Vitiligo

What is vitiligo?

Vitiligo is a long-term skin condition where patches of the skin lose their pigment due to the loss or malfunction of melanocytes, the cells responsible for producing skin pigment. These patches often become stark white, contrasting sharply with the surrounding skin. This condition is especially prominent in individuals with darker skin tones but can affect people of all races. It's important to differentiate vitiligo from conditions like tinea versicolor, which has a different cause and presentation.

What causes vitiligo?

While the exact cause of vitiligo remains uncertain, the primary theory is that it arises from an autoimmune response wherein the body's immune system targets and destroys melanocytes. This condition often co-exists with other autoimmune disorders. Genetic factors may also play a role, suggesting a combination of genetic susceptibility and environmental triggers may lead to its onset.

What are the symptoms of vitiligo?

Vitiligo is identified by well-defined patches of skin that lack pigment. These patches can manifest on various parts of the body, with common areas being the face, neck, extremities, body folds, nipples, navel, and genitalia. Further characteristics of vitiligo include:

• Development of patches at sites of physical trauma

• Possible triggering or exacerbation from emotional stress

• Hair within or surrounding the patches may turn white

• The onset around existing moles

• Variation in the color intensity of the patch edges

How do I treat vitiligo?

Managing vitiligo varies in effectiveness based on the location and duration of the patches. Recent patches are generally more receptive to treatment than older ones, with areas like the hands and feet being particularly challenging. When repigmentation occurs, it often starts around hair follicles. Treatment avenues comprise:

• Topical corticosteroids (limited use is advised to avoid long-term side effects)

• Topical immunomodulators like pimecrolimus or tacrolimus

• Topical JAK inhibitors, such as ruxolitinib or tofacitinib

• UVB phototherapy

• Cosmetic options like makeup or tattooing to camouflage the patches

• Oral medications, which might include JAK inhibitors, corticosteroids, methotrexate, cyclosporin, or mycophenolate mofetil

• For extensive vitiligo, depigmentation of the unaffected skin is an option, though it necessitates lifelong vigilant sun protection