Doctor's Notes on Vitiligo
Vitiligo is an autoimmune skin disease where there is a progressive destruction of the skin's pigment-producing cells (melanocytes), that results in areas of abnormally white skin. Signs and symptoms of vitiligo are white spots or irregular areas adjacent to normally pigmented skin. Often, if skin involves hair growth on the face or arms, the development of gray or pigment-free hair results. Over time, these patches may gradually enlarge. In some patients, vitiligo extends down the entire length of a limb (termed segmental vitiligo). Patients with this disease can develop psychological factors and social problems. Many people do not know that vitiligo is not a transmittable or an infectious disease.
Although vitiligo seems to be autoimmune disease, it is not known what triggers the autoimmune system to destroy melanocytes. There are numerous theories; some suggest that environmental factors interact with genes to predispose a patient to this disease. Exposure to certain phenol-like chemicals in some individuals can produce a skin condition that is identical to vitiligo.
What Are the Treatments for Vitiligo?
Although treatment options vary, there are three main treatments that are available, and they may be used in combination. The three main options are as follows:
- Anti-inflammatories like a topical corticosteroid cream
- Anti-inflammatories like oral or IV corticosteroids
- Immune system modulators like calcineurin, tacrolimus
- Phototherapy: narrow band UV light
- Phototherapy combined with psoralen (topical or oral)
- Depigmentation agents to blend normal skin color and vitiligo
- Skin grafting: replace vitiligo with a person's healthy skin
- Blister grafting: cause blisters on normal skin and then transplant blister top skin to vitiligo
- Cellular suspension transplant: normal skin growth in laboratory solutions then transplanted onto vitiligo
Researchers are developing ways to stimulate melanocytes to develop in vitiligo but is not available to date. You and your doctors may design treatments that are best fitted to treat your condition.
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Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.