White patches on face-Vitiligo
Dr Vivekananda Bhat
Lavelle road, Bengaluru Feb 9, 2017
Vitiligo is a skin disorder that affects 0.4% to 8.8.% of the Indian population. People with vitiligo have discoloured patches on their skin. The patches could appear anywhere around the body like the parts exposed to the sun such as the face, arms and feet, inside the mouth and other similar mucous membranes, nostrils, genitals behind the eye, in the hearing system of the ear, etc. When vitiligo occurs in patches that contain hair, then the hair growing on these patches turn white.
What is Vitiligo?
Vitiligo is a condition in which the cells responsible for skin colour, i.e. the melanocytes, are completely destroyed. Melanocytes produce a pigment called melanin that gives our skin its colour and protects our skin from the damage caused by the sun.
Vitiligo may start as a white patch and then affect different parts of the body; this doesn't mean that the condition is contagious. Patients with vitiligo cannot transmit the disease to others.
Symptoms and Types of Vitiligo
The most significant symptom of vitiligo is the white, discoloured patches on the skin. Most vitiligo patients mainly show loss of skin color on the hands and face. Other common areas where patches could be found include, the skin under your arms and around your groin. The patches can appear in any part of the body and usually appear in the following patterns:
Segmental or Focal
As the name suggests, these patches focus on just one area of the body. These patches progress much slower when compared to generalised vitiligo. The condition develops for a year or so then stops.
Non-segmental or Generalised
Unlike the focal pattern, in this case, the patches appear symmetrically on both the sides of the body. This form of patches is one of the most common and can affect any part of the body. The rate of the development of these patches is hard to determine as they start and stop occurring many times in a person's lifetime.
Risk Factors of Vitiligo
The cause of vitiligo is still being determined. It isn’t a hereditary condition, as most patients who have vitiligo do not have a family history with the condition. Yet, certain research indicates that family history or having conditions that affect the immune system may increase your risk of developing vitiligo.
There are genetic factors, i.e. having the genes NLRP1 and PTPN22 are associated with vitiligo. Researchers classify vitiligo as an autoimmune disorder as our body is attacking its own cells. It was also found that around 20% of vitiligo patients have some other form of autoimmune disorder such as scleroderma, psoriasis, alopecia areata, thyroiditis, lupus, type 1 diabetes, Addison's disease, pernicious anaemia or rheumatoid arthritis.
Patients who were subjected to the following incidents were also found to have developed vitiligo.
Getting severe sunburns or cuts
Heavy exposures to toxins or cuts
Complications of Vitiligo
Vitiligo is a disorder that brings about very few physical side effects. Loss of melanin increases your risk for sunburn, and some serious complications might affect the eye and the ear.
Unfortunately, the disorder has a huge effect on a person's mental health. In some cases, it has brought in negative effects to their personal relationships. Some patients also reported having extreme anxiety as the condition had an unpredictable way of developing.
Patients with vitiligo also reported that:
They have been avoiding physical activities
Disinterest in attending events
Felt as if they were disfigured
They felt like an emotional burden to their close ones
It is important for the patients to confide these negative feelings to their doctor or someone who they are comfortable with. Educate yourself about the disorder to help you understand how to deal with the symptoms.
Diagnosis of Vitiligo
The obvious diagnosis of vitiligo is by examining the discoloured patches. But doctors also enquire about your medical history, conduct lab tests and may ask you about other possible contributing factors such as sunburns, having an autoimmune disorder, etc. This is done to determine the probable cause of the condition.
The vitiligo patches will also be examined under an ultraviolet lamp to differentiate between vitiligo and other similar skin conditions.
Sometimes vitiligo patches are biopsied, i.e. the sample of the skin is taken to be tested. This will help doctors understand the state of melanocytes. Besides, it helps diagnose other disorders that usually occur with vitiligo such as thyroid conditions, anaemia or diabetes.
Treatment of Vitiligo
Doctors’ approach to treating vitiligo is restoring the colour balance of the skin. Treatments may include removing or adding in pigments.
Vitiligo treatment may include surgical and medical means or a combination of both. Treatment options vary depending on the severity of the condition, location and size, quantity, spread and your response to the treatment. Once the treatment begins, it will at least take three months to show proper effects.
Medical Treatment for Vitiligo
Doctors prescribe creams containing corticosteroids that help return colour the white patches. Besides that. Other creams that help reduce the growth of the patches are also prescribed. These creams are very strong and may bring about side effects such as skin shrinkage, thinning of the skin, irritation and discomfort, or increased hair growth.
Oral medication to treat vitiligo include steroids and certain antibiotics available through prescriptions.
Psoralen and ultraviolet A (PUVA) therapy
Psoralen is a type of drug that is known for being light-sensitive and absorbing long-wave ultraviolet, thus substituting as a form of UV radiation. The UV light activates the psoralen help return the skin back to its original colour.
Patients need to avoid sun exposure and wear protective accessories like glasses. This form of treatment brings side effects such as sunburn, nausea, itching or hyperpigmentation.
Narrowband UVB light:
This is an alternative form of PUVA therapy but is a more focused form of therapy, thus preventing a few side effects. This treatment can be done at home, provided that it is done under a doctor’s supervision.
Excimer Laser Treatment
This laser treatment is recommended when treating a really small area of patches. It takes up to visiting the doctor tow to three times per week for four months to heal.
Depigmentation is a treatment procedure recommended to vitiligo patients with 50% of their body covered in patches. Doctors turn to depigmentations when other forms of treatment have not yielded any results.
This treatment involves fading the rest of the skin colour to match that of the patches using medication. It takes up to tp years to be effective, and comes with a downside; you are more prone to inflammation. Besides that, depigmentation is permanent and your skin becomes extra sensitive to sunlight.
Surgical Treatment of Vitiligo
When medications and light therapy don’t work, doctors switch to surgical methods. Patients who are being treated by surgery must not have had any new patches in the last few months. Surgery is also not recommended for patients whose cause of vitiligo is sunburn.
The types of surgery include:
This procedure involves removing healthy, pigmented skin and transfers it to the discoloured patches. SKin grafting comes with side effects such as scarring, infection, and in some cases, the skin may fail to re-pigment. Surgeons sometimes go for a less risky option where they use blisters instead. In this procedure, the doctors create blisters on the unaffected skin and transfer the top of this blister to the discoloured area.
This procedure involves taking a sample of melanocytes from the body of the patient and then culturing them in a laboratory. Once the melanocytes have grown and multiplied, they are transplanted to the affected areas of the skin.
In this procedure, the doctor will inject pigment into your skin, something like tattooing. This procedure is mainly used to return colour into the skin around the lips, but it is quite challenging to match the natural skin colour.
Even though you might be undergoing various medical treatments, it takes up to months for proper results to show. Until then, there are certain ways you can manage the symptoms of vitiligo and prevent it from worsening. These include;
It is important to reduce sun exposure to the skin once you have been diagnosed with vitiligo. For one, the depigmented regions of the skin have no protection from the harsh sun rays, therefore are more prone to sunburns and blisters. Besides that, when the non-affected areas tan due to sunlight exposure, it makes the discoloured region more visible. Hence use a sunscreen with really high SPF to receive more protection.
Cosmetics help by evening out your skin tone by using tanning lotions or makeup. Self-tanning lotions are preferable as they last longer than makeup.
Managing your Mental Health
Patients with vitiligo have negative mental health effects. Visiting a psychiatrist and going for therapy will help you manage the effects on mental health. Also, talk to people you trust regarding how you feel; they are there to constantly support you.
There are studies that also suggest that individual cognitive behaviour therapy (CBT) can help with the effects that vitiligo can have on the patient's mental health by;
Helping improve the patient's self-esteem
managing conditions like depression
having a positive effect on the overall quality of life
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