What is vitiligo?

 

Vitiligo is an autoimmune disease, in which the body attacks its own pigment cells (melanocytes), resulting in white patches on the skin. 

 

The patches vary from a few millimetres to many centimetres in size. Significantly, there is no change in texture of the involved skin ie. the skin is not scaly, thickened or red.   Furthermore, there are no symptoms eg. itch, burning, stinging or pain.  The only sign of its existence is a visible change in colour.   Vitiligo cannot be felt.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

How is Vitiligo caused?

 

In Vitiligo patches, there is a complete absence of melanocytes (pigment cells). The cause of Vitiligo is unknown. As in any condition where the cause is unknown, several theories exist. These include:

 

1.      The autoimmune hypothesis:  

The body's immune system destroys its own pigment cells.  It is thought that immune cells are manufactured to get rid of some unknown invading substance eg. a virus.  These immune cells confuse the body's pigment cells for the virus and destroy them (the pigment cells) instead. The actual trigger factor remains unknown. Support for this theory comes from the fact that Vitiligo is sometimes seen in association with other diseases in which there is over-active immunity eg. Anaemia, Diabetes and Thyroid disease.

 

2.      Neurogenic hypothesis:

Nerve endings release substances which destroy pigment cells.

 

3.      Self destruct theory of Lerner:

The pigment cells destroy themselves by releasing toxins.

 

 

Is vitiligo curable?

 

No, but many treatments exist.

To view a list of treatments, please check out the TREATMENT page.

 

 

What support does the Vitiligo Society provide?

 

The VSSA provides support through its FACEBOOK page, through this website by listing the available treatments for the condition, by providing a link to all dermatologists in the country, and by having support group meetings at intervals.The treatment of vitligo is individualised. For this reason, no opinion can be offered regarding an individual's vitiligo. For an opinion, please make an appointment with a dermatologist to discuss treatment options.

 

For your convenience, the names of dermatologists interested in treating vitiligo are listed in this website. To find details of any dermatologist in South Africa, please see FIND A DERMATOLOGIST.

 

 

Can Vitiligo be inherited?

 

Yes, Vitiligo is thought to be an inherited disease.   Forty per cent of affected individuals have a family history. 

 

 

How common is Vitiligo?

 

The condition affects 1% of the world's population.

 

 

At what age does Vitiligo start?

 

Vitiligo may start at any age although over 50% of individuals are below the age of 20 years. Any part of the body may be involved.   

 

 

What is the Koebner phenomenon?

 

When white patches develop at sites of injury eg. scratch marks, the situation is referred to as a Koebner phenomenon.  This situation of disease developing after injury is also seen with viral warts, molluscum contagiosum, lichen planus and a few other conditions.

 

 

Can areas other that the skin be involved with Vitiligo?

 

Pigment cells are found in the skin, the inner ear and the lining membrane of the brain.  Any of these cells may be involved in vitiligo, although other sites are rarely involved.Usually pigment cells in the upper part of the skin are involved (epidermis).  Occasionally, however, pigment cells in the deeper part of the skin, around the hair follicles (roots of the hair), may be involved, in which case emerging hairs appear white.

 

 

Can Vitiligo improve without treatment?

 

Spontaneous repigmentation is seen in 20% of patients with Vitiligo.  In the rest, the condition is gradually progressive.   However, with treatment, up to 80% can expect some improvement in their condition.  

 

 

How does treatment work?

 

Treatment involves the stimulation of pigment cells around the hair follicles and their movement upwards into the epidermis. It can take up to three months before the effects of treatment is appreciated. The success of treatment is measured by the appearance of small pigmented spots around hair follicles within the white patch. These spots gradually enlarge and join up until the patch becomes completely covered.  It stands to reason that parts of the body not populated by hair follicles are difficult to treat eg. the lips, palms and soles, and the tips of the fingers.

 

How is Vitiligo treated?

 

If you are ever told that your vitiligo cannot be treated, please seek another opinion.

 

TOPICAL TREATMENTS (externally applied)

 

• Topical corticosteroids:   These are applied followed by sun exposure for half an hour daily, ideally before 10am or after 3pm in order to avoid sunburn in the white patches.

• Topical Tacrolimus (Protopic) has been shown in numerous studies to assist with repigmentation in Vitiligo. See Pearls from the Literature

• Pseudocatalase and superoxide dismutase (Vitix), derived from the melon Coucomis melo,  has been reported to improve vitiligo, especially when combined with phototherapy or heliotherapy (sunllight exposure)

 

UV LIGHT

 

• Photosensitisers:   Topical psoralens (applied form of the medication) or Eau de Cologne can be used to make the skin sensitive to sunlight.   Sun exposure following application stimulates repigmentation.  Blister formation is not uncommon with this type of treatment. 

• Oral trisoralens followed by Sun exposure. Tablets are taken followed by Sun exposure.  Blister formation is a common side effect.

• PUVA (Psoralens and Ultra Violet A light): A promising treatment utilising ingestion of Trisoralen tablets followed by exposure to Ultra Violet A light from a special UVA machine.   Special spectacles have to be worn during treatment and for 24 hours thereafter in order to protect the eyes from Ultra Violet damage. With this treatment, it could take up to six months to a year for successful re-pigmentation to occur, if treatment is administered once a week. In some centres, Khellin is used in place or psoralen.

• Narrow band UVB:    Treatment with this machine does not require the ingestion of Psoralen capsules prior to exposure.  Although special goggles need to be worn whilst in the machine, no glasses have to be worn after treatment.  Treatment time is much shorter than with PUVA.  There is also no age limit with this machine and young children from the age of two months may be treated. 

• The excimer laser is the most recent addition to the armamentarium of treatments for Vitiligo.  This laser emits light in the same spectrum as the narrow band UVB machine (308nm).  The number of treatments is shortened to about one third compared to narrow band UVB.  Areas like the eyelids can be treated in as few as 5 treatments.  This type of treatment is useful only for small areas of Vitiligo.  Excimer laser treatments are usually performed one to three times per week.

 

SURGICAL TREATMENTS

 

• Surgical methods involve the removal of skin from the normally pigmented parts of the body and inserting it into areas of pigment loss. Several surgical methods are currently performed for the treatment of Vitiligo.  These include Suction Blister Grafting, Punch Grafting, Cultured melanocyte transplantation, Non-cultured melanocyte transplantation and other techniques

 

COSMETIC

 

• Bleaching:   If Vitiligo is very extensive, it is not unreasonable to depigment (remove pigment) from remaining pigmented areas using 20% Monobenzyl ether of Hydroquinone, making the entire skin surface white in colour. One has to consider this form of therapy very carefully, as pigment removal is permanent. 

• Liquid nitrogen cyrotherapy: To remove areas of pigmentation in patients who have extensive vitiligo, liquid nitrogen may be used.