Vitiligo frequently asked questions FAQ
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Below are some frequently asked questions about Vitiligo.
Vitiligo or leukoderma is a chronic skin condition that
causes loss of pigment, resulting in irregular pale patches
of skin. The precise etiology of the disease is complex and
not fully understood.
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1. What is vitiligo?
Patients with Vitiligo develop white spots in the skin
that vary in size and location. The spots occur when pigment
cells, or melanocytes, are destroyed and the pigment melanin
can no longer be produced. Melanocytes normally occur
throughout the skin, and in the hair follicles, mouth, eyes,
and some parts of the central nervous system. In Vitiligo,
pigment cells can be lost in any of these areas. Common
sites of pigment loss are:
- Exposed areas: hands, face, upper part of the chest
- Around body openings: eyes, nostrils, mouth, nipples,
umbilicus, genitalia
- Body folds: arm pits, groin
- Sites of injury: cuts, scrapes, burns
- Hair: early greying of hair of the scalp, beard or other
areas
- Area immediately surrounding pigmented moles
- Choroid of the eye [top of
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2. Who gets vitiligo?
Vitiligo affects at least 1% of the population. About half
of the people who develop this skin disorder experience some
pigment loss before the age of 20, and about one third of
all Vitiligo patients say that other family members also
have this condition. Even though most people with Vitiligo
are in good general health, they face a greater risk of
having: Hyperthyroidism or hypothyroidism (increased or
decreased thyroid function), Pernicious anaemia (Vitamin B12
deficiency), Addison's Disease (decreased adrenal function),
Alopecia Areata (round patches of hair loss), and/or Uveitis
(inflammation of the eyes). [top
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3. What determines skin
colour?
Melanin is the substance that normally determines the
colour of skin, hair, and eyes. This pigment is produced in
cells called melanocytes. If melanocytes cannot form melanin
or if their number decreases, skin colour will become
lighter or completely white as in Vitiligo.
Leukoderma is a general term that means white skin. Severe
trauma, like a burn, can destroy pigment cells resulting in
leukoderma. Vitiligo is just one of the forms of leukoderma.
[top of page]
4. What is the cause of
vitiligo?
The precise cause of Vitiligo is not known. A combination
of genetic, immunologic and neurogenic factors is of major
importance in most cases. Many people report pigment loss
shortly after a severe sunburn. Others relate the onset of
Vitiligo to emotional trauma associated with an accident,
death in the family, divorce, etc. Early greying of hair is
part of Vitiligo. Patients with Vitiligo appear to have
normal pigment cells. An increase in something such as
nitric oxide, may be toxic for pigment cells or there may be
a lack of growth factors that are required for normal
pigment cells to be viable. [top
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5. How does vitiligo
develop?
The beginning of Vitiligo and the severity of pigment loss
differs with each patient. Light skinned people usually
notice the pigment loss during the summer as the contrast
between the vitiliginous skin and the suntanned skin becomes
distinct. People with dark skin may observe the onset of
Vitiligo at any time. Individuals who have severe cases will
lose pigment over their entire body surface. There is no way
to predict how much pigment an individual will lose, Illness
and stress can result in more pigment loss. The degree of
pigment loss can also vary within each Vitiligo patch, and a
border of abnormally dark skin may encircle a patch of
depigmented skin.
Vitiligo frequently begins with a rapid loss of pigment
which may be followed by a lengthy period when the skin
colour does not change. Later, the pigment loss may resume
perhaps after the individual has suffered physical trauma or
stress. The loss of colour may continue until, for unknown
reasons, the process stops. Cycles of pigment loss, followed
by periods of stability may continue indefinitely. It is
rare for a patient with Vitiligo to repigment or regain skin
colour spontaneously. Most patients who say that they no
longer have Vitiligo may actually have become depigmented
and are no longer bothered by contrasting skin colour. While
such patients appear to be "cured", they really are not.
People who have Vitiligo all over their bodies do not look
like albinos because the colour of their hair may not change
or it can be dyed and eye colour does not change. [top
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6. What is the treatment for
vitiligo?
Even though treatment of Vitiligo is not completely
satisfactory, there are two basic methods: to try to restore
the normal pigment (repigment), or to try to destroy the
remaining pigment cells (depigment). [top
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7. What is repigmentation
therapy for vitiligo?
To get repigmentation, new pigment cells must be produced
from existing ones. That means that new pigment cells must
come from the base of hair follicles, from the edge of the
lesion or from the patch of Vitiligo itself if
depigmentation is not complete. The maximum amount of
repigmentation that can be expected in any one spot in a
year of treatment is an eighth to a quarter of an inch. If
in a given area most of the hair follicles would provide
pigment cells that radiate to one eighth to a quarter of an
inch, there could be marked repigmentation. However, if the
hairs are white or if there are no hairs, repigmentation
must occur from the edge.
In repigmentation therapy, a patient is given a psoralen
drug and then is exposed to ultraviolet light A (UV-A). When
psoralen drugs are activated by UV-A, they stimulate
repigmenation by increasing the availability of
colour-producing cells at the skin's surface. The response
varies among patients and body sites.
The psoralen drugs used for repigmentation therapy are
trimethylpsoralen and 8-methyoxypsoralen. A patient takes
the prescribed dose by mouth two hours before lying in the
sun or under artificial ultraviolet (UV-A) light. The ideal
time for natural sunlight is between 11 AM and 1 PM when the
sun is highest. Treatment every other day is recommended.
Too much ultraviolet light can be harmful.
Treatment schedules can be adjusted for each patient. If the
day is cloudy or if sun exposure is not possible on a
scheduled treatment day, then the patient does not take any
medication because the drug does not work without
appropriate sunlight. In the northern part of the United
States, patients usually begin therapy in May and continue
until September. Moderate repigmentation should take place
during this time.
Treatment is usually discontinued during the winter. This
rest period is desirable so that patients do not tire of
continual treatment. Artificial sources of UV-A light can be
used throughout the year, but patients should consult their
dermatologist to determine whether such treatments are
accessible and desirable. UV-A light systems for home use
are expensive and treatment with them time consuming.
Ordinary sunlamps are not effective with the psoralen
medications. Only UV-A light produces the desired
interaction. A dermatologist's supervision is required
during all aspects of repigmentation therapy.
Patients with Vitiligo should always protect their skin
against excessive sun exposure by wearing protective
clothing, staying out of the Sun at peak periods except
during treatment time, and/or applying sunscreen lotions and
creams. Sun protection products are numbered according to
the sun protection factor (SPF), with the higher numbers
giving more protection. Patients with Vitiligo should use a
sunscreen with an SPF of 1 5 or higher, except during the
hours of treatment. During treatment, an SPF of 8 to I 0
protects against sunburn but does not block the UV-A needed
for treatment. Sunscreens should be reapplied after swimming
or perspiring. To prevent potential damage to the eyes,
special sunglasses with protective lenses should be worn
during sunlight exposure and for the remainder of the day on
which the psoralen drug was taken. Another method of
psoralen treatment, used occasionally for patients with
small, scattered Vitiligo patches, involves the application
of a solution of the drug directly to the affected skin
area. This is then exposed to sunlight. Such topical
treatment makes a person very susceptible to severe burn and
blisters following too much sun exposure.
Hydrocortisone-type compounds when applied to the skin slow
the process of depigmentation and sometimes even enhance
repigmentation. The weak Hydrocortisones that are sold over
the counter, such as 0.5% hydrocortisone, are too weak to
help. The very potent Hydrocortisones when used daily for a
long-time produce side effects, such as thinning of the
skin. Under the care of a dermatologist it is usually
possible to adjust the treatment with topical
hydrocortisones so that side effects are at a minimum. [top
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8. Who is a good candidate
for vitiligo repigmentation treatment?
All patients are not good candidates for re-pigmentation.
The ideal person for this therapy should meet these
requirements:
Pigment loss of less than five years duration for patients
over 20 years of age. In general, children and young adults
respond better than older people.
Patients should be at least 10 years old. Treatment is safe
for younger children, but because the method is tedious,
better results are achieved when the child is interested in
treatment. An individual must be committed to the treatment
because it is a long process that requires a great deal of
patience.
Patients should be healthy. No one with a sensitivity or
allergy to sunlight can be treated. Any associated illness,
such as hyperthyroidism, should be treated at the same time
as the Vitiligo.
The patient should have the opportunity to be exposed to
sunlight for one or two hours three times a week during the
summer months for a period of two to five years. [top
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A pregnant woman should not be treated because of the
potential harmful effects of the drug on her developing
baby. About 75% of the patients who undergo psoralen - UV-A
light therapy respond to some extent. Even for these,
complete repigmentation rarely occurs. After the initial two
to three weeks of exposure to sunlight, patients will look
worse since the contrast between light and tanned skin
increases. With time, repigmentation will begin, and the
appearance of the skin improves. If patients stop the
therapy in winter, most will retain at least half of the
colour they achieved during the summer months. [top
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9. What is depigmentation
therapy and when is it warranted?
If a person has Vitiligo over more than half of the
exposed areas of the body, he or she is not a candidate for
repigmentation. Rather, such a person may want to try
depigmentation of the remaining pigmented skin. The drug for
depigmentation is monobenzylether of hydroquinone. Many
patients with Vitiligo are at first apprehensive about the
idea of depigmentation and reluctant to go ahead. However,
patients who achieve complete depigmentation are usually
satisfied with the end results. Some people become allergic
to the medication and must discontinue therapy. [top
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10. Can cosmetics be used
to make vitiligo less noticeable?
Most patients, even those who are responding well to
therapy, would like to make the Vitiligo less obvious. Many
find that a combination of cosmetics effectively
deemphasizes their skin disorder. Patients who are
interested in dyes and stains should consult a dermatologist
for the names of suitable commercial products. [top
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11. Is vitiligo curable?
Is there a cure for vitiligo?
The precise answer at this time is no. Vitiligo is
probably caused by a variety of factors interacting in
specific ways. Research has advanced the understanding of
the physical and psychosocial aspects of Vitiligo, but the
cause and cure for this disease are unknown. [top
of page]
12. What is the future for
vitiligo?
Research on pigment cells as related to Vitiligo has
increased greatly in the past ten years. Attempts to stop
Vitiligo by the use of hydrocortisone compounds applied to
the skin appear promising. Melanocyte transplants, where the
dermatologist takes pigment cells from an unexposed normally
pigmented patch of skin, grows them in culture to large
numbers, and returns them into a white patch, is also
promising. [top of page]
13. Does anyone care about
vitiligo?
Yes, there is much concern for the patient with Vitiligo.
The National Institute of Health grants approximately
$500,000 annually toward pigment research programs. In
addition, research continues in the United States and around
the world to various degrees. Many Universities such as
Cincinnati, Harvard, Howard and Yale, have active programs
in Vitiligo research. But, as is often the case, funds are
sparse. [top of page]
Source: National Vitiligo Foundation.
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