Vitiligo

Symptoms Of Vitiligo

Vitiligo presents itself clinically as white spots on the body distributed symmetrically and more obvious in people with dark skin. Discoloration first shows on sun-exposed areas like hands, lips, arms, and face. Other symptoms include:

• Loss of skin color 

• Loss of color inside of your mouth and nose

• Change in color of the inner layer of the eyeball 

• Hyperpigmentation at the edges of the discolored patches on the skin

• White patchy lesions

• Development of vitiligo at specific trauma prone sites, like cut, burn, or abrasion

• Premature graying of the hair

Types Of Vitiligo

Vitiligo has 3 major types and they include:

1. Segmental vitiligo: Also called unilateral or localized vitiligo, it is an autoimmune disease. Segmental vitiligo affects one side of the body. It is generally seen in younger age groups, affecting about 30% of children diagnosed with vitiligo.

2. Non-segmental vitiligo: It is the most common type with 90% of cases. This is also an autoimmune disease which affects both sides of the body, most often appearing on sun-exposed parts like the face, neck, and hands.

3. Mixed vitiligo: This type is a convergence of both types of vitiligo, rare cases where segmental becomes non-segmental.

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Causes Of Vitiligo

Vitiligo occurs when the melanocytes (cells producing melanin, a pigment that gives color to eye skin and hair) die or stop functioning. The exact cause of vitiligo is unknown, though it is frequently associated with multiple autoimmune diseases. There are various theories and it is hypothesized that genetic factors can influence the age of onset of vitiligo.

Risk Factors For Vitiligo

Vitiligo is often related to autoimmune disorders, and your chances of developing vitiligo increase if you have the following risk factors:

Gender

Both sexes are equally affected, however, some studies report an increased risk for more extensive depigmentation in the female gender.

Family history

Vitiligo sometimes runs in families, but the inheritance pattern is complex because of multiple causative factors.

Immunotherapy

It is an option for treating melanoma(a type of skin cancer) that can lead to autoimmune side effects, including vitiligo-like depigmentation.

Autoimmune conditions

Studies show that vitiligo seems more common in people who have certain autoimmune diseases, like Addison's disease, pernicious anemia, psoriasis, rheumatoid arthritis, systemic lupus erythematosus (SLE), thyroid disease, and type 1 diabetes.

Sunburn

Research has shown that a history of a blistering sunburn may be associated with a higher risk of developing vitiligo in a population of white women.

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Stress

Studies suggest that environmental and psychological stressors are triggers for the onset and progression of vitiligo.

Industrial chemicals

Chemical triggering factors, both household and industrial (occupational) play a very significant role in the induction and propagation of vitiligo.

Viral infections

Vitiligo may be an example of an autoimmune disease triggered by a viral infection in an individual who is genetically susceptible.

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Diagnosis Of Vitiligo

The diagnosis of vitiligo is generally straightforward and does not usually require confirmatory laboratory tests. Diagnosis can be confirmed by the following:

Physical examination and medical history

The diagnosis of vitiligo is usually made on clinical features and the important while examining and taking past medical history must include:

• How long has the lesion been present

• Factors or events that may have caused the onset of vitiligo

• Are there any symptoms associated with the lesions

• How is the progression or spread of lesions

• Are there any changes in lesions over time

• Presence of any other diseases

• Current medications

• Occupational history or any exposure to chemicals or radiation

• Family history of vitiligo and other autoimmune diseases

Wood’s lamp test

The Wood's lamp is often used to diagnose skin disorders like melasma (patches and spots on the skin) and vitiligo. Under the Wood’s light, the vitiligo lesions emit a bright blue-white fluorescence and appear well demarcated.

Dermoscopy

It is useful in assessing the stage and disease activity of vitiligo. Typically vitiligo shows residual pigmentation and telangiectasia, which are usually absent in other hypopigmentation disorders.

Other tests

These are usually done to exclude other disorders. They include:

• Blood tests to check for other autoimmune conditions

• An eye exam to check for uveitis (inflammation of part of the eye)generally seen in individuals with vitiligo.

• A skin biopsy to examine the tissue for the missing melanocytes seen in the depigmented skin of a person with vitiligo.

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Prevention Of Vitiligo

Vitiligo isn’t preventable or curable as the exact cause for it is still not very clear. However, there are certain tips that can help prevent future depigmentation and return some amount of color to the skin by protecting your immune system and skin. They include:

Protect yourself from the sun

Sunburns can worsen vitiligo. You can protect your skin from the sun with the following. To protect your skin from the sun, follow these tips:

• Seek shade especially when you see a short shadow because the sun’s damaging rays are the strongest during that time

• Wear clothing that protects your skin from the sun

• Use a hat and clothing to protect your skin from vitiligo from the sun

• Use a sunscreen that best suits your skin every day when you go outside

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Try to avoid injuries

Skin injuries like cuts, scrapes, and burns can trigger new spots or patches. It is best to be careful and steer clear of anything that can cause an injury.

Stay away from artificial tanning

Never use a tanning bed or sun lamp and can burn skin that has lost pigment worsening vitiligo. If you want to add color to your skin, use camouflage makeup, self-tanner, or skin dye. 

Understand the risks of getting a tattoo

Tattoos can be tempting and seem like a nice alternative to cover up a light spot or patch but, a tattoo can wound your skin leading to the Koebner phenomenon, which causes new spots of vitiligo to develop where you injure your skin.

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Opt for a healthy lifestyle

Vitiligo is an autoimmune disease which means that your immune system is attacking healthy cells. Choosing a healthy lifestyle that consists of eating right, exercising regularly, managing your stress, and avoiding alcohol and cigarettes can take you a long way.

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Specialist To Visit

Vitiligo is a disease that causes the skin to lose color in patches. The doctors that can be your best option to treat and manage vitiligo are:

• Primary care provider

• Dermatologist

A primary care provider is a doctor that prevents, diagnoses, and treats diseases. A dermatologist focuses on disorders of the skin, nails, and hair.

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Treatment Of Vitiligo

There are various types of treatments available from topical medications to therapies that can help manage this condition and these include:

Medications

No medications or therapy can stop vitiligo, but there are certain drugs that when used alone or with light therapy, can help restore some skin tone. They include:

1. Corticosteroids: The main therapeutic effect of corticosteroids in vitiligo is modulation and inhibition of inflammation. Corticosteroids are also given orally with the main objective to suppress the immune response and stabilize the disease. The most commonly used corticosteroids are:

   1. Betamethasone

   2. Clobetasol

2. Calcineurin inhibitors: These are immunomodulators that inhibit inflammation. These are recommended for the head and neck areas as they have fewer side effects.

3. Vitamin D3 analogs: Vitamin D is an essential hormone synthesized in the skin and is responsible for skin pigmentation. Vitamin D analogs that are known to induce repigmentation in patients with vitiligo are:

   1. Calcipotriol

   2. Tacalcitol

4. Methotrexate: It decreases the number of T cells and has anti-inflammatory, and immunomodulatory effects.

5. Prostaglandin F2 alpha analogs: These are used for ocular hypertension that happens due to hyperpigmentation.

6. Statins: These are lipid-lowering drugs and their role in vitiligo is to provide anti-inflammatory and immunomodulatory effects.

7. Azathioprine: This is an immunosuppressant that inhibits DNA synthesis in immune effector cells.

8. Cyclosporine: Certain studies suggest cyclosporine leads to earlier disease stabilization in active vitiligo activity when given in low doses.

9. Tofacitinib: It is an arthritis drug that has shown some promising results in management of vitiligo.

Topical management

Topical formulations that are helpful for repigmentation of skin and with the least amount of side effects are:

• Methoxsalen

• Trioxsalen

• Psoralen

• Corticosteroids like 

  • Betamethasone

  • Valerate

  • Fluticasone propionate

• Triamcinolone

• Alobetasol

Phototherapy

It is a treatment done with a special type of light (not sunlight). Phototherapy for vitiligo uses UV-A and narrowband UV-B therapy, which constitutes the principal treatment modality for generalized vitiligo. Longer treatment duration, at least 6 months should be encouraged to enhance the treatment response. 

Recent advances

Vitiligo needs comprehensive treatment and the most recent advances to treat vitiligo are:

• Minocycline: Studies suggest that minocycline 100 mg helped in arresting disease activity.

• Afamelanotide: This a longer-acting synthetic analog of the alpha-melanocyte motivating hormone, has also shown promise in initial clinical studies.

• Surgical transplantation: A variety of cellular transplantation techniques have been investigated in vitiligo that have shown some promising results.

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Home-care For Vitiligo

There are many treatment options from creams, oral medicines, and ultraviolet treatment, to treat vitiligo and they totally depend upon the condition and response of the skin cells. There are certain effective natural home remedies used to treat vitiligo and they have no side effects, however, always consult your doctor before starting anything new. The natural ingredients that can be beneficial for vitiligo include:

• Mustard oil (Sarson ka tel): This is a very effective home remedy used to heal vitiligo. Make a paste with turmeric and mustard oil and apple for 20 mins the affected area. Turmeric along with mustard oil stimulates the pigmentation of the skin.

• Turmeric (Haldi): Turmeric has a lot of medicinal benefits and also acts as a home remedy to cure vitiligo disease. One can lower the effects of vitiligo by using turmeric.

• Honey (Shahad): It is a natural moisturizer filled with antioxidants and directly applying honey on the face gives it a much-needed boost of nutrition and moisture.

• Ginger (Adrak): This is the best home remedy to treat vitiligo and many other skin diseases. Drinking ginger juice twice a day can help heal vitiligo.

• Ghee: It has numerous benefits like blood purification, increasing immunity increases and aiding in skin-related problems.

• Black pepper (kali mirch): It is known for its benefits in skin problems and wrinkles. 

Note: One effective home remedy used to treat vitiligo is to heat 10 peppers in 10 gm of ghee. Then, remove the pepper and mix this ghee with normal ghee. Consuming this ghee regularly will purify the blood and improve immunity.

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Complications Of Vitiligo

Vitiligo can make one conscious about the way they look and can cause social stigmatization and mental stress. Other complications include:

• Eye involvement like iritis (swelling and irritation in the colored ring around your eye's pupil)

• Depigmentation of the skin making it more prone to sunburn, and skin cancer

• Loss of hearing due to melanocytes impairment in the inner ear 

• Skin degeneration after prolonged use of topical steroids.

Alternative Therapies For Vitiligo

The latest alternative or complementary therapies have proven to yield good results in treating vitiligo. Some of them include:

Depigmentation therapies

These refer to medical treatments that remove skin pigmentation. These therapies are generally recommended for extensive and refractory vitiligo, when >50% of the body surface is affected or if cosmetically sensitive areas are the major component involved.

Skin grafting

Studies have shown that skin grafting can be used in patients with acute and hard-to-heal chronic wounds, burns, and stable vitiligo. The use of advanced therapies may improve the quality of life, and accelerate the re-pigmentation of patients with vitiligo.

Suction blister grafting (SBG)

SBG is an easy and cost-effective method of repigmentation generally done to treat vitiligo at difficult sites like the angle of the lip. The quality of repigmentation matches accurately with the adjacent skin.

Micro-pigmentation

Also termed medical tattooing, micro-pigmentation can be used as an alternative treatment for patients with vitiligo who are resistant to conventional treatments. It involves implanting small particles of natural pigment under the skin just like a tattoo.

Living With Vitiligo

Vitiligo may not be a life-threatening disorder but the toll it can take on one’s mind and body can be massive. The human race has still not evolved on matters of appearance and the social stigma around the way one looks can be quite disturbing. Learning to accept your condition and adapt to it can help improve your quality of life. Here are a few things to keep in mind while living with vitiligo include:

Give mental health the utmost priority

If you feel depressed or self-conscious about changes to your appearance, talk to your dermatologist who might recommend counseling or a support group. Counseling can be helpful in coming to terms with these issues.

Learn more about your condition

Knowledge is power and knowing about treatment, what can worsen your vitiligo, and other facts can help you decide what’s right for you and can play an active role in your care, which can help you feel more in control.

Connect with other people with vitiligo

The emotional aspects of having vitiligo are often overlooked, but the struggle is real. Talking to others with the same condition can help you feel less alone and there's real power in supporting others, no matter the cause, and whether you're someone who lives with vitiligo yourself.

Eat the right kind of diet

Add vegetables, fruits, nuts, seeds, and spices that are all high in antioxidants. Foods high in omega-3 (but lower in omega-6) could also help improve your symptoms. These include oily fish, nuts, seeds, and algae. Also, try a gluten-free diet as gluten can worsen inflammation, and add fiber and probiotics to your diet.

Note: Avoid inflammatory foods like processed meats, sugary drinks, trans fats, and processed snack foods.

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Take supplements 

Although it is considered preferable to consume nutrients through whole foods, there are certain supplements that can aid repigmentation in vitiligo patients. These include:

• Ginkgo biloba

• Alpha lipoic acid

• Vitamin C

• Vitamin E

• Vitamin D

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Vitiligo in kids: Tips for parents

Children usually cope best with vitiligo better and your own over-consciousness as a parent may create more problems for your child than the actual vitiligo. Here are a few things to keep in mind:

• Let your child know that vitiligo is not a serious skin problem

• Teach your child how to answer this/her friends, teachers, and relatives, if they inquire about vitiligo

• Communicate with close relatives, informing them about vitiligo and requesting them not to discuss it with your child

• Avoid discussing your child’s vitiligo repeatedly

• Examine the spots when your child is asleep

• Encourage your child to engage in any activities or hobbies that he/she loves

• Do not allow vitiligo to interfere with your child’s joy and self-esteem

• Help your child boost his/her self-confidence.