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Vitiligo: A common cause of loss of skin pigment.

Vitiligo is a long term problem in which growing patches of skin lose their colour. The patches appear when melanocytes within the skin die off. Melanocytes are the cells responsible for producing the skins pigment, melanin, which gives skin it’s colour and protects it from the sun’s UV rays. The total area of skin that can be affected by vitiligo varies between individuals. There is no way to determine if vitiligo will spread or remain confined to one location. There is no way to prevent vitiligo.

Symptoms of vitiligo.

1. Patches of skin lose colour. This can include the eyes or the mucous membrane in your mouth or nose.

2. Patches of hair on your head or face turn prematurely grey or white.

Causes of vitiligo.

Autoimmune disorder- The affected person’s immune system may develop antibodies that destroy melanocytes.

Neutrogenic factors- A substance that is toxic to melanocytes may be released at nerve endings in the skin. 

Genetic factors- certain factors may increase the chances of getting vitiligo. About 30% of vitiligo cases run in the family.

Self destruction- A defect in melanocytes cause them to destroy themselves.

It can also be triggered by certain events, such as physical or emotional stress.

Types of vitiligo.

Nonsegmental vitiligo ( also known as bilateral vitiligo, vitiligo vulgaris and generalized vitiligo)

This is the most common type of vitiligo which results in white patches appearing on both sides of the body. It usually starts near the hands, around the eyes or mouth, on the feet, or in an area of the body where the skin rubs together frequently.

With nonsegmental vitiligo, colour loss comes in spurts over the course of one’s life, spreading and becoming more noticeable as time goes on.

2. Segmental vitiligo ( also known as unilateral vitiligo ) 

Is a type of vitiligo usually starts when a person is young. It generally progresses for a year or so before it stops. It appears in one area. Such as one hand or leg.

Subtypes of vitiligo.

1. Localized- the vitiligo appears in just one or a couple of spots on the body.

2. Generalized – The patches of colour loss appear in many areas of the body.

3. Universal- Most of the original skin colour is gone. It is very rare.

Diagnosis.

Medical history.

Information about your past and current health may help your doctor confirm a diagnosis. Your doctor may also ask if you have been diagnosed with an autoimmune disease.

Physical Exam.

Your doctor performs a thorough physical exam to determine if vitiligo is affecting your skin and if so to identify the type.

Skin biopsy.

A skin biopsy can definitely tell the difference between missing melanocytes which indicates vitiligo and melanocytes that are malfunctioning for another reason. Vitiligo is diagnosed only if these pigment producing cells are missing.

Blood test.

Rarely, your doctor may recommend a blood test to get more information about possible autoimmune response related to vitiligo.

Treatment for vitiligo.

No medical treatment (use of cosmetics to camouflage lost colour).

Cosmetic include make up, self tanners and skin dyes. Often recommended for children because it avoids possible side effects from medicine.

Medicine applied to the skin.

The most commonly prescribed medicine is a potent or super potent corticosteroids that you apply to your skin. About 45% of patients regain at least some skin color after 4 – 6 months.

Light treatment.

Uses light to restore lost colour to the skin. Patients may sit in a light box or receive excimer laser treatment. About 70% see results with an excimer. Patients need 2- 3 treatments per week for several weeks. It may be combined with another treatment such as corticosteroids that apply to your skin.

PUVA light therapy.

This uses UVA light and a medicine called psoralen to restore skin colour. It may be applied to the skin or taken as a pill. About 50% to 75% effective in restoring pigment to face, trunk, upper arms and upper legs. 

Surgery. 

It involves removing skin with your natural colour or skin cells and replacing these where you need colour. Can be effective for 90% to 95% of patients.

Unconventional treatment.

Some vitamins, mineral, amino acids and enzymes have been reported to restore skin colour in people who have vitiligo. 

Most have not been studied, so there is no evidence to support these treatments and no knowledge of possible side effects.

Depigmentation.

It involves removal of remaining pigment from the skin. Very few patients opt for this treatment.

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