone, may be tried. A number of surgical options are available for those who do not improve with other measures. A combination of treatments generally has better outcomes. Counselling to provide emotional support may be useful.
Globally about 1% of people are affected by vitiligo. Some populations have rates as high as 2–3%. Males and females are equally affected. About half show the disorder before age 20 and most develop it before age 40. Vitiligo has been described since ancient history.
Signs and symptomsEdit
The only sign of vitiligo is the presence of pale patchy areas of depigmented skin which tend to occur on the extremities. The patches are initially small, but often grow and change shape. When skin lesions occur, they are most prominent on the face, hands and wrists. The loss of skin pigmentation is particularly noticeable around body orifices, such as the mouth, eyes, nostrils, genitalia and umbilicus. Some lesions have increased skin pigment around the edges. Those affected by vitiligo who are stigmatized for their condition may experience depression and similar mood disorders.
Although multiple hypotheses have been suggested as potential triggers that cause vitiligo, studies strongly imply that changes in the immune system are responsible for the condition. Vitiligo has been proposed to be a multifactorial disease with genetic susceptibility and environmental factors both thought to play a role.
The TYR gene encodes the protein tyrosinase, which is not a component of the immune system, but is an enzyme of the melanocyte that catalyzes melanin biosynthesis, and a major autoantigen in generalized vitiligo. The NIH states that sunburns can cause the disease but there is not good evidence to support this.
Variations in genes that are part of the immune system or part of melanocytes have both been associated with vitiligo. It is also thought to be caused by the immune system attacking and destroying the melanocytes of the skin. A genomewide association study found approximately 36 independent susceptibility loci for generalized vitiligo.
Vitiligo is sometimes associated with autoimmune and inflammatory diseases such as Hashimoto's thyroiditis, scleroderma, rheumatoid arthritis, type 1 diabetes mellitus, psoriasis, Addison's disease, pernicious anemia, alopecia areata, systemic lupus erythematosus, and celiac disease.
Among the inflammatory products of NALP1 are caspase 1 and caspase 7, which activate the inflammatory cytokine interleukin-1β. Interleukin-1β and interleukin-18 are expressed at high levels in patients with vitiligo. In one of the mutations, the amino acid leucine in the NALP1 protein was replaced by histidine (Leu155->His). The original protein and sequence is highly conserved in evolution, and is found in humans, chimpanzee, rhesus monkey, and the bush baby. Addison's disease (typically an autoimmune destruction of the adrenal glands) may also be seen in individuals with vitiligo.
An ultraviolet light can be used in the early phase of this disease for identification and to determine the effectiveness of treatment. Skin with vitiligo, when exposed to a blacklight, will glow blue. In contrast, healthy skin will have no reaction.
Classification attempts to quantify vitiligo have been analyzed as being somewhat inconsistent, while recent consensus have agreed to a system of segmental vitiligo (SV) and non-segmental vitiligo (NSV). NSV is the most common type of vitiligo.
In non-segmental vitiligo (NSV), there is usually some form of symmetry in the location of the patches of depigmentation. New patches also appear over time and can be generalized over large portions of the body or localized to a particular area. Extreme cases of vitiligo, to the extent that little pigmented skin remains, are referred to as vitiligo universalis. NSV can come about at any age (unlike segmental vitiligo, which is far more prevalent in teenage years).
Classes of non-segmental vitiligo include the following:
- Generalized vitiligo: the most common pattern, wide and randomly distributed areas of depigmentation
- Universal vitiligo: depigmentation encompasses most of the body
- Focal vitiligo: one or a few scattered macules in one area, most common in children
- Acrofacial vitiligo: fingers and periorificial areas
- Mucosal vitiligo: depigmentation of only the mucous membranes
Segmental vitiligo (SV) differs in appearance, cause, and frequency of associated illnesses. Its treatment is different from that of NSV. It tends to affect areas of skin that are associated with dorsal roots from the spinal cord and is most often unilateral. It is much more stable/static in course and its association with autoimmune diseases appears to be weaker than that of generalized vitiligo. SV does not improve with topical therapies or UV light, however surgical treatments such as cellular grafting can be effective.
Chemical leukoderma is a similar condition due to multiple exposures to chemicals. Vitiligo however is a risk factor. Triggers may include inflammatory skin conditions, burns, intralesional steroid injections and abrasions.
Other conditions with similar symptoms include the following:
There is no cure for vitiligo but several treatment options are available. The best evidence is for applied steroids and the combination of ultraviolet light in combination with creams. Due to the higher risks of skin cancer, the United Kingdom's National Health Service suggests phototherapy only be used if primary treatments are ineffective. Lesions located on the hands, feet, and joints are the most difficult to repigment; those on the face are easiest to return to the natural skin color as the skin is thinner in nature.
Topical preparations of immune suppressing medications including glucocorticoids (such as 0.05% clobetasol or 0.10% betamethasone) and calcineurin inhibitors (such as tacrolimus or pimecrolimus) are considered to be first-line vitiligo treatments.
Phototherapy is considered a second-line treatment for vitiligo. Exposing the skin to light from UVB lamps is the most common treatment for vitiligo. The treatments can be done at home with an UVB lamp or in a clinic. The exposure time is managed so that the skin does not suffer overexposure. Treatment can take a few weeks if the spots are on the neck and face and if they existed not more than 3 years. If the spots are on the hands and legs and have been there more than 3 years, it can take a few months. Phototherapy sessions are done 2–3 times a week. Spots on a large area of the body may require full body treatment in a clinic or hospital. UVB broadband and narrowband lamps can be used, but narrowband ultraviolet picked around 311 nm is the choice. It has been constitutively reported that a combination of UVB phototherapy with other topical treatments improves re-pigmentation. However, some vitiligo patients may not see any changes to skin or re-pigmentation occurring. A serious potential side effect involves the risk of developing skin cancer, the same risk as an over-exposure to natural sunlight.
Ultraviolet light (UVA) treatments are normally carried out in a hospital clinic. Psoralen and ultraviolet A light (PUVA) treatment involves taking a drug that increases the skin's sensitivity to ultraviolet light, then exposing the skin to high doses of UVA light. Treatment is required twice a week for 6–12 months or longer. Because of the high doses of UVA and psoralen, PUVA may cause side effects such as sunburn-type reactions or skin freckling.
Narrowband ultraviolet B (NBUVB) phototherapy lacks the side-effects caused by psoralens and is as effective as PUVA. As with PUVA, treatment is carried out twice weekly in a clinic or every day at home, and there is no need to use psoralen.
In mild cases, vitiligo patches can be hidden with makeup or other cosmetic camouflage solutions. If the affected person is pale-skinned, the patches can be made less visible by avoiding tanning of unaffected skin.
In cases of extensive vitiligo the option to de-pigment the unaffected skin with topical drugs like monobenzone, mequinol, or hydroquinone may be considered to render the skin an even colour. The removal of all the skin pigment with monobenzone is permanent and vigorous. Sun-safety must be adhered to for life to avoid severe sunburn and melanomas. Depigmentation takes about a year to complete.
Descriptions of a disease believed to be vitiligo date back to a passage in the medical text Ebers Papyrus circa 1500 BC in ancient Egypt. Mentions of whitening of the skin were also present circa 1400 BC in sacred Indian texts such as Atharvaveda as well as Shinto prayers in East Asia circa 1200 BC. The Hebrew word "Tzaraath" from the Old Testament book of Leviticus dating to 1280 BCE (or 1312 BCE) described a group of skin disease associated with white spots, and a subsequent translation to Greek led to continued conflation of those with vitiligo with leprosy and spiritual uncleanliness. Medical sources in the ancient world such as Hippocrates often did not differentiate between vitiligo and leprosy, often grouping these diseases together. In Arabic literature, the word "alabras" has been associated with vitiligo, with this word found in the Quran. The name "vitiligo" was first used by the Roman physician Aulus Cornelius Celsus in his classic medical text De Medicina.
The etymology of the term "vitiligo" is believed to be derived from "vitium", meaning "defect" or "blemish".
- Pop music singer Michael Jackson revealed in an interview with Oprah Winfrey in February 1993 that he had vitiligo. Following his death in 2009, Jackson's autopsy confirmed his claim, and clarified that he specifically had vitiligo universalis.
- Canadian model Chantelle Brown-Young (known by her stage name Winnie Harlow) has a prominent form of vitiligo. Her participation in the America's Next Top Model contest led to her being called a "vitiligo spokesmodel".
- P. Sathasivam, who is the current Governor of Kerala, in office since 2014, has vitiligo. He previously served as the 40th Chief Justice of India from 2013 to 2014.
- Former WBC Interim Middleweight Boxing Champion Marco Antonio Rubio has vitiligo.
- NFL assistant coach Karl Dunbar was diagnosed with the condition in the 7th grade.
- Michaela DePrince, a Sierra Leonean American ballet dancer, is the only dancer of African origin in the Dutch National Ballet, lived in a refugee camp as a child and was called "devil's child" because of vitiligo.
- Bryan Lloyd Danielson, an American retired professional wrestler best known for his tenure in WWE under the name Daniel Bryan, stated on Twitter that he has vitiligo.
- Scott Jorgensen, an American mixed martial arts fighter, has publicly demonstrated all the stages of vitiligo from beginning to end.
Michael Jackson as photographed on the packaging of his 1979 album, Off the Wall
In October 1992, a scientific report was published of successfully transplanting melanocytes to vitiligo affected areas, effectively re-pigmenting the region. The procedure involved taking a thin layer of pigmented skin from the patient's gluteal region. Melanocytes were then separated out to a cellular suspension that was expanded in culture. The area to be treated was then denuded with a dermabrader and the melanocytes graft applied. Between 70 and 85 percent of patients experienced nearly complete repigmentation of their skin. The longevity of the repigmentation differed from person to person. By now, several transplantation techniques have been developed, including transplantation of melanocyte precursors derived from hair follicles. Transplantation procedures are frequently used to treat segmental vitiligo which is poorly responsive to other types of treatment. In non-segmental vitiligo, success is achieved when treating patches that are not expanding (so called stable vitiligo).
Society and cultureEdit
The change in appearance caused by vitiligo can affect a person's emotional and psychological well-being and may create difficulty in getting or keeping a job. People with this disorder can experience emotional stress, particularly if vitiligo develops on visible areas of the body, such as the face, hands, arms, feet, or on the genitals. Participating in a vitiligo support group may improve social coping skills and emotional fortitude.
- Albinism, uniform absence of melanin
- Alphos, a non-contagious leprosy formerly referred to as "vitiligo"
- Amelanism, lack of pigmentation
- Erythrism, excessive red pigmentation
- Heterochromia iridum, another condition characterized by pigment variations
- Leucism, reduced pigmentation
- Melanising agents
- Melanism, uniform saturation of melanin
- Nevus depigmentosus
- Pityriasis alba
- Quadrichrome vitiligo, characterized by patches of reduced but not absent pigment
- Ezzedine, K; Eleftheriadou, V; Whitton, M; van Geel, N (4 July 2015). "Vitiligo". Lancet. 386 (9988): 74–84. doi:10.1016/s0140-6736(14)60763-7. PMID 25596811.
- "Questions and Answers about Vitiligo". NIAMS. June 2014. Archived from the original on 21 August 2016. Retrieved 11 August 2016.
- Whitton, M; Pinart, M; Batchelor, JM; et al. (May 2016). "Evidence-based management of vitiligo: summary of a Cochrane systematic review". The British journal of dermatology. 174 (5): 962–9. doi:10.1111/bjd.14356. PMID 26686510.
- Chopra, Parul; Niyogi, Rageshree; Katyal, Gauri (2009). Skin and Hair Care: Your Questions Answered. Byword Books Private Limited. p. 2. ISBN 9788181930378. Archived from the original on 23 March 2017.
- Krüger C; Schallreuter KU (October 2012). "A review of the worldwide prevalence of vitiligo in children/adolescents and adults". Int J Dermatol. 51 (10): 1206–12. doi:10.1111/j.1365-4632.2011.05377.x. PMID 22458952.
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (March 2007). "What Is Vitiligo? Fast Facts: An Easy-to-Read Series of Publications for the Public Additional". Archived from the original on 15 July 2010. Retrieved 18 July 2010.
- Halder RM (2007). "72. Vitiligo". In Wolff K, Freedberg IM, Fitzpatrick TB. Fitzpatrick's dermatology in general medicine (7th ed.). New York: McGraw-Hill Professional. ISBN 978-0-07-146690-5. OCLC 154751587.
- Halder, RM; Chappell, JL (2009). "Vitiligo update". Seminars in cutaneous medicine and surgery. 28 (2): 86–92. doi:10.1016/j.sder.2009.04.008. PMID 19608058.
- Huggins RH, Schwartz RA, Janniger CK (2005). "Vitiligo" (PDF). Acta Dermatovenerologica Alpina, Pannonica et Adriatica. 14 (4): 137–42, 144–5. PMID 16435042. Archived (PDF) from the original on 10 December 2006.
- Picardi A, Pasquini P, Cattaruzza MS, et al. (2003). "Stressful life events, social support, attachment security and alexithymia in vitiligo. A case-control study". Psychotherapy and Psychosomatics. 72 (3): 150–8. doi:10.1159/000069731. PMID 12707482.
- Ongenae, Katia; Van Geel, Nanny; Naeyaert, Jean-Marie (Apr 2003). "Evidence for an Autoimmune Pathogenesis of Vitiligo". Pigment Cell Research. 16 (2): 90–100. doi:10.1034/j.1600-0749.2003.00023.x. PMID 12622785.
- "Questions and Answers about Vitiligo". June 2014. Archived from the original on 5 October 2015. Retrieved 4 October 2015.
- Grimes PE, Nashawati R (2017). "The Role of Diet and Supplements in Vitiligo Management". Dermatol Clin (Review). 35 (2): 235–243. doi:10.1016/j.det.2016.11.012. PMID 28317532.
- Staff, Mayo Clinic (15 May 2014). "Vitiligo Causes". Mayoclinic. Archived from the original on 30 April 2015. Retrieved 22 April 2015.
- Spritz, Richard A. (May 2013). "Modern vitiligo genetics sheds new light on an ancient disease". The Journal of Dermatology. 40 (5): 310–318. doi:10.1111/1346-8138.12147.
- Van Driessche F, Silverberg N (2015). "Current Management of Pediatric Vitiligo". Paediatr Drugs (Review). 17 (4): 303–13. doi:10.1007/s40272-015-0135-3. PMID 26022363.
- Lamkanfi M, Vande Walle L, Kanneganti TD (2011). "Deregulated inflammasome signaling in disease". Immunol Rev (Review). 243 (1): 163–73. doi:10.1111/j.1600-065X.2011.01042.x. PMC . PMID 21884175.
- Gregersen PK (2007). "Modern genetics, ancient defenses, and potential therapies". The New England Journal of Medicine. 356 (12): 1263–6. doi:10.1056/NEJMe078017. PMID 17377166.
- Jin Y, Mailloux CM, Gowan K, et al. (2007). "NALP1 in vitiligo-associated multiple autoimmune disease". The New England Journal of Medicine. 356 (12): 1216–25. doi:10.1056/NEJMoa061592. PMID 17377159.
- Picardo, Mauro; Taïeb, Alain, eds. (2009). "Introduction". Vitiligo. Berlin: Springer. ISBN 978-3-540-69360-4.
- Halder, R. M.; et al. (2007). "Vitiligo". In Wolff, K.; et al. Fitzpatrick's Dermatology in General Medicine (7th ed.). New York: McGraw-Hill Professional. ISBN 978-0-07-146690-5.
- van Geel N, Mollet I, Brochez L, et al. (February 2012). "New insights in segmental vitiligo: case report and review of theories". British Journal of Dermatology. 166 (2): 240–6. doi:10.1111/j.1365-2133.2011.10650.x. PMID 21936857.
- "Disturbances of Pigmentation". [978-0-323-31967-6 Andrews' diseases of the skin : clinical dermatology] Check
|url=value (help). 2016. pp. Ebook. ISBN 9780323319676.
- James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: Clinical Dermatology. Saunders Elsevier. p. 864. ISBN 0-7216-2921-0.
- Whitton, ME; Ashcroft, DM; González, U (Oct 2008). "Therapeutic interventions for vitiligo". Journal of the American Academy of Dermatology. 59 (4): 713–7. doi:10.1016/j.jaad.2008.06.023. PMID 18793940.
- Anon. "Vitiligo -Treatment". Patient UK. NHS. Archived from the original on 6 June 2013. Retrieved 3 June 2013.
- Scherschun, L; Kim, JJ; Lim, HW (2001). "Narrow-band ultraviolet B is a useful and well-tolerated treatment for vitiligo". Journal of the American Academy of Dermatology. 44 (6): 999–1003. doi:10.1067/mjd.2001.114752. PMID 11369913.
- Don, Philip; Iuga, Aurel; Dacko, Anne; Hardick, Kathleen (2006). "Treatment of vitiligo with broadband ultraviolet B and vitamins". International Journal of Dermatology. 45 (1): 63–5. doi:10.1111/j.1365-4632.2005.02447.x. PMID 16426381.
- Gauthier, Yvon; Benzekri, Laila (2009). "Historical Aspects". In Picardo, Mauro; Taïeb, Alain. Vitiligo (Online-Ausg. ed.). Berlin: Springer. ISBN 978-3-540-69360-4.
- Kurzweil, Arthur (2008). The Torah For Dummies (PDF). For Dummies. p. 11. ISBN 978-0-470-28306-6. Retrieved 2010-08-19.
- History Crash Course #36: Timeline: From Abraham to Destruction of the Temple Archived 20 July 2014 at the Wayback Machine., by Rabbi Ken Spiro, Aish.com. Retrieved 2010-08-19.
- Duke, Alan (7 May 2013). "Autopsy reveals Michael Jackson's secrets". CNN Entertainment. CNN. Archived from the original on 7 May 2013. Retrieved 7 May 2013.
The autopsy apparently confirmed what Jackson told people who questioned why his skin tone became lighter in the 1980s. Jackson had 'vitiligo, a skin pigmentation disease,' [LA coroner Dr. Christopher] Rogers said. 'So, some areas of the skin appear light and others appear dark.'
- Taylor, Victoria (8 May 2014). "'America's Next Top Model' contestant hasn't let rare skin condition hold her back". New York Daily News. Archived from the original on 10 May 2014. Retrieved 9 May 2014.
- "New Delhi: Justice Sathasivam sworn in as chief justice of India" Archived 13 July 2015 at the Wayback Machine.. mangalorean.com. July 19, 2013
- Gonzalez, Edgar (2011). "Can Rubio beat Chavez?" Archived 4 March 2016 at the Wayback Machine.. My Boxing Fans.
- "Skin condition hasn't stopped Dunbar". Archived from the original on 17 November 2015.
- "HuffPost Teen's '18 Under 18' Of 2012! (PHOTOS)". Huffington Post. 31 December 2012. Archived from the original on 26 October 2016.
- "Daniel Bryan (July 30, 2011). "Tweet Number 97214858474422272". Twitter". 31 October 2014. Archived from the original on 11 January 2014.
- "Scott Jorgensen Says His Vitiligo Makes His Tattoos Look Even Better | FIGHTLAND". Fightland. Archived from the original on 2 July 2016. Retrieved 17 June 2016.
- Fabrikant J; et al. (Jul 2013). "A review and update on melanocyte stimulating hormone therapy: afamelanotide". J Drugs Dermatol. 12 (7): 775–9. PMID 23884489.
- "For vitiligo patient, arthritis drug restores skin color". Archived from the original on 22 July 2015.
- Olsson MJ, Juhlin L (1992). "Melanocyte transplantation in vitiligo". Lancet. 340 (8825): 981. doi:10.1016/0140-6736(92)92875-G. PMID 1357390.
- Olsson MJ, Juhlin L (2002). "Long-term follow-up of leucoderma patients treated with transplants of autologous cultured melanocytes, ultrathin epidermal sheets and basal cell layer suspension". The British Journal of Dermatology. 147 (5): 893–904. doi:10.1046/j.1365-2133.2002.04837.x. PMID 12410698.
|Wikimedia Commons has media related to Vitiligo.|