Vitiligo

Vitiligo (Dutch: Vitiligo, [vɪˈtiligɔ]) is a long-term condition causing depigmentation of the skin, mucous membranes, and hair. This leads to well-defined white patches on various parts of the body. It can be localized or generalized. While it does not lead to other health problems, psychosocial complications may occur as a result of the cosmetic impact.

Etymology

The term "vitiligo" comes from the Latin word vitium, meaning "defect," and the Greek word leukós, meaning "white." The condition was first described in the Western world by the Roman physician Aulus Cornelius Celsus around 25 BCE.

Signs and symptoms

The primary symptom of vitiligo is the appearance of pale, milky white, smooth, round or oval macules or patches on the skin. The affected area can be flat or slightly raised and its border may be sharp or irregular. The patches are typically symmetrically distributed and they can appear anywhere on the body, although some areas are more commonly involved than others (such as hands, feet, arms, and face).

Other possible symptoms include premature greying or whitening of the hair in the affected areas, depigmentation of the inner part of the eyebrow or eyelash, loss of color in the mucous membranes lining the inside of the mouth and nose, and depigmentation of the tissue lining the vagina or scrotum. In some cases, vitiligo may also affect the pigmentation of nail beds.

Risk factors

Vitiligo occurs equally in men and women and at all ages, including children. The exact cause is unknown, but several factors are thought to contribute to its development:

Diagnosis

Diagnosing vitiligo is usually straightforward based on its characteristic appearance and patient history. Wood's lamp examination is useful for detecting early or subtle lesions and may help rule out other conditions with similar presentations such as pityriasis alba or tinea versicolor. Laboratory tests are rarely required unless other conditions need to be ruled out or if the patient also has signs of an autoimmune disorder. Skin biopsy may be done when there is doubt about the diagnosis or when monitoring disease activity over time.

Treatment

There is currently no cure for vitiligo; however, several treatments are available to improve skin color match and manage associated psychological effects. A combination approach often yields better results than single therapy alone:

1. Skin Care: Regular sunscreen application helps protect against further damage from UV light exposure and prevents darker surrounding skin from appearing more contrasted with depigmented areas. Moisturizers may also reduce itching and prevent dryness caused by sunscreens.
2. Corticosteroids: Topical corticosteroids can help repigment affected skin in some cases when applied consistently over extended periods (months to years). Potent topical steroids should be used under professional supervision due to potential side effects such as thinning of the skin and increased risk of infection.
3. Calcineurin inhibitors: Tacrolimus ointment and pimecrolimus cream can be alternatives for patients who cannot tolerate steroids or those with autoimmune disorders since they have fewer side effects than topical steroids. However, these medications can still cause itching and burning sensations in some individuals.
4. Phototherapy: Two types of phototherapy - narrowband ultraviolet B (UVB) phototherapy and PUVA therapy (psoralens combined with UVA) - have been found to be effective in repigmenting vitiligo patches when used multiple times a week over several months to years. The advantage of phototherapy is that it selectively affects melanocytes without systemic side effects like corticosteroids do. However, it requires regular attendance at dermatology clinics and can cause adverse effects such as skin redness, burning sensation, blistering, and increased sensitivity to sunlight. Sun protection measures are essential after treatment discontinuation to minimize recurrence.
5. Laser treatment: Q-switched lasers (e.g., carbon dioxide laser, pulsed dye laser) target depigmented cells through selective photothermolysis, resulting in their fragmentation and gradual removal over time. Multiple sessions are needed for optimal outcomes, which take several weeks to months to become apparent. Side effects include temporary hyperpigmentation, hypopigmentation, scarring, and pain during treatment sessions. These therapies should ideally be performed by experienced practitioners as improper use can lead to unwanted consequences like worsening vitiligo or scarring.
6. Hay Cura para el vitiligo: Hay Cura ("Healing Cure" in Spanish) is a homeopathic remedy popular in Mexico made from tea tree oil extract. Studies on its effectiveness for treating vitiligo are limited and inconsistent; therefore, it should not be considered a proven treatment option at this time based on current evidence.
7. Vitiligo Ointment: Various commercial creams advertised as "vitiligo ointments" contain ingredients such as betakonialdehyde, hydroquinone, kojic acid, niacinamide, soy protein extracts, licorice root extracts, methyl nicotinate esters, cysteamine bitartrate, phytono vegetal garcinia cambogia extracts etc., claimed to promote melanin production or inhibit melanocyte destruction in the hope of repigmenting affected areas. There is limited scientific support for many of these ingredients' efficacy; therefore caution should be exercised when choosing products to treat vitiligo without consulting a dermatologist first. Regular follow-up visits with healthcare providers are important for monitoring treatment progression and adjusting therapies as needed while minimizing risks associated with prolonged use of topical medications.
8. Supportive Measures: Emotional support for dealing with psychosocial challenges related to vitiligo is essential for maintaining quality of life during treatment courses and beyond. Support groups provide valuable resources for sharing experiences, coping strategies, and knowledge about available therapies among those affected by vitiligo worldwide. In addition, counseling services may prove beneficial for individuals experiencing self-esteem issues related to their condition to develop more positive self-images over time..

Prognosis

The course of vitiligo varies widely among affected individuals; some people see minimal spread over time while others experience rapid progression leading to complete loss of pigmentation in widespread areas of the body (segmental vitiligo). Repigmentation also varies significantly between cases: some spontaneously repigment without any intervention; others show gradual repigmentation following topical medication use or phototherapy treatments; some never regain lost pigment despite exhaustive efforts at treatment over extended periods (stable vitiligo). Nevertheless, successful outcomes are possible even after decades living with the condition when appropriate management strategies are employed under medical guidance tailored to individual needs and circumstances..