Vitiligo

What is Vitiligo?

Vitiligo is a chronic skin disease characterized by a loss of skin pigmentation resulting in spots and patches of lighter skin. It affects people of all colors and affects each person differently. It can begin at an early age. It is not contagious, but can negatively impact self-esteem, self-confidence and quality of life. There is no cure, but treatment can help restore lost skin color. Studies report that gaining an even skin tone can significantly improve mental and physical well-being.

What are the symptoms?

The most noticeable symptom of vitiligo is the appearance of depigmented or white patches on the skin. These patches can vary in size and shape and often occur on areas exposed to the sun, such as the face, hands, arms, feet, and lips. Vitiligo can also affect other parts of the body, including the eyes, mouth, and hair.

What is the course of the disease?

The course of the disease begins with a few small patches of lighter skin that may stay the same size or grow larger over years. New patches can appear and may be close to existing patches or in another area.

There are several types.

• When the spots develop in one area or in a few places on the body, it is called localized vitiligo.
• If a person loses most of their skin color, it is called universal vitiligo.
• When it causes scattered patches of color loss on different areas of the body it is called generalized vitiligo.
• When patches appear on both sides of the body, both hands, both knees, etc., it is called non-segmental vitiligo. This is the most common type and typically spreads slowly over the course of a lifetime.
• When patches rapidly appear on one side of the body or on one part of the body, the disease tends to stabilize after six to twelve months. Once it stops then no new patches or spots develop. This is called segmental vitiligo.

What is the prognosis?

There is no way to predict how much skin will lose color or whether a person will develop new patches or enlarged patches. However, Dr. Rains can help reduce the spread and possibly even restore your natural skin tone.

What causes vitiligo?

Vitiligo occurs when melanocytes, the cells responsible for producing melanin (the pigment that gives color to the skin, hair, and eyes), are destroyed or stop functioning. Vitiligo is an autoimmune disease which means your immune system is attacking healthy cells in your body. When this happens the melanocytes are attacked, and destroyed, causing the skin to look milky-white. There may also be a genetic component.

How is it diagnosed?

Dr. Rains will review your medical and family history and perform a thorough physical exam. He may use a special lamp called a Wood’s lamp to help him see the affected skin more clearly. Sometimes he may take a skin biopsy and/or blood tests to rule out other conditions or to confirm the diagnosis. Further, because vitiligo is an autoimmune disease, he may order other blood tests to identify other autoimmune diseases you may have.

What are the treatment options?

People with vitiligo have options. Some may choose to live with their appearance, others may choose to use makeup, skin dye and self-tanners. Dr. Rains will create a treatment plan for you with the goals of restoring lost skin color, stopping patches and spots from enlarging, and preventing new spots. It is important to understand that treatments can take time.

Treatment options include:

• Short – term corticosteroids. These work best for people with recently developed vitiligo.
• Tacrolimus ointment or cream. This is best to restore lost color on the head and neck. A common side effect is a burning sensation when the medicine is applied. This drug is used to manage autoimmune conditions by suppressing the immune system.
• A new type of medication called a JAK inhibitor helps to restore lost skin color in people with vitiligo.
• Phototherapy (using UV light). This works by exposing your skin to a type of UV light that can restore your natural skin color. It works best on the face and neck.
• Surgery can help restore skin color but is usually a last resort. It may involve a skin graft or cell transplants.
• People with vitiligo are often more susceptible to sunburn and skin cancer on the depigmented areas. Therefore, it’s essential for individuals with vitiligo to use sunscreen and protective clothing when exposed to the sun.
• Psychological Impact. Vitiligo can have a significant psychological impact on individuals, as it may affect their self-esteem and body image. Support from healthcare professionals and support groups can be beneficial in managing the emotional aspects of the condition.

Dr. Michael Rains is a board-certified dermatologist and the founder of Beacon Dermatology in Asheville, North Carolina. His approach to aesthetic and dermatological treatments are holistically focused on revealing and enhancing a patient’s natural beauty. Dr. Rains is known for his caring and compassionate approach to medicine, listening to his patients’ concerns and goals and ensuring they receive excellent care and education to ensure they can make informed decisions about their treatments.