“Vitiligo in Latin means defect or blemish. Vitiligo can occur at any age but most commonly occurs in people between 10-30 years old. This autoimmune condition is manifested by the appearance of white spots and plaques on various parts of the body, such as the hands, feet, armpits, around the mouth, eyes and genitals, as well as at sites of skin trauma from various causes (Koebner effect)”, explains Dr. Amalia Tsiatoura.
Causes
Vitiligo, or “light sickness” is a fairly common dermatological condition and is more common in countries with intense sunlight. It affects 1-2% of the population worldwide, with the most common age of onset being around 20 years. But at what age does vitiligo appear? The age of onset of vitiligo varies and many times vitiligo starts in childhood affecting the psychology and self-esteem of children. The first symptoms of vitiligo are skin discoloration or white spots, which lack the melanin pigment.
Autoimmune diseases, such as vitiligo, are diseases in which the body itself attacks its own tissues and organs. In the case of vitiligo, the body itself attacks certain melanin cells in the body and causes a disruption in the secretion of melanin, resulting in the appearance of white marks or hairs. The causes of an autoimmune disease vary, but have been shown to be mainly due to bacteria, toxins, and environmental or psychological factors. In individuals predisposed to vitiligo, the chances increase when the individual has an increased immune system response to physiological stimuli. In addition, it has been observed that vitiligo is a multifactorial disease, as its occurrence is due to a multitude of factors.
The most recent theory on the causes of vitiligo is that the immune system is the most important. In particular, as has been shown in other autoimmune diseases, mutations in immune system genes have been observed, which are thought to cause the destruction of melanocytes in the skin.
Types
Vitiligo
Depending on how it appears, Vitiligo is divided into localized, segmental and generalized. It is usually diagnosed clinically. Biopsy may be necessary in case of differential diagnosis from other conditions causing hypochromia such as post-inflammatory hypopigmentation, spongiform mycosis and dandruff.
The most widespread classification of vitiligo distinguishes it into segmental vitiligo (SV) and non-segmental vitiligo (NSV). The most common type of vitiligo is non-segmental vitiligo. In this case, symmetry of the discoloured plaques is usually observed and the appearance of new lesions over time cannot be excluded. Non-segmental vitiligo may occur over large parts of the body or remain in a specific area. There is no general rule for its occurrence, as it can be seen at any age. Unlike non-segmental vitiligo, segmental vitiligo is localised to a specific part of the body and is usually age-exclusive, as it occurs mainly during the teenage years. Its spread is much more rapid than that of non-segmental vitiligo. Due to the differences between these two categories, their treatment differs considerably.
Non-segmental vitiligo is divided into the following categories:
- Generalized vitiligo: this is the most common category of non-segmental vitiligo.
- Universal vitiligo: has a high percentage of discoloration.
- Focal vitiligo: characterized by a few scattered white spots concentrated in one area. It usually occurs during childhood.
- Acrofacial vitiligo: the most common areas of occurrence are the toes and hands, as well as the face and neck area.
- Mucosal vitiligo: discoloration of the skin is observed only in the mucous membrane area.
Symptoms
Vitiligo
The fact that vitiligo is an autoimmune disease makes it difficult to diagnose and also to identify the factor responsible for the appearance of vitiligo. Vitiligo spots appear mainly on sun-exposed areas such as the face, lips, hands and feet. The initial stage of vitiligo is usually characterized by a plaque often on the abdomen and in some cases, it appears with the symptoms of itching or hyperhidrosis. Several times vitiligo also appears on the hair and hair follicles.
Apart from the appearance of the characteristic white marks, some patients may also suffer from symptoms of itching or severe pain at the site of the vitiligo. However, these cases are rare and for the most part, patients with vitiligo feel completely healthy and have no other symptoms.
- The progression of vitiligo is unpredictable, as it can either spread or cure itself, or in many cases remain stable. Usually, the achromatic spots of Vitiligo gradually increase in size and lead to a significant aesthetic problem, especially in people with darker skin. The first symptoms of vitiligo appear after the body’s own attack on its melanin cells, the cells responsible for hair and skin colour, which makes it an autoimmune disease. The onset of the disease is often associated with thyroid and other autoimmune diseases and may be linked to a form of heredity.
- When vitiligo occurs extensively and in fairly prominent areas, it can cause significant self-confidence problems in individuals and lead to aesthetic and psychological problems. Many cases have been reported where patients have stated that they feel ashamed and have difficulty forming relationships. For this reason, although vitiligo does not pose any risk to the individual, treatment is recommended.
- The time that vitiligo will appears depends largely on the skin colour of the patient. People with fair skin colour notice the first symptoms of vitiligo during the summer months, while in people with darker skin the initial stage of vitiligo can become visible at any time of the year. It has also been shown that the appearance of vitiligo also depends on the age of the person. Most patients will develop vitiligo quite young, with the most common age of onset being 20 years.
- At the same time, the appearance of vitiligo is sometimes associated with the presence of other diseases, such as thyroid disease (hyperthyroidism, hypothyroidism or Hashimoto’s thyroiditis), as well as with the presence of rheumatoid arthritis or pollen alopecia. Although no one wants to develop a disease, the appearance of vitiligo has a positive side. Patients who suffer from vitiligo are significantly less likely to develop skin cancer, and more specifically melanoma, because the melanin cells are eliminated in the achromatic plaques.
Treatment
Quite often people who develop vitiligo are unaware of its importance and do not know how it can be treated. The treatment of Vitiligo should be individualized according to the patient, taking into account the benefit of the treatment in relation to the possible side effects of each of them. The results of the treatments available to date vary and it is not possible to guarantee complete recoloration of the area. The methods available for the treatment of Vitiligo are the following:
Phototherapy with UVB ultraviolet rays – Bathwater PUVA
It is mainly applied in extreme cases of vitiligo and offers a recoloration rate of more than 70% in patients with recent onset or localized disease. It is considered a second-line treatment. Phototherapy should be repeated 2-3 times a week. It can be used alone or in combination with another treatment, although it has been shown to enhance re-pigmentation when combined with other topical treatments. UVB phototherapy is devoid of the side effects that can be caused by other forms of phototherapy.
Treatment with Laser Excimer
Effective in stable lesions of small size that occupy less than 30% of the total body surface. It is the most revolutionary treatment for the fight against vitiligo. By using Laser Excimer, localized treatment of discolored skin can be achieved, leaving the adjacent skin surface intact. It can be combined with topical preparations, as well as with short term oral medication.
Topical Corticosteroids
It is the most commonly used method and it offers moderate effectiveness. Their use should be avoided in areas around the eyes. They are the first-line treatment.
Topical use of calcineurin inhibitors
Alternative effective treatment, particularly when lesions are located on the head and neck. Can be combined with Laser Excimer or NB-UVB treatment.
Topical use of Vitamin D analogues
Suppress the immune system, through action on lymphocytes. Can be combined with NB-UVB or PUVA therapy.
Systemic Corticosteroids
Long-term treatment is required with several side effects.
Discoloration of healthy skin
In special cases where the healthy areas occupy a small area, skin uniformity with discoloration of the healthy skin may occur. This treatment is recommended in very special and rare cases. It is usually carried out by topical application of skin-discoloring drugs. A period of one year is required to complete the discoloration.
Recolouring
Recoloring of the lesions of vitiligo takes place. The results of this treatment are questionable, as the vitiligo may recur.
Surgical Treatments
In well-localized lesions and if the disease is stabilized and has not spread for at least 2 years. Surgical treatment of vitiligo is indicated for people to whom other methods have been unsuccessful. During this method, skin and skin cells are removed from a healthy area of the patient and transplanted into the desired affected area.
Use of local covering creams
It is not a cure, but it can cover the signs of vitiligo that lead to the person feeling low self-confidence.
Use of Drugs effective for rheumatoid arthritis
In some cases, it has been shown effective to treat vitiligo traditionally with a drug that is widely used to treat rheumatoid arthritis. It can lead to partial restoration of the color, but without having proven results. The reason why a rheumatoid drug may be particularly effective in treating vitiligo as well is that both diseases are among the autoimmune diseases, so some of their mechanisms may be similar.
Treatment
Vitiligo
For the strategic treatment of vitiligo there are some principles that have been proposed by the medical community.
For the treatment of segmental vitiligo, it is recommended:
- First-line treatment: involves avoiding factors that may activate mechanisms that stimulate the development of vitiligo. First-line treatment includes the topical use of corticosteroids.
- Second-line treatment: involves the treatment of vitiligo using ultraviolet radiation, such as the Excimer Laser.
- Third-line treatment: this treatment refers to patients with unsatisfactory results from first- or second-line treatment.
For the treatment of non-segmental vitiligo, it is recommended:
- First-line treatment: avoidance of factors that may stimulate the development of vitiligo and use of Laser Excimer for at least 3 months.
- Second-line treatment: for patients in whom vitiligo is progressing rapidly.
- Third-line treatment: this is the treatment of vitiligo by surgical grafting in areas that do not respond to first- or second-line treatment.
- Fourth-line treatment: this is the treatment of extensive vitiligo, i.e. where white patches cover more than 50% of the body surface.
FAQ
Vitiligo
How can I stop the spread of Vitiligo?
In order to protect and prevent the spread of vitiligo white areas, it is necessary to avoid injuries, to avoid the appearance of new lesions, as well as follow a regular use of sunscreen, both to protect the white areas due to the lack of melanin, and to protect the normal skin from burns in the territory of which it is possible to develop new Vitiligo lesions.
Is Vitiligo contagious?
Vitiligo is not an infectious or contagious disease, so it is not transmitted through physical contact or body fluids from the affected person to other healthy people.
Is Vitiligo hereditary?
While there is a greater chance of a child developing vitiligo if the gene responsible for its occurrence is present in the family history, vitiligo is not considered as an inherited disease.
Is Vitiligo associated with stress?
Although it is not the main cause of vitiligo, it has been shown that intense anxiety and stress, as well as intense emotional events in everyday life (e.g. loss, bereavement, disappointment), can lead to the development of vitiligo.
Why should I choose Cosmetic Derma Medicine for the treatment of Vitiligo?
Cosmetic Derma Medicine Medical Group is the largest and most specialized medical group with 16 clinics in Greece & Cyprus, and more than 15 years of experience in the field of Dermatology & Plastic Surgery.
The Medical Director of Cosmetic Derma Medicine is the Dermatologist – Venereologist Dr. Amalia Tsiatoura, trained in Colorado, USA, while the staff consists of a medical team of highly experienced and specialized doctors of many different specialties, as well as a fully trained team of nurses. Our team is by your side every day, 24/7 for whatever you need.