White Patches On The Skin – Is Vitiligo Treatable Through Medication And Surgery?
It is hard to live with some of the embarrassing skin disorders. Vitiligo is one such condition though is not deadly, but the loss of natural skin color can shatter your emotional well-being. Let’s discuss all about vitiligo and its various treatment options.
Vitiligo is a skin disease in which a person loses the pigment of skin causing discoloration. The loss of skin color occurs in white patches and can affect any part of the body. Normally, pigment melanin produced by melanocytes cells determines the skin color. When these cells stop producing or die, it can cause vitiligo. The condition is not contagious in nature.
Vitiligo is harmless and not painful but the social stigma attached to it might cause serious embarrassment. Some people even associate this condition with leprosy.
How common is vitiligo?
The condition affects any age group and people of different skin types. However, it may be more noticeable in people with dark skin colors. According to Dr. Arvind Singh, secretary, Indian Medical Association (Varanasi) vitiligo in India affects about 2-5 percent of the total population.
In most of the cases, the condition develops early in life between the age group of 10-30. Most often, vitiligo will appear before 40 years of age.
What causes vitiligo?
Experts don’t know what causes the skin producing cells to die and cause vitiligo. However, some relate this condition to:
- Auto immune response in which the immune system of the body attacks these cells causing discoloration.
- Hereditary condition, as about 30 percent of people with vitiligo has a family member with the same condition.
- Trigger as from stress, sunburn or exposure to certain chemicals.
- Autoimmune diseases such thyroid disease (hashimoto thyroiditis), hyperthyroidism, alopecia aerata, Addison’s disease or type 1 diabetes.
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Signs and symptoms of vitiligo
The classic symptom of vitiligo is the patchy loss of skin color. The patches first appear on the areas of sun exposure such as face, lips, hands, arms and feet. Other symptoms include:
- The hair on the scalp, eyebrows, eyelashes and beard will prematurely become white or gray.
- Change or complete color loss of the inner layer of the eyeball
- The lining of the inside of mouth and nose also known as mucous membranes result in the loss of color
Pattern of vitiligo
Depending on the type of vitiligo, the patches may appear on:
- The discolored patches appear symmetrically on both sides of the body. This is called generalized vitiligo which is the most common type.
- In segmental pattern, the discoloration occurs at one part of the body. It usually beings at younger age and then progress for a couple of years and stop.
- In focal pattern, the discoloration of skin occurs on few small regions.
Sometimes it is difficult to predict the condition as patches cease to form without treatment.
Diagnosis of vitiligo
In most of the cases, the condition can be easily diagnosed by physical examination. The doctor may also ask about medical history or ask you questions related to family history of the condition.
Biopsy - You might be suggested to go through sample skin test (biopsy) for confirming the diagnosis. The biopsy can reveal the absence of pigment.
Blood tests - The doctor may also take a blood sample for checking any underlying conditions such as anemia or diabetes. The blood tests might also be ordered to examine the thyroid function and level of vitamin B-12 in the body. If the thyroid gland is overactive or if there is lack of vitamin B-12, it may indicate vitiligo.
Treatment – Is vitiligo curable?
Vitiligo has no cure and one has to live lifelong with this condition. However, various treatments focus on restoring pigment on your skin. This may take several months and it may happen that you would not get expected results. The treatment can be divided into different categories:
Steroids - Topical steroid medications are used to restore the pigment on the area of the white patches. These medications can be used by children and adults. Steroids need daily application for about 3 months to see desired results, especially if you have started using it in the early phase. However, there are side effects of these medications such as streaks of colour appearing on the skin or thinning of the skin.
Immunomodulators - These medications are ointments containing ingredients including pimecrolimus or tacrolimus. It might prove beneficial for people with small areas of depigmentation. These medications affect the immune system, hence called immunomodulators.
Phototherapy – Ultraviolet light therapy can help restore pigment. The treatment is often combined with a medication known a psoralen with light therapy. After taking this medication, you are exposed to ultraviolet light that makes your skin to become sensitive to light. The treatment can darken the lighter areas of the skin. You may need to repeat the procedure thrice a week for over 6-12 months.
Depigmentation – This therapy is used when other treatments fail to heal the white patches. This option is for those who have more than half of the body covered in patches. Depigmentation lightens the unaffected or normal area by applying a medication known as monobenzone on the skin to match the discolored areas.
This treatment may last upto 9 months and may induce side effects such as swelling, redness, dry skin and itching. Remember, this treatment is permanent and you will remain sensitive to sunlight.
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In cases where light therapy other things fail to give results, there are surgical procedures available. The aim of these procedures is to restore skin colour.
Skin grafting – This technique replaces the lost areas of pigment with normal pigmented skin. Skin grafting is used for small patches of vitiligo. Risks include scarring, infection and spotty colour appearance.
Blister grafting – The doctor creates blisters on the normal skin using suction. Then the top of the blisters is removed and transplanted on the patchy areas. Possible side effects include scarring and the skin damage occurred due to suctioning might trigger another patch.
Micropigmentation – Also known as tattooing, in this procedure, a special surgical instrument is used to implant pigment into the skin. The technique works for people with patches on lips or those who have a dark complexion. The possible side effect of this technique is that sometimes there is problem in matching the skin colour as well as risk for developing more patches.
Treatments which are being studied
Vitiligo has no cure but there is extensive research going on to create a new ray of hope for the patients. The potential future treatments currently being studied include:
- Afamelanotide – The drug is implanted under the skin to stimulate colour producing cells (melanocytes).
- Prostaglandin E2 – This is a kind of gel applied on the skin to restore skin colour.
- Tofacitinib – The oral drug used for treating rheumatoid arthritis has shown promising results for vitiligo.
Vitiligo is not a life-threatening condition. However, a person suffering from vitiligo may feel embarrassment and emotionally disturbed. Seeking proper care from a dermatologist and support from family members and relatives is the key to cope with the condition.