Vitiligo – causes, types, symptoms, prognosis. How To Treat Vitiligo?

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Vitiligo is a skin disease in which discoloration appears on the skin of a sick person. Affected areas of skin usually enlarge over time. The condition can affect the skin on any part of the body and usually starts in the hands, forearms, feet, and face. It can also affect the hair and the inside of the mouth. Vitiligo affects people of all skin types, but may be more noticeable in people with darker complexions. The condition is not life threatening or contagious, although it may be inherited depending on the type. It is estimated that around 1% of the world’s population has albinism.

Areas of discoloration can develop anywhere on the body, including:

1. in areas exposed to sunlight, such as the hands, feet, arms and face;
2. inside the mouth or other mucous membranes;
3. in the nostrils;
4. on the eyes (the irises of the eye turn pink, red or light blue);
5. on the genitals;
6. within the ear.

If there is hair in a particular area of ​​the skin, it may also turn gray or white.

Although vitiligo can affect many different parts of the body, it is not contagious.

See also: The seven worst skin diseases

On the other hand, when we talk about congenital vitiligo, the patient has almost completely white hair, eyebrows and eyelashes (as we age, the hair color may slowly darken), blue eyes (a low level of melanin in the iris means that the eyes may appear slightly translucent, and in certain light, they can appear red or pink because the light is reflecting off the retina) and very pale skin. Other symptoms include visual impairment (e.g. myopia, total or partial blindness, nystagmus, strabismus), hearing impairment, skin keratosis, or hypersensitivity to sunlight (the lack of pigment prevents the iris from being completely blocked by sunlight, thanks to which the person is sensitive to light).

See also: Eye color has to do with skin conditions

Vitiligo – types

There are two main types of vitiligo in terms of vitiligo.

1. Congenital albinism (called albinism) results from changes in genes that result in a deficiency of the enzyme tyrosinase, which in turn leads to a deficiency of melanin. The lack of dye is manifested not only by very pale skin, but also by light eyes and hair. Congenital albinism is rare and is thought to occur once in 10 births.
2. Vitiligo (vitiligo) results from the action of the body’s antibodies, which are mistakenly directed towards the melanocytes, which in turn are destroyed. It occurs at some point in life, regardless of age, usually before the age of 20 in men and women, it also happens in children, and affects 1-2% of the world’s population.

In addition to this major division, vitiligo can be classified according to the range of symptoms:

1. generalized congenital albinism, which covers more than 80% of the skin, is also characterized by photophobia and changes in the retina;
2. partial congenital albinismSymptoms may be limited along the nerves; spots do not appear on the hands and feet;
3. generalized vitiligowhere more than 80% of the skin is dye-free – spots also appear on the face and limbs;
4. partial vitiligowhere lesions have a narrow range, they may be limited to only 1 or 2 spots in different places of the body.

There are several different types of congenital vitiligo. Pigmentation levels vary depending on the type of albinism. The different types of congenital vitiligo include:

1. Oculocutaneous albinism (Oculocutaneous albinism): Oculocutaneous albinism, or OCA, is the most common type of albinism. People with OCA have extremely light hair, skin, and eyes. There are seven different OCA subtypes, caused by mutations in one of the seven genes (OCA1 to OCA7).
2. Ocular albinism (Ocular albinism): Ocular albinism, or OA, is much less common than OCA. Ocular albinism affects only the eyes. People with osteoarthritis usually have blue eyes. Sometimes the irises (the colored part of the eyes) are very pale so the eyes may appear red or pink. This is because the blood vessels in the eyes show through the irises. The color of the skin and hair is usually normal.
3. Hermanski and Pudlak’s team: Hermanski-Pudlak Syndrome or HPS is a type of albinism that includes a form of OCA along with blood disorders, bruising problems, and lung, kidney, or bowel disease.
4. Chediak-Higashi syndrome: Chediak-Higashi syndrome is a type of albinism that involves a form of OCA and immune and neurological problems.

Several genes related to vitiligo are also linked to other autoimmune diseases, such as rheumatoid arthritis, type 1 diabetes, and thyroid disease. About 1 in 4 people with vitiligo are thought to have another autoimmune disease.

Scientists have found that having a specific genetic profile makes people more likely to develop vitiligo. Nearly 50 genes associated with Vitiligo have been identified, including two known as NLRP1 and PTPN22. These and other genes currently associated with vitiligo are known to be involved in the regulation of the immune system and inflammation.

Vitiligo appears to be the result of both a pre-existing genetic makeup and something in the environment triggering an autoimmune response that destroys melanocytes. Potential triggers include sunburn, exposure to certain chemicals, and trauma or damage to the skin. These triggers can also induce Vitiligo to spread in people who already have the condition.

Congenital albinism, or albinism, is an inherited disorder that occurs from birth. Children have a chance to be born with vitiligo if both of their parents have albinism or both parents are carriers of the albinism gene. The cause of vitiligo is a defect in one of several genes that produce or distribute melanin, the pigment that gives color to the skin, eyes, and hair. The defect may result in a lack of melanin production or a reduction in melanin production.

For most types of congenital vitiligo, both parents must carry the gene for their child to develop the disease. Most people with albinism have parents who only carry the gene and have no symptoms of the disease. Other types of albinism, including those that affect only the eyes, most commonly occur when the mother passes the albinism gene to the boy.

See also: New genes related to vitiligo have been discovered

Vitiligo – diagnosis

Albinism (congenital albinism) is usually seen by the baby’s appearance at birth. Your child’s hair, skin, and eyes may be examined for signs of lack of pigment.

Since congenital vitiligo can cause a number of eye problems, your child may be referred to an ophthalmologist for examination. Electrodiagnostic tests are also sometimes used to diagnose vitiligo. This is where small electrodes are taped to the scalp to examine the connections between the eyes and the part of the brain that controls vision.

Genetic testing is a reliable way to diagnose vitiligo. However, they are expensive and doctors do not consider them necessary in families with a history of albinism.

In the case of vitiligo, during the visit, the doctor will conduct a medical examination, ask about the patient’s medical history and conduct laboratory tests.

Be sure to report anything that may be a contributing factor, such as recent sunburn, premature graying of your hair, or any autoimmune conditions. You should also tell your doctor if someone in your family has vitiligo or any other skin disease.

Other questions your doctor may ask include:

1. where on the body did the changes begin?
2. does anyone in your family have albinism?
3. does anyone in your family have an autoimmune disease?
4. have we tried any treatments yet?
5. Are any areas of the body improving or deteriorating?

A popular tool in the diagnosis of vitiligo is an ultraviolet lamp. I am talking here more specifically about the so-called Wood’s lamp, which helps the doctor find the difference between vitiligo and other skin conditions.

Sometimes, your doctor may also want to take a skin sample, that is, perform a biopsy. The lab will look at these samples. Skin biopsies can show whether a patient still has pigment-producing cells in a particular area of ​​the body. In turn, blood tests can help diagnose other problems that may accompany vitiligo, such as thyroid disease, type 1 diabetes or anemia.

Also check: What do our genes say about us?

People with albinism must take care of proper eye care, including:

1. use prescription glasses;
2. use dark glasses to protect your eyes from the sun;
3. cover the body with sunscreen;
4. wear a hat;
5. regularly check your eyes.

Surgery to the optic muscle can sometimes minimize the “tremor” that occurs in nystagmus. Procedures to minimize strabismus may make it less noticeable, but surgery does not improve vision. The level of effectiveness in reducing symptoms varies from person to person.

Patients should carefully observe their skin for any changes and use sunscreen to protect it.

In the case of vitiligo, treatments are aimed at restoring the skin’s color balance. Some of them are designed to add pigment while others remove it. Treatment will vary depending on:

1. the severity of the patient’s condition;
2. the location and size of the discoloration;
3. the amount of discoloration (spots on the skin);
4. response to treatment.

For vitiligo, medical treatments, surgery, or a combination of both may be used. However, not all treatments work for everyone, and some may have unwanted side effects. Always see your doctor if you start to get side effects from the treatment. Professionals can adjust the dose or provide alternatives.

Medical treatments usually last a minimum of 3 months and include the following possible options.

1. Topical creams. Certain creams, including corticosteroids and calcineurin inhibitors (anti-inflammatory creams), can help restore the color of white discoloration in the early stages. Others help slow the growth of discoloration. The patient will need a prescription for creams that are strong enough but can also cause side effects when used for a long time. Side effects can include skin atrophy, thinning, excess hair growth, and skin irritation.
2. Oral medications. Certain medications, such as steroids, can be effective in treating vitiligo. They are available only by prescription.
3. PUVA irradiation. This combination of treatments requires the patient to take psoralen orally or apply it to the skin in the form of a cream. The doctor then exposes the patient to UVA light to activate medications that help restore the skin tone. Subsequently, the patient must minimize sun exposure and wear goggles. PUVA has side effects that can include sunburn, nausea, itching, and discoloration.
4. Narrowband ultraviolet B light therapy. It is an alternative to traditional PUVA therapy. This treatment provides a more focused light therapy, often leading to fewer side effects. It can also be used as part of a home treatment program under medical supervision.
5. Laser Excimerowy. This treatment helps with small areas of skin and takes less than 4 months, two to three times a week.
6. Depigmentation. The doctor may recommend depigmentation if the disease has affected more than 50 percent of the body and the patient wants to balance the skin color. This is often the solution when skin pigment-restoring treatments have failed. Depigmentation focuses on fading the rest of the skin to fit areas that have lost their color. Drugs such as monobenzone are used as prescribed by your doctor. Although this may take up to 2 years, treatment is usually permanent. In addition to causing inflammation, it can also increase your sensitivity to sunlight.

Surgery is used when medications and light therapy are not working. Your doctor may recommend surgical options if your skin patches are stable and if your vitiligo was not caused by sunlight. Surgical procedures include three main procedures.

1. Skin transplant. The surgeon transfers healthy, pigmented skin to pigment-free areas. Risks include infection, scarring, or lack of re-pigmentation.
2. Melanocyte transplants. The doctor removes a sample of healthy tissue, grows the melanocytes, and then transplant the cells into the discolored areas.
3. Micropigmentation. The doctor will tattoo the pigment on your skin. This is best for the lip area, but skin color matching can be difficult.

Due to the fact that sometimes it takes a long time to see the effects of treatment, the patient may also consider other methods.

1. Sunscreen cream. Limiting your exposure to the sun can help maintain an even skin color. Sunbathing will add contrast to the skin, making the vitiligo-affected areas more visible. It is important to use sunscreen with a high SPF as non-pigmented areas are prone to sun damage.
2. Cosmetics. Make-up lotions or self-tanners can help even out your skin tone. Self-tanning lotions may be preferred as the effect lasts longer, even after bathing.
3. Mental health management. Some studies suggest that medications and psychotherapy can improve quality of life. If you are experiencing negative mental health effects, speak to your doctor.

See also: What are the types of psychotherapy? Indications for a visit to a psychotherapist [WE EXPLAIN]

Vitiligo – complications

The most common physical problems associated with vitiligo are sunburn and skin cancers. Part of this is because skin with no natural color is more prone to sunburn. The function of melanin (the pigment that gives the skin color that is missing in patches of skin in people with vitiligo) is to help block some of the dangerous ultraviolet rays, making skin without it more susceptible to sun damage. However, sun protection is also important because avoiding a tan can make vitiligo spots less noticeable and some vitiligo treatments can be disrupted by sun exposure.

Since the skin in areas affected by vitiligo can burn more easily, it may be surprising that instead of increasing the risk of skin cancer, there is a lower risk of vitiligo. A study from the University of Amsterdam published in the British Journal of Dermatology found a three-fold lower risk of melanoma and non-melanoma skin cancer in people with vitiligo compared to people without it.

There are several theories as to why this is so. The same genes associated with vitiligo may also lower the risk of malignant melanoma; the second theory is that whatever causes the immune system to destroy melanocytes, it also causes it to destroy cancer cells. This is good news for people with vitiligo, but it doesn’t mean that they should rely on their condition to give them absolute protection from the effects of the sun.

Vision problems in people with vitiligo can also limit a person’s job opportunities and ability to obtain a driver’s license. In addition, the person may have reading difficulties which lead to learning delays.

About a quarter of vitiligo patients have another autoimmune disease. Therefore, it is important to discuss any new or unusual health problems we are experiencing with your primary care physician. Some of the most common autoimmune diseases associated with vitiligo: autoimmune thyroid disease, rheumatoid arthritis, type 1 diabetes, psoriasis, pernicious anemia, systemic lupus erythematosus.

Vitiligo sufferers may face serious social problems such as social discrimination and stigmatization at school or in the workplace because they look different. And it can be difficult for children and teens to cope with changes among other changes in their bodies, minds, and emotions – especially if their peers do not understand or react sensitively to what is happening. For many, learning to deal with vitiligo means finding someone to talk to about the experience, whether it’s a trusted doctor, close family members and friends, or a mental health professional. These social factors can lead to stress, low self-esteem and isolation.

Interestingly, in some African countries some people believe that having sex with a woman with vitiligo heals AIDS. This false belief has led to murders, rape, and additional HIV infections. In 2015, the United Nations called for ‘urgent’ measures to prevent attacks against people with albinism.

See also: Self-esteem – how to understand this term and what to do to raise it?

Vitiligo – prevention

Congenital albinism is an inherited disorder. People with a family history of albinism should consider genetic counseling.

Since it is not known exactly what causes vitiligo, no one can tell you how to prevent it. In general, it is wise for everyone to follow habits of being safe in the sun and caring for their skin.

Also check: Basics of genetic diseases

Most people with albinism live a normal life. People with Hermanski-Pudlak syndrome and Chediak-Higashi syndrome are at increased risk of shortened life time due to associated conditions.

Bielactwo – dieta

According to some, people with this genetic condition may lack healthy levels of certain nutrients. However, there is no evidence that eating certain foods can improve or worsen their condition.

Despite this lack of evidence, some say they have been successful with a variety of home remedies. Popular topical home remedies include:

1. a mixture of lemon extract and sweet basil;
2. ginkgo biloba paste;
3. a mixture of turmeric and mustard oil.

While there is no officially prescribed diet for vitiligo, the best nutritional steps you can take include eating a healthy diet full of good nutrients and drinking plenty of water. As with any autoimmune disorder, you can benefit from immune-boosting foods that contain phytochemicals, beta-carotene, and antioxidants.

Here are some foods that people with vitiligo have listed as helpful for their condition:

1. bananas;
2. apples;
3. leafy greens such as kale or romaine lettuce;
4. chickpea;
5. root vegetables, especially beets, carrots and radishes;
6. figs and dates.

Just as there is no prescribed diet for vitiligo, there are also no medically recognized foods to worsen the condition. However, anecdotal evidence shows that some people experience a negative reaction when eating certain foods, especially those that contain hydroquinones, which contain depigmenting agents. Every body is different and may react differently to certain foods.

Here are some of the most problematic foods that some people with vitiligo cite:

1. alcohol;
2. berries;
3. citrus;
4. coffee;
5. cottage cheese;
6. the fish;
7. fruit juice;
8. gooseberry;
9. grapes;
10. pickles;
11. grenade;
12. pears;
13. red meats;
14. tomatoes;
15. wheat products.

Some vitiligo patients have reported that certain substances, such as vitamins and herbs, appear to reduce discoloration of their skin. These substances have not been found to be medically effective in the treatment of vitiligo and are only supported by anecdotal evidence:

1. vitamin B-12, or folic acid;
2. vitamin C;
3. vitamin D;
4. beta-karoten;
5. ginkgo biloba;
6. amino acids;
7. enzymes.

Certain minerals have also been listed as helpful in preventing vitiligo flare-ups, including:

1. Copper. Many people maintain the correct amount of copper by drinking a glass of water from a copper cup.
2. Iron. Many people maintain the correct amount of iron by eating foods cooked in a cast iron skillet.
3. Zinc. Since many zinc-rich foods are on the restricted list of vitiligo foods, you can simply ingest zinc through supplementation.