Vitiligo is characterized by stark-white skin patches that may cause a serious cosmetic problem. It results from the destruction and loss of melanocytes (pigment cells). This condition affects about 1 % of the U.S. population, usually people betWeen ages 10 and 30, with peak incidence around age 20.
There is no cure for vitiligo. The goal of treatment is to stop or slow the progression of depigmentation and, if you desire, attempt to return some color to your skin.
The cause of vitiligo is unknown. One theory implicates an autoimmune process that destroys existing melanocytes. Even at the periphery of lesions, melanocytes appear abnormal and in various stages of cell demise. Melanocytes may migrate from residual areas, such as hair follicles, and repigment lesions.
Other theories implicate enzymatic self-destructing mechanisms and abnormal neurogenic stimuli. Heredity may play a role: About 30% of patients with vitiligo have family members with the same condition.
Some link exists between vitiligo and several other disorders that it commonly accompanies: thyroid dysfunction, pernicious anemia, Addison's disease, aseptic meningitis, diabetes mellitus, photophobia, hearing defects, alopecia areata, and halo nevi.
The most common precipitating factor is a stressful physical or psychological event, such as severe sunburn, surgery, pregnancy, loss of a job, and bereavement. Chemical agents, such as phenols and catechols, may also cause this condition.
In fair-skinned patients, Wood's light examination in a darkened room is used to detect vitiliginous patches: Depigmented skin reflects the light; pigmented skin absorbs it.
Treatment to cure vitiligo
Repigmentation therapy combines systemic or topical psoralen compounds, or both, with exposure to sunlight or artificial ultraviolet A (UVA) light. New pigment rises from hair follicles and appears on the skin as small freckles, which gradually enlarge and coalesce. Body parts that contain few hair follicles (such as the fingertips) may resist this therapy.
Because psoralens and UVA affect the entire skin surface, systemic therapy enhances the contrast between normal skin, which turns darker than usual, and white, vitiliginous skin. The use of sunscreen on normal skin may minimize the contrast while preventing sunburn.
Depigmentation therapy is suggested for patients with vitiligo that affects more than 50% of the body surface. A cream containing 20% monobenzone permanently destroys melanocytes in unaffected skin areas and produces a uniform skin tone. This medication is applied initially to a small area of normal skin once daily to test for unfavorable reactions. If no such reactions occur, the patient begins applying the cream twice daily to those areas he wants to depigment first. Eventually, the entire skin may be depigmented to achieve a uniform color. Depigmentation is permanent and results in extreme photosensitivity.
Commercial cosmetics may help deemphasize vitiliginous skin. Some patients prefer dyes because they remain on the skin for several days.
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