Vitiligo is a chronic skin condition which develops over time and is often described as degenerative. Vitiligo Support International claim as many as 2-5 million Americans live with the condition and it impacts 1% of the world’s population as a whole. The condition can be hard to live with and it can get worse over time. This isn’t always the case and with all conditions, the more you know, the more prepared you are to handle any changes or developments.
What is Vitiligo?
Vitiligo is usually described as a chronic or persistent skin condition. It is characterized by the loss of the skin’s natural pigment, causing it to become very pale in color or a pink tone. It can occur at any age but most people who have the condition begin to notice symptoms before they turn twenty. The extent of the condition cannot be predicted. Some people will experience small patches of loss of skin pigment color, whereas others will experience total loss of skin color. The condition can change over time, with most people experiencing long periods of stability. Some people even see the return of some of their pigment, but it is very rare for pigmentation to return fully.
There are two different defined versions of vitiligo currently:
- Common Vitiligo: This is the type of vitiligo most patients experience. It usually begins as one or two paler patches but over time more patches appear.
- Segmental Vitiligo: As the name suggests this kind of vitiligo affects certain segments of the body. It usually affects just one segment of the skin and usually occurs in childhood. It may start and grow rapidly but then it stops growing. It does not improve without treatment but it also doesn’t expand beyond the “segment” it has taken up on the body.
Are there any known causes of Vitiligo?
Vitiligo involves the loss of melanin in the skin. Melanin is the pigment which gives skin its normal color. It is made by cells known as melanocytes and in patches of vitiligo these cells are inactive, but they are still present. There is not yet enough research or information about why this is the case and it is not yet fully understood why vitiligo occurs. The condition is considered an “autoimmune” problem. This means the body is rejecting its own cells, melanocytes in this instance. People who have other autoimmune system conditions may find they are more susceptible to vitiligo and vice versa. Rubbing or scratching at the skin can also cause vitiligo.
The condition affects people of all races equally, but it can be more pronounced and more noticeable for people of color, due to naturally darker skin tones. Currently there are no medical links which suggest diet, alcohol consumption or smoking can impact on the development of vitiligo. Vitiligo does have a genetic basis but less than 50% of people who have vitiligo know of someone in their family who also has the condition. It does not necessarily mean that it will be passed onto your children if you have the condition either.
Symptoms of Vitiligo
Vitiligo is not usually a painful condition. It doesn’t tend to get itchy or sore, but some people do say they experience some itchiness and irritation just before new patches appear. Overexposure to the sun can cause painful sunburn to affected areas of the body. It can also result in self-esteem and related mental health problems as people try to come to terms with the change in their appearance as the patches go and spread.
Appearance of Vitiligo
Vitiligo manifests in the form of irregularly shaped patches on the skin. These patches lack the normal pigmentation as melanin levels are low. Patches are usually pale, pink or nearly white in color and they can stand out clearly against the rest of your skin. It often appears in symmetrical patches on both sides of the body. It is very rare that it appears on a single part of the body and it can be found in localized areas in rarer cases. The skin usually feels entirely normal, but it changes in appearance.
Common sites for vitiligo are around the hands and face, as well as around the body’s openings such as the eyes mouth, umbilicus and genitals. It also appears commonly in the groin and underarms. When the condition affects any area with hair growth, the hairs may also lose their pigment and turn white. The process of re-pigmentation (the recovery period) usually begins around hair follicles and can result in the skin appearing speckled. There is no cure for the condition, but people do sometimes regain some of their skin pigment.
Does Vitiligo always Spread?
As already mentioned, vitiligo is not easy to predict. It changes from patient to patient and the speed at which it stops occurring will depend on the individual. However, most studies show that patients will continue to see their condition worsen over time. It can be a slow and gradual process for some patients whereas others may find a small patch which very rapidly expands. For most people, the condition will eventually stabilize, and no more patches will appear. This doesn’t mean it won’t begin again, but when no more spots are found for a period of around ten years, dermatologists consider the condition stable.
Diagnosis of Vitiligo
Diagnosis of vitiligo is usually very straightforward for your doctor. They may refer you to a specialist such as a dermatologist so the specific patches of the condition and their severity can be assessed. Examination under an ultraviolet lamp is a helpful process to confirm the patches and the extent of the patches. This is especially necessary in light-skinned people and once diagnosis has been made, you can begin tests for related conditions. Thyroid disease and related autoimmune conditions can be ruled out or confirmed through blood tests and other scans. Doctors often take clinical photographs of vitiligo patches so they can monitor the progress or any changes in the condition.
Recovery periods from vitiligo are unfortunately not a sign that the condition is cured. The spread of the condition cannot currently be prevented, though treatment may help in the restoration of the skin’s natural color.
Traditional Treatments for Vitiligo
There are a range of common and effective treatments for vitiligo. You can discuss them at length with your doctor or dermatologist. For some people, the only treatment necessary is good sun protection, especially if you have particularly pale skin. Some people also choose to use camouflage treatments such as powders and creams to balance their skin tone.
Below is a closer look at the main treatments for vitiligo:
- Sunscreens: Patches of vitiligo are particularly prone to sunburn. The risks of sunburn can be more pronounced and people with the condition must take extra care to protect their skin. Using a sunscreen with high levels of sun protection factor (SPF) should be applied to all exposed areas. If it is applied more widely it can also help to reduce the contrast been affected parts of the skin and the natural skin tone.
- Corticosteroids: The most potent and strongest corticosteroids can be applied topically. They can help to restore some of the pigment, but they can also lead to side effects such as thinning of the skin and stretch marks. Oral steroids are also prescribed sometimes but again these can result in skin thinning and even other conditions such as cataracts and mood changes.
- Other Topical Creams: Other topical creams and ointments may also be recommended. Anti-inflammatory creams such as Vitamin D preparations and calcineurin inhibitors are often prescribed to limit the skin thinning properties caused by regular use of corticosteroids.
- Surgical and Laser Treatments:Surgical transplant is sometimes an option for patients with vitiligo. It involves the transplantation of small areas of skin to stable areas of vitiligo. This is not a common treatment, but it has been found to have some positive effects and may become a more regular option for patients. Using the Excimer laser has also become a treatment option. This kind of laser treatment works on stable patches of vitiligo which are relatively small in time. It is sometimes offered in combination with steroids and other topical treatments.
- Phototherapy: Phototherapy is the process of exposing the skin to artificial ultraviolet light. It often needs to be prolonged to have a positive impact and does help a proportion of patients with the condition. It is almost impossible to achieve full re-pigmentation, but some patients do see their pigment return to some degree. It is another treatment that may be combined with others.
- Pigment Removal: Some patients who have vitiligo covering more than 50% of their body choose to have the pigment removed from the rest of their skin. This is an extreme choice and not something all doctors will recommend. However, in some cases it is the most effective way of achieving an even skin tone. The medical, psychological and even social impact of this treatment can be extreme, so it is something doctors only discuss with a minority of patients.
- Skin Camouflage: Experts and dermatologists specializing in vitiligo can help patients find the right camouflage to cover their vitiligo patches. There are a wide range of specialist camouflage products on the market, many of which are fully water resistant and shouldn’t just rub away with ease.
- Psychological Support: Unfortunately, people with vitiligo often experience psychological or emotional distress. This can be due to looking and feeling different to others or due to the reactions of others to them. Professional help can support patients in finding coping mechanisms and also support those around them such as parents and carers.
- New Treatments for Vitiligo: Researchers and specialists from many leading dermatological organizations and charities work continuously to find more treatment for vitiligo. The newest therapies include combinations of oral medications currently approved for rheumatoid arthritis combined with ultraviolet-B light therapy. There has also been considerable expansion of the melanocyte-keratinocyte transplant procedure across the US. World Vitiligo Day is a national event which brings awareness to the condition and takes place on 25th June and it brings together influencers such as models with the conditions and experts in the field, allowing for discussion, organization of further trials and studies and much more. The Vitiligo International Symposium is also an opportunity to experts in the condition and those interested in finding out more. It brings together physicians, researchers and representatives of companies developing new treatments as well as patient advocates. Events such as these help with furthering awareness of the condition as well as bringing together the right people who may be able to make a difference in the future, in terms of treatment and managing vitiligo.
Natural Remedies for Vitiligo
Some patients with vitiligo look for more natural approaches to managing their condition. People who prefer to find natural and organic treatment for any condition will find there are some methods which have an impact. Research into natural remedies for vitiligo was published in BMC Dermatology and found varying levels of success. It looks at the use of a number of naturally occurring ingredients including algae and measures their success in treating the condition.
There is no prescribed diet for vitiligo but as recommended for all people, a balanced diet with regular water intake is of course recommended. As vitiligo is an autoimmune disorder, patients should also try to include immune-system boosting foods in their diet. This includes foods reach in beta-carotene, anti-oxidants and phytochemicals.
Examples of such foods include:
- Dark leafy greens such as kale and spinach
- Red bell peppers
- Root vegetables including carrots and radishes
- Figs and dates
People with vitiligo often find they have deficiencies in vitamin B12, zinc and copper too so may want to add foods high in these nutrients too. In all instances it is recommended you discuss any extreme diet changes with your doctor who may be able to advise the best course of action.
There are also some foods which patients with vitiligo and some physicians recommend avoiding. These foods include those which contain hydroquinone which is known for its depigmentation properties. Hydroquinone is found in high volumes in foods such as citrus fruits. People with food intolerances to lactose, dairy and egg can also find eating foods containing these can cause the condition to worsen.
Additionally, there is a range of topical home remedies that patients use to treat their vitiligo. They include:
Fresh papaya is one of the less common exotic fruits, with many health encouraging properties. It has been shown to be effective against vitiligo. To use it to treat the condition it should just be rubbed directly against the affected patches of skin. Drinking fresh papaya juice can also replenish the body’s melanin count, much of which is lost as vitiligo develops.
Basil is well-known for its anti-aging properties and anti-viral properties too. Both of these are useful in dealing with vitiligo. Mixing basil leaves in with fresh lime juice can help the body stimulate the production of melanin on the skin. The mixture of basil leaves and lime juice can be applied directly to the skin daily for the best results.
Turmeric is one of the most tested home remedies for vitiligo. When mixed with mustard oil it is particularly effective as both ingredients stimulate the pigmentation of the skin. Applying a mixture of the two together to the affected area for around 15-20 minutes daily may soon have positive effects.
Gingko Biloba has been found to cause re-pigmentation in a recent study published by the International Society for Complementary Medicine Research. The study saw patients given 60 milligrams twice a day for a twelve-week period. At least 25% of participants experienced what was described as a “clinically significant improvement” while 30% achieved re-pigmentation to some degree.
While all these natural remedies are worth considering, it is always best to consider the treatments suggested by medical practitioners in the first instance. Patients can trial any home remedy but should be sure to continue any treatment provided by their doctor. Natural treatments can be hugely beneficial for many patients.
Sun Safety Tips
As people with vitiligo are more at risk of sunburn it is important to practice sun safety. The pain and long-term damage sunburn can cause can also result in vitiligo becoming more pronounced and re-pigmentation is less likely.
Below are some general sun safety tips which are particularly important for people living with vitiligo:
- Ensure your exposed skin is protected with clothing. You need to wear a hat which protects your face, beck and ears. UV protective sunglasses are recommended too.
- Avoid the sun at peak times between 11am and 3pm.
- Make sure to choose sun protection with high protection SPF (30 or more). It is important to apply plenty of sunscreen at least 15 minutes before going out in the sun. It should be reapplied every two hours.
It is especially important to remember that sunscreen is not a replacement for appropriate clothing and spending time in the shade in peak hours. No sunscreen can provide 100% sun protection. If you have large patches or significant vitiligo coverage, then you may need Vitamin D supplements. This is another thing you can discuss with your doctor.
Vitiligo and the Aging Process
Vitiligo can be a hard condition to live with and for some people it does worsen as they age. As mentioned, ingredients and treatments with anti-aging properties can help in treating vitiligo. Although most people with vitiligo experience it throughout their lives, there are more and more examples of late onset vitiligo occurring. Late onset vitiligo is when the condition is diagnosed or begins when the patient is over 55 years of age. Again, it’s close link with other autoimmune systems could be the reasons for this. Thyroid function and other autoimmune system functions can start to decrease with age, and for some people the same can be said for their melanin production.
Psychosocial Impact of Vitiligo
As vitiligo is a condition which impacts a person’s appearance and so it is understandable it may have an impact on their self-esteem and social comfortability. Considerable research has been published into Vitiligo and social acceptance as well as the psychological impact of the condition. Doctors and medical professionals are becoming much more aware of the non-physical impact of the condition which in turn is ensuring the right psychological support can be provided. This is also why there has been a growth in camouflage services and further support for patients looking to manage their condition so they can be comfortable and happy in public. It can take time to find confidence with a new diagnosis, but most patients are able to manage their “new normal” in time. It can help to connect with charities and online communities where people can get in touch with others living with the same condition.
One of the difficult issues for patients living with vitiligo is that stress can exacerbate the condition. Stress and anxiety can be hard to avoid if you’re finding day to day life difficult due to the condition. This is why it is even more important to seek help in any instance, whether that’s for a new treatment for the condition or emotional support.
Living with Vitiligo
More and more people are publicly choosing to live openly with their vitiligo. While this isn’t for everyone, it can be inspiring and helpful for people just diagnosed with the condition. While camouflage treatments are widely available and a great idea, it is also inspiring to see people with the condition on a more regular basis, helping it to appear more mainstream.
Vitiligo does not have a cure but there are treatments to help people who are uncomfortable with their change in appearance. Alternatively, more and more people are coming around to their condition and embracing it as part of who they are.