Vitiligo
Einstein Health Glossary
ICD 10 - L80
What is vitiligo?
It is a dermatological condition characterized by the inhibition or destruction of melanocytes, the cells responsible for producing melanin (the pigment that gives color to the skin). This results in depigmented areas that appear as white patches.
Incidence
Vitiligo affects all races, ages, and genders. It may be related to heredity—30% of patients have family members with the same condition. It is estimated that about 1 to 2% of the global population has the disease. Like most non-infectious skin conditions, it can be influenced by stress.
Cause
The exact cause of vitiligo is unknown, and there is no way to prevent it. The most widely accepted theory suggests that certain individuals experience an alteration in their immune system, which begins to produce autoantibodies against their own pigment system. An association between vitiligo and thyroid disorders has been observed in many patients (in both hyperthyroidism and hypothyroidism cases). However, a definitive explanation for this phenomenon has not yet been found. Other associated conditions include pernicious anemia, alopecia areata, diabetes, and Addison’s disease (adrenal gland insufficiency).
Symptoms
Vitiligo is characterized by the appearance of white patches of varying shapes and sizes (ranging from a few millimeters to several centimeters). These patches may gradually increase in size and, along with the appearance of new ones, can eventually affect the entire body. Sometimes, the patches have more pigmented borders than the surrounding normal skin, and the hair within them may turn white. Whether single or multiple, the patches can affect any part of the body, although they are more commonly found on the knees, elbows, fingers, legs, wrists, armpits, lower back, and areas around the mouth, anus, eyes, and nose. Occasionally, depigmentation affects the mucous membranes of the lips, gums, nipples, and genitals. It is also common for injured areas of the skin to become depigmented due to vitiligo.
Diagnosis
The diagnosis is based solely on the clinical examination of the patient.
Treatment
First of all, it’s important to clarify that vitiligo is a benign condition, with its only effects being aesthetic. There are cases of spontaneous regression. To conceal the condition, some people use specialized makeup: waterproof cosmetics with shades very close to their normal skin tone.
If treatment is chosen, there are several options, with topical treatments using immunomodulators and corticosteroids being the most common. Another possibility is light-based therapy, known as phototherapy. Phototherapy can be done using ultraviolet A (UV-A) or ultraviolet B (UV-B) light. When using UV-A, the patient takes psoralen (a drug that makes the skin more sensitive to ultraviolet light) and, two hours later, is exposed to ultraviolet radiation in a special booth while wearing protective goggles to shield the eyes from the radiation.
Despite its effectiveness, phototherapy is time-consuming: it may require 50 to 60 sessions, typically two to three times per week. A sign of improvement is the appearance of small “islands” of pigmentation in the center of the patches. Like sun exposure, phototherapy can lead to freckles and spots—and prolonged treatment over years may sometimes trigger skin cancer. When going to the beach or pool, sunscreen should be used to prevent sunburn and to avoid tanning the skin around the patches, which would increase the contrast of the depigmentation.
Alternative Treatments
In cases with only a few patches, the micrografting technique can be used. The grafted skin is normal, meaning it contains active melanocytes—the cells capable of producing melanin, the pigment that gives skin its color. Another variation involves grafting cultured melanocytes. In this case, a small sample of the patient’s normal skin is taken, melanocytes are cultured, and then grafted onto the affected area.
A widely discussed treatment is one developed in Cuba, which uses a medication called melagenin, derived from the placenta. Although it is reputed to be revolutionary and effective, this therapy is not accepted by the global scientific community: researchers in other countries have conducted controlled studies on melagenin and did not obtain good results.
More information about vitiligo can be found on the Vida Saudável blog