Dr. Ahmed
Vitiligo is a skin condition in which different areas of your skin lose color. It does not specifically target any one area of the body and is not transmissible.
However, the exact cause of vitiligo is unknown; it is believed to involve a mix of genetic, autoimmune, and environmental factors.
Based on an assessment of the prevalence of vitiligo in the United States, Europe, and Japan conducted in 2020, 1.4% of adult Americans have been diagnosed with the condition [ref].
What is Vitiligo?
Vitiligo is a condition in which white patches or spots appear on the skin as the skin loses its pigment.
The exact cause of this is unknown, but it affects people of all races—many of them children and teenagers. Vitiligo is striking in black people because white patches are more obvious in black vs white people.
Each person experiences vitiligo in a different total area of skin, and it is difficult to predict its spread.
The patches may stay stable for months or years, or the spread may take several weeks. Moreover, it may impact the hair, inside of the mouth, and eyes.
The affected areas of the skin are more sensitive to the sun as this is a photosensitive condition. Sometimes, the affected areas might stay discolored for the remainder of the affected person’s life.
Vitiligo is not a medically dangerous condition, however, it may be associated with social phobia and anxiety as the person may feel embarrassed.
Vitiligo is not a cancer of the skin. It is not a precancerous condition as well. In fact, some studies suggest that vitiligo may be protective [Ref]. Most vitiligo sufferers are as healthy as the general population.
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How Does Vitiligo Develop?
The melanocyte cells present in the skin give the skin its color. These cells create melanin, which is a pigment that protects your skin from harmful sun rays and as well as provides color to your skin.
Although we all have a similar number of melanocytes at birth, the activity of those cells determines skin color instead of their quantity.
Individuals with darker skin tones naturally produce a greater amount of melanin in their cells than those with lighter skin tones.
Sometimes, the melanin production from the skin suddenly stops, resulting in the formation of a spot lighter than the skin around it, called a macule.
With time, these white areas might enlarge and encompass a greater area of the body. These white patches can occasionally spread quickly at first and then stay steady for years. In other instances, the spread happens more slowly and gradually over time.
Although vitiligo affects individuals of all races equally, darker-skinned people are more prone to its effects.
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Risk Factors of Vitiligo:
The following factors may make you more susceptible to vitiligo:
- Vitiligo in the family history
- Autoimmune illnesses in the family
- Non-Hodgkins lymphoma or melanoma
- Another autoimmune disorder
- Specific gene alterations
Types of Vitiligo:
1. Non-segmental vitiligo
Non-segmental vitiligo is also named bilateral vitiligo/vitiligo vulgaris / generalized vitiligo.
In this type, the decoloration occurs on both sides of the body (with some extent of symmetry) – i.e., affecting areas that are most exposed to the sun, mainly knees or the back of hands, eyes, arms, armpits, elbows, feet, mouth, nose, scalp, neck and navel.
Mucous membrane-lined regions like the lips and mouth, as well as the groin/genital and rectal areas, can occasionally be impacted [ref].
Usually, it begins with an abrupt loss of skin color, followed by a brief period of respite. It might be especially noticeable on the fingers, wrists, hands, feet, or around the mouth and eyes.
After some time, color loss may restart and then stop again (a phenomenon known as start-and-stop cycles).
Various subtypes of vitiligo are medically classified as non-segmental just because they do not accurately fit the attributes of segmental conditions.
Localised / focal vitiligo:
As the name suggests, one or more localized patches occur on the body(occurring in just one site or separately in a few portions of the body). One or two patches may also appear in a discrete body area.
Generalized:
Generalized is a more common sub-type than localized. In this patches are spread in various locations around the body.
Moreover, it has further sub-types with specific characteristics impacting the body in different ways.
These sub-types are:
Acrofacial Vitiligo:
The face (usually the mouth region), fingers (usually the fingertips), and toes are the main areas where patches develop.
Universal Vitiligo:
An extremely uncommon subtype that results in widespread pigment loss throughout the body (i.e., total or near-complete depigmentation).
Vitiligo Vulgaris:
The patches are dispersed all over the body.
2. Segmental vitiligo
Segmental vitiligo, also known as unilateral vitiligo, typically affects one side of the body in an asymmetric pattern, such as the arm, leg, or face.
It frequently occurs along the trigeminal nerve line. It usually begins early and lasts for approximately a year before showing any signs of stopping.
When it comes to hair, at least half of those who have this type will experience some loss of color, including in areas like the eyebrows and eyelashes, as well as hair that grows on the scalp.
Additionally, there have been reports of affected skin areas connected to nerves that originate from the dorsal roots of the spine.
Moreover, segmental vitiligo is much less common and less unpredictable than non-segmental vitiligo; it responds better to topical treatments. It has nothing to do with autoimmune disorders or thyroid issues.
3. Mixed vitiligo
Some people suffer from both segmental and non-segmental vitiligo, referred to as mixed vitiligo.
While segmental vitiligo only affects one side or segment, non-segmental vitiligo causes symmetrical white patches to appear on both sides of the body.
A person with mixed vitiligo may exhibit both segmental and symmetrical depigmentation in combination with these patterns.
This means that while white patches may develop in a fairly balanced pattern over the body, they can also appear in isolated areas that are affected on only one side.
4. Drug-induced vitiligo
Medication use can occasionally lead to vitiligo in people. Most frequently, immune-modifying drugs such as immunomodulators, biologics, and targeted therapies used in cancer treatment cause drug-induced vitiligo, also known as drug-induced leukoderma.
Applying monobenzone or another compound in the phenol class topically is another factor that can result in vitiligo.
Drug-induced vitiligo spreads more quickly than segmental or generalized vitiligo and frequently appears later in life. In newly developed drug-induced vitiligo, small white dots are frequently seen.
However, after stopping the medication, the drug-induced vitiligo may reverse.
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The bottom line:
Vitiligo is a skin condition with various types that affects people of all races but has a higher impact on darker skin.
It sometimes runs in families but can have a variety of causes. Most symptoms are cosmetic or surface-level, and the affected individuals are normally healthy. Additionally, People who suffer from vitiligo may also have other autoimmune conditions.
