Vitiligo is signified by acquired white or hypopigmented macules or patches. Affected areas are generally well differentiated, and are spherical, oblong, or linear in shape. Borders can be convex . Generally, the lesions grow centrifugally as the time passes at an erratic rate. Size of the lesions can differ from millimeters to centimeters. In the beginning, lesions appear very often on the hands, forearms, feet, and face. Perioral and periocular areas are most favorable sites.
Vitiligo lesions may be seen only in an area or many areas all over the body, but commonly it widely affects the entire body. In such cases, the macules are generally seen on both sides of the trunk, either evenly or unevenly aligned.
Vitiligo commonly affects the face, neck, and scalp. Mostly, it affects the areas that are subjected to recurrent trauma. Common involvements are bony prominences, extensor surface of forearm, ventral aspects of wrists, dorsal side of hands, and digital phalanges.
Mucous membranes are involved in cases of generalized vitiligo. It generally develops surrounding the body orifices like the lips, genitals, gingiva, areolas, and nipples.
Depigmented body hair (leukotrichia) can be seen in vitiliginous macules. Vitiligo affecting the scalp develops as a limited area of white or gray hair, but complete depigmentation of entire scalp hair may take place. Scalp is involved very frequently, followed by the eyebrows, axillary hair, and pubic hair.
Entire Body System
[…] perpetuate inflammation and prevent repigmentation in patients with vitiligo disease. [som.uci.edu]
Current treatments are moderately effective at reversing disease by suppressing autoimmune inflammation in the skin and promoting melanocyte regeneration. [ncbi.nlm.nih.gov]
Uveitis, a general term that describes inflammation or swelling in the eye. Inflammation in the ear. Causes of Vitiligo Scientists believe that vitiligo is an autoimmune disease in which the body’s immune system attacks and destroys the melanocytes. [niams.nih.gov]
Immune imbalance, inflammation and consequent reduction of melanocytes’ number and viability are the key triggers of skin depigmentation in vitiligo. [omicsonline.org]
And with that, opportunities started to fall into my lap and I thank God for all of them. Try loving yourself.” [people.com]
Please note that studies investigating HSP70iQ435A-based treatment thus fall out of the remit of this project. All other Topic Editors declare no competing interests with regards to the Research Topic subject. [frontiersin.org]
People with other autoimmune diseases, specifically Hashimoto's disease (which affects the thyroid gland) and alopecia (which makes hair fall out), are more likely to get vitiligo as well. [health.com]
[…] study: https://www.umassmed.edu/vitiligo/blog/blog-posts1/2017/06/topical-jak-inhibitor-shown-to-be-effective-for-facial-vitiligo/ The trial was started in the spring of 2017 and recruited 157 participants, completing enrollment for the study in the fall [umassmed.edu]
I went to consult another doctor and he said that the high exposure to the UV light was the reason why I was falling sick. This was before 2012 and there wasn’t much awareness about vitiligo,” she says. [thenewsminute.com]
- Short Stature
Additional features are seizures, diabetes mellitus, hearing loss, cardiac disease, short stature, endocrinopathies, neuropsychiatric dysfunctions and skin alterations including hypertrichosis, eczema, and vitiligo. [frontiersin.org]
The other autoimmune disorders associated with vitiligo in our study were alopecia areata, diabetes mellitus, and Rheumatoid arthritis. [omicsonline.org]
We report the case of a 17-year-old boy who presented to our clinic with trauma-induced skin blistering, alopecia, deafness, dental caries, nail dystrophy and vitiliginous areas. [ncbi.nlm.nih.gov]
It may be more common in people who suffer from autoimmune diseases such as: hyperthyroidism alopecia areata adrenocortical insufficiency pernicious anemia However, the vast majority of affected people do not have any other autoimmune disorder. [news-medical.net]
It is also under investigation as a treatment for alopecia areata, Ritlecitinib, also known provisionally as PF-06651600, is a JAK3 and tyrosine kinase inhibitor. [managedhealthcareexecutive.com]
In vitiligo and piebaldism the lack of melanin in the epidermis is due to the fact that melanocytes are missing. [ncbi.nlm.nih.gov]
Schwartz, Piebaldism: an update, International Journal of Dermatology, 43, 10, (716-719), (2004). [doi.org]
Is piebaldism the same as vitiligo? No. Both conditions cause white or light patches of skin or hair. Piebaldism occurs when a portion of your skin doesn’t have melanocytes, which are cells that produce pigment (melanin). [my.clevelandclinic.org]
ISBN 1-4160-2999-0. v t e Pigmentation disorders/Dyschromia (L80–L81, 709.0) Hypo-/ leucism Loss of melanocytes Vitiligo Quadrichrome vitiligo Vitiligo ponctué Syndromic Alezzandrini syndrome Vogt–Koyanagi–Harada syndrome Melanocyte development Piebaldism [en.wikipedia.org]
Types & treatments Childhood eczema Adult eczema Insider secrets Types of hair loss Treatment for hair loss Causes of hair loss Hair care matters Insider secrets What is psoriasis Diagnosis & treatment Skin, hair & nail care Triggers Insider secrets What [aad.org]
In the control group of 50 cases of chronic eczema, 3(6%) cases had the evidence of presence of autoimmune disorders, 2(4%) cases had alopecia areata and 1(2%) case had hyperthyroidism. [omicsonline.org]
Post-inflammatory hypopigmentation, following inflammatory skin conditions such as eczema. Pityriasis alba. This may be a type of eczema or an inflammatory reaction following mild eczema. Leprosy, especially the tuberculoid variety. Halo naevus. [patient.info]
- Koebner Phenomenon
According to Falabella,  a lesion with lack of progression or no new lesions for 2 years, absence of recent Koebner phenomenon, positive minigrafting test, absence of Koebner phenomenon at donor site, and evidence of repigmentation of existing patches [jcasonline.com]
As side effects were observed hyperpigmentation of the treated area and the appearance of Koebner phenomenon in the donor area. [ncbi.nlm.nih.gov]
- Skin Atrophy
Side effects Side effects of topical corticosteroids include: streaks or lines in your skin (striae) thinning of your skin (atrophy) visible blood vessels appearing (telangiectasia) excess hair growth (hypertrichosis) contact dermatitis (inflammation [hse.ie]
Vitiligo on the face is currently treated with a topical calcineurin inhibitor (pimecrolimus or tacrolimus) because of the concern about steroid induced skin atrophy on the face. [bmj.com]
The patient departs quietly but with inner turmoil and anger. The physician has tried to shame the patient into believing that no real problem exists. The patient wishes that the physician [jamanetwork.com]
Moellmann G, Klein-Angerer S, Scollay DA, Nordlund JJ, Lerner AB. Extracellular granular material and degeneration of keratinocytes in the normally pigmented epidermis of patients with vitiligo. J Invest Dermatol. 1982 Nov. 79(5):321-30. [Medline]. [medscape.com]
Irritating the skin also may trigger melanocytes in dark-skinned people to produce more pigment. This is why using a skin care product that irritates the skin may worsen melasma. [web.archive.org]
The reported side effects included skin redness, irritation, and acne, although they were all quite mild. "Topical ruxolitinib has the potential to change the way vitiligo is treated. [newatlas.com]
Research shows that there are few side effects of phototherapy, but possible side effects include stinging or irritation on the skin and a sunburn-like reaction. Laser Treatment The excimer laser is a highly focused beam of UVB light. [nyulangone.org]
Side effects of topical application of ruxolitinib were mild and included redness and irritation at the application site and mild acne. "Topical ruxolitinib has the potential to change the way vitiligo is treated. [sciencedaily.com]
Mequinol should not be used by people that are allergic to any ingredient in mequinol, if you are pregnant, if you have eczema, irritated or inflamed skin, an increased number of white blood cells or if you are sensitive to sunlight or must be outside [en.wikipedia.org]
Top sun safety tips Protect your exposed skin with clothing, and don’t forget to wear a hat that protects your face, neck and ears, and a pair of UV protective sunglasses. Spend time in the shade between 11am and 3pm when it’s sunny. [britishskinfoundation.org.uk]
It allowed me to forget about the patches, once I’d covered them up. Paula The downside of the ‘cover-up’ was that it gave me an inferiority complex, a disbelief when someone complimented me on my looks. [huffingtonpost.co.uk]
Top sun safety tips Protect your exposed skin with clothing, and don’t forget to wear a hat that protects your face, neck and ears, and a pair of UV protective sunglasses. Spend time in the shade between 11am and 3pm when it is sunny. [skinhealthinfo.org.uk]
Diagnosis of vitiligo usually is made with the help of clinical findings, but sometimes biopsy is beneficial in individualization of vitiligo from various hypopigmentary disorders.
Vitiligo is sometimes seen along with various autoimmune diseases like thyroid disease, diabetes mellitus, pernicious anemia, Addison disease, and alopecia areata. Individuals should have knowledge about manifestations of these diseases. In case the disease is manifested than necessary tests should be done . Vitiligo lesions are analyzed with the help of a Wood lamp.
No drug can stop the process of vitiligo, but some drugs when used individually, or along with light therapy, may be helpful in improving the skin's appearance.
- Local application: A topical corticosteroid may help repigment the skin, especially when used in the beginning of the disease. For several months there might be no change in skin color. Topical calcipotriene which is a form of vitamin D may be used along with corticosteroids or ultraviolet light. Ointments comprising of tacrolimus or pimecrolimus (calcineurin inhibitors) can be beneficial for people with tiny areas of depigmentation, particularly on the face and neck.
- Combined medication and light therapy: In this treatment a drug called psoralen is combined with light therapy (photochemotherapy) to regain color on the light patches. Once psoralen is taken by mouth or applied on the affected skin, than the person is exposed to ultraviolet A (UVA) or UVB light. The drug affects your skin in such a way that the skin becomes more sensitive to the light, and it turns pink. As the skin starts healing, normal skin color starts appearing.
- Light therapy: In this therapy narrow band UVB light is used. Maximum results are seen on the face, trunk and limbs
- Laser therapy: In this treatment an excimer laser is used to bring back the color in areas of light skin. It makes use of a particular wavelength of UVB light. This laser can be used on small areas only, and is generally used along with a drug applied on the skin.
- Removing the remaining color (depigmentation): This therapy is considered if the vitiligo is widespread and other treatments have failed. A medication containing monobenzone is applied on normal areas of skin. Because of this, the normal skin gradually lightens and blends with discolored skin.
- Surgery is the last option for those in whom light therapy and drugs do not have any effect. Various procedures like skin grafting, blister grafting or tattooing are used to cover the patches.
Generally, limited vitiligo involving the face and trunk in children of recent onset is very receptive to treatment. Wide-spread disease in adults and disease affecting the hands and feet is resistant to therapy.
The incidence worldwide is less than 1% . Around 30% of the cases are seen within a group of members in a family. Appearance of the vitiligo is independent of the age, although the onset is usually observed in persons aged 10-30 years. In most of the cases, the person suffers from vitiligo at early age in life.
Vitiligo can be caused by both genetic and non-genetic factors. Even though the actual cause remains unknown, commonly considered factors are that there are no functional melanocytes left in the affected skin and there is damage of histochemically identified melanocytes, leading to their destruction. Theories regarding destruction of melanocytes include the following:
Autoimmune destruction of melanocytes
The autoimmune theory  suggests changes in humoral and cellular immunity in the devastation of melanocytes of vitiligo. The most assuring data of an autoimmune involvement is the existence of circulating antibodies in persons suffering from vitiligo . Substantial data points towards link between cellular immunity and vitiligo.
Intrinsic defect of melanocytes
Vitiligo melanocytes might have an intrinsic defect causing death of melanocyte. These melanocytes exhibit different abnormalities like unusual, harsh endoplasmic reticulum and inadequate synthesis and transformation of melanocytes.
Disruption in oxidant-antioxidant mechanism in vitiligo
Studies suggest that piling up of free radicals lethal to melanocytes results in their devastation. Current investigations are deployed to figure out the action of oxidative stress by calculating the levels of antioxidant enzymes superoxide dismutase (SOD) and catalase (CAT) in the affected as well as the unaffected skin of patients suffering from vitiligo and in the skin of totally unaffected control persons. It was proved that oxidative stress is raised in vitiligo, as determined by increased levels of SOD and decreased levels of CAT in the skin of people suffering from vitiligo .
Case reports portray that patients suffering from an injury to nerve along with having vitiligo, are also suffering from hypopigmentation or depigmentation in those denervated regions. In addition, segmental vitiligo regularly develops in a dermatomal pattern, which indicates that some chemical mediators are liberated from nerve endings affecting the melanin production. Additionally, sweating and vasoconstriction are raised in depigmented patches of vitiligo, suggesting high adrenergic activity. Ultimately, increased excretion of homovanillic acid and vanillylmandelic acid in urine has been recorded in patients suffering from vitiligo. This can be a basic or trivial episode .
Genetics of vitiligo
Vitiligo is characterized by partial penetrance, many sensitive areas, and genetic heterogeneity . Vitiligo caused due to inheritance can be due to involvement of genes related to the biosynthesis of melanin, reaction to oxidative stress, and control of autoimmunity .
There is no way to prevent vitiligo, but using sunscreens with a minimum sun protection factor (SPF) of 15 to protect the skin from the sun is always a healthy decision.
Vitiligo is a condition that causes depigmentation of segments of the skin. Being a genetic disorder there is no way of preventing this disease; it is advised to start the treatment as early as possible. As the disease is associated with various other autoimmune diseases, care must be taken to diagnose and treat them too. Emotional support is another important part of vitiligo therapy as the skin changes caused by vitiligo can affect people emotionally and socially.
Even in today’s world due to unawareness people feel that vitiligo can also spread due to close contact but that is not true, vitiligo is not a communicable disease. It does not cause any disability and the patient is fit for any type of work. Now due to progress in cosmetic industry there are many local applications that are available to hide small areas of vitiligo on the exposed area. The creams camouflages with the skin such that no one can make out the difference.
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