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Vitiligo is a skin condition whose exact cause is unknown. In vitiligo, patches of skin lose their pigmentation when the pigment producing cells, the ‘melanocytes’ are attacked and destroyed. It may affect the skin, mucous membranes, eyes, inner ear or hairs leaving white patches. The usual type of vitiligo is called ‘Vitiligo Vulgaris’ (means: common vitiligo). Variant types include linear, segmental, trichrome and inflammatory vitiligo.
This disease affects an estimated 1% of the world’s population. It affects individuals of all ethnic origins and both sexes, but is much more easily noticed on darker skin as areas that fail to tan. It is hereditary in one third of those affected. Vitiligo often starts on the hands, feet or face, and frequently pigment loss is progressive. Half the patients first notice vitiligo before 20 years of age. It often appears in an area of minor injury or sunburn.
It is believed that vitiligo is an autoimmune disorder (autoimmune means the body’s own immune system turns on itself). Certain white blood cells direct the destruction of melanocytes. People with vitiligo are also somewhat more prone to other autoimmune diseases, such as alopecia areata, autoimmune thyroid disorders, Addison’s disease, pernicious anemia, and diabetes mellitus.
The diagnosis of vitiligo is usually straightforward, and no special testing is needed. While vitiligo is a cutaneous problem and does not affect the health directly, it is disfiguring and may be psychologically traumatic. The condition cannot be cured at present, but treatments are available that may be very helpful. Medical treatments target the immune system, and try to reverse the destruction. Surgical treatments are less commonly done, and transplant healthy melanocytes from other areas. Both treatments may be difficult and prolonged.
The goal is to restore the skin’s color by restoring healthy melanocytes to the skin (repigmentation) allowing the skin to regain its normal appearance. 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. Repigmentation occurs slowly as the cells creep back in over months to years.
Sun-induced darkening of the surrounding normal skin makes vitiligo look worse. All patients with vitiligo should always protect their depigmented skin against excessive sun exposure by wearing protective clothing, applying a UVA/UVB sunscreen daily, and avoid prolonged sun exposure.
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