Vitiligo

Vitiligo presents itself clinically as white spots on the body distributed symmetrically and more obvious in people with dark skin. Discoloration first shows on sun-exposed areas like hands, lips, arms, and face. Other symptoms include:

• Loss of skin color
• Loss of color inside the mouth and nose
• Change in color of the inner layer of the eyeball
• Hyperpigmentation at the edges of the discolored patches on the skin
• White patchy lesions
• Development of vitiligo at specific trauma-prone sites, such as cuts, burns, or abrasions
• Premature graying of the hair

Vitiligo occurs when the melanocytes (cells producing melanin, a pigment that gives color to the skin, eyes, and hair) die or stop functioning. The exact cause of vitiligo is unknown, though it is frequently associated with multiple autoimmune diseases. There are various theories regarding its etiology, and it is hypothesized that genetic factors can influence the age of onset of vitiligo.

Vitiligo is often related to autoimmune disorders, and your chances of developing vitiligo increase if you have the following risk factors:

• Gender: Both sexes are equally affected; however, some studies report an increased risk for more extensive depigmentation in females.
• Family history: Vitiligo sometimes runs in families, but the inheritance pattern is complex due to multiple causative factors.
• Immunotherapy: This treatment for melanoma (a type of skin cancer) can lead to autoimmune side effects, including vitiligo-like depigmentation.
• Autoimmune conditions: Vitiligo appears more common in individuals with certain autoimmune diseases, such as Addison's disease, pernicious anemia, psoriasis, rheumatoid arthritis, systemic lupus erythematosus (SLE), thyroid disease, and type 1 diabetes.
• Sunburn: Research indicates that a history of blistering sunburn may be associated with a higher risk of developing vitiligo, particularly in white women.
• Stress: Environmental and psychological stressors are suggested triggers for the onset and progression of vitiligo.
• Industrial chemicals: Both household and occupational chemical exposure play a significant role in the induction and propagation of vitiligo.
• Viral infections: Vitiligo may be an autoimmune disease triggered by a viral infection in genetically susceptible individuals.

The diagnosis of vitiligo is generally straightforward and does not usually require confirmatory laboratory tests. Diagnosis can be confirmed by the following:

• Physical examination and medical history

The diagnosis of vitiligo is usually made based on clinical features. Important considerations while examining and taking past medical history must include:

• Duration of the lesion
• Factors or events that may have caused the onset of vitiligo
• Associated symptoms with the lesions
• Progression or spread of lesions
• Changes in lesions over time
• Presence of any other diseases
• Current medications
• Occupational history or exposure to chemicals or radiation
• Family history of vitiligo and other autoimmune diseases

Other diagnostic methods include:

• Wood’s lamp test: The Wood's lamp is often used to diagnose skin disorders like melasma and vitiligo. Under the Wood’s light, the vitiligo lesions emit a bright blue-white fluorescence and appear well demarcated.
• Dermoscopy: This method is useful in assessing the stage and disease activity of vitiligo. Typically, vitiligo shows residual pigmentation and telangiectasia, which are usually absent in other hypopigmentation disorders.
• Other tests: These are usually performed to exclude other disorders and may include:
  • Blood tests to check for other autoimmune conditions
  • An eye exam to check for uveitis, which is generally seen in individuals with vitiligo
  • A skin biopsy to examine the tissue for missing melanocytes in the depigmented skin of a person with vitiligo

Vitiligo isn’t preventable or curable as the exact cause for it is still not very clear. However, there are certain tips that can help prevent future depigmentation and return some amount of color to the skin by protecting your immune system and skin. They include:

• Protect yourself from the sun: Sunburns can worsen vitiligo. You can protect your skin from the sun with the following:
• Seek shade, especially when you see a short shadow, as the sun’s damaging rays are strongest during that time.
• Wear clothing that protects your skin from the sun.
• Use a hat and clothing to shield your skin from sun exposure.
• Apply a sunscreen that is suitable for your skin every day when going outside.
• Try to avoid injuries: Skin injuries like cuts, scrapes, and burns can trigger new spots or patches. It is best to be careful and steer clear of anything that can cause an injury.
• Stay away from artificial tanning: Avoid using tanning beds or sun lamps, as they can burn skin that has lost pigment, worsening vitiligo. If you want to add color to your skin, consider using camouflage makeup, self-tanner, or skin dye.
• Understand the risks of getting a tattoo: Tattoos can be tempting as a way to cover up a light spot or patch, but a tattoo can wound your skin, leading to the Koebner phenomenon, which causes new spots of vitiligo to develop where you injure your skin.
• Opt for a healthy lifestyle: Vitiligo is an autoimmune disease, meaning your immune system is attacking healthy cells. Choosing a healthy lifestyle that includes eating right, exercising regularly, managing stress, and avoiding alcohol and cigarettes can be beneficial.

There are various types of treatments available from topical medications to therapies that can help manage this condition. These include:

Medications

No medications or therapy can stop vitiligo, but certain drugs, when used alone or with light therapy, can help restore some skin tone. They include:

• Corticosteroids: The main therapeutic effect of corticosteroids in vitiligo is modulation and inhibition of inflammation. Corticosteroids are also given orally with the main objective to suppress the immune response and stabilize the disease. The most commonly used corticosteroids are:
  • Betamethasone
  • Clobetasol
• Calcineurin inhibitors: These are immunomodulators that inhibit inflammation and are recommended for the head and neck areas as they have fewer side effects.
• Vitamin D3 analogs: Vitamin D is an essential hormone synthesized in the skin and is responsible for skin pigmentation. Vitamin D analogs known to induce repigmentation in patients with vitiligo include:
  • Calcipotriol
  • Tacalcitol
• Methotrexate: It decreases the number of T cells and has anti-inflammatory and immunomodulatory effects.
• Prostaglandin F2 alpha analogs: These are used for ocular hypertension that occurs due to hyperpigmentation.
• Statins: These lipid-lowering drugs provide anti-inflammatory and immunomodulatory effects in vitiligo.
• Azathioprine: This immunosuppressant inhibits DNA synthesis in immune effector cells.
• Cyclosporine: Certain studies suggest cyclosporine leads to earlier disease stabilization in active vitiligo when given in low doses.
• Tofacitinib: An arthritis drug that has shown promising results in the management of vitiligo.

Topical management

Topical formulations that are helpful for repigmentation of skin with minimal side effects include:

• Methoxsalen
• Trioxsalen
• Psoralen
• Corticosteroids such as:
  • Betamethasone
  • Valerate
  • Fluticasone propionate
  • Triamcinolone
  • Alobetasol

Phototherapy

This treatment uses a special type of light (not sunlight). Phototherapy for vitiligo employs UV-A and narrowband UV-B therapy, which constitutes the principal treatment modality for generalized vitiligo. A longer treatment duration of at least 6 months is encouraged to enhance the treatment response.

Recent advances

Vitiligo requires comprehensive treatment, and the most recent advances include:

• Minocycline: Studies suggest that minocycline 100 mg helps in arresting disease activity.
• Afamelanotide: This longer-acting synthetic analog of the alpha-melanocyte stimulating hormone has shown promise in initial clinical studies.
• Surgical transplantation: Various cellular transplantation techniques have been investigated in vitiligo and have shown promising results.

There are many treatment options from creams, oral medicines, and ultraviolet treatment to address vitiligo, and they depend on the condition and response of the skin cells. There are certain effective natural home remedies used to treat vitiligo that have no side effects; however, always consult your doctor before starting anything new. The natural ingredients that can be beneficial for vitiligo include:

• Mustard oil (Sarson ka tel): This is a very effective home remedy used to heal vitiligo. Make a paste with turmeric and mustard oil and apply it to the affected area for 20 minutes. Turmeric along with mustard oil stimulates the pigmentation of the skin.
• Turmeric (Haldi): Turmeric has numerous medicinal benefits and acts as a home remedy to alleviate vitiligo. Regular use of turmeric can help reduce the effects of vitiligo.
• Honey (Shahad): A natural moisturizer filled with antioxidants, honey can be directly applied to the face to provide a much-needed boost of nutrition and moisture.
• Ginger (Adrak): This is an excellent home remedy for treating vitiligo and many other skin diseases. Drinking ginger juice twice a day can aid in healing vitiligo.
• Ghee: Ghee offers numerous benefits such as blood purification, increased immunity, and assistance with skin-related problems.
• Black pepper (Kali mirch): Known for its benefits in addressing skin issues and wrinkles.

Note: One effective home remedy for treating vitiligo is to heat 10 black peppers in 10 grams of ghee. After removing the peppers, mix this ghee with regular ghee. Consuming this ghee regularly will purify the blood and enhance immunity.

Vitiligo can make one conscious about their appearance and can lead to social stigmatization and mental stress. Other complications include:

• Eye involvement such as iritis (swelling and irritation in the colored ring around the pupil)
• Depigmentation of the skin, increasing susceptibility to sunburn and skin cancer
• Loss of hearing due to impairment of melanocytes in the inner ear
• Skin degeneration following prolonged use of topical steroids

The latest alternative or complementary therapies have proven to yield good results in treating vitiligo. Some of them include:

• Depigmentation therapies: These refer to medical treatments that remove skin pigmentation. These therapies are generally recommended for extensive and refractory vitiligo, when more than 50% of the body surface is affected or if cosmetically sensitive areas are the major component involved.
• Skin grafting: Studies have shown that skin grafting can be used in patients with acute and hard-to-heal chronic wounds, burns, and stable vitiligo. The use of advanced therapies may improve the quality of life and accelerate the re-pigmentation of patients with vitiligo.
• Suction blister grafting (SBG): SBG is an easy and cost-effective method of repigmentation generally done to treat vitiligo at difficult sites like the angle of the lip. The quality of repigmentation matches accurately with the adjacent skin.
• Micro-pigmentation: Also termed medical tattooing, micro-pigmentation can be used as an alternative treatment for patients with vitiligo who are resistant to conventional treatments. It involves implanting small particles of natural pigment under the skin, similar to a tattoo.

Vitiligo may not be a life-threatening disorder, but the toll it can take on one’s mind and body can be significant. The human race has still not evolved on matters of appearance, and the social stigma surrounding one's looks can be quite disturbing. Learning to accept your condition and adapt to it can help improve your quality of life. Here are a few things to keep in mind while living with vitiligo:

• Give mental health the utmost priority. If you feel depressed or self-conscious about changes in your appearance, talk to your dermatologist who might recommend counseling or a support group. Counseling can be helpful in coming to terms with these issues.
• Learn more about your condition. Knowledge is power; understanding treatment options, factors that can worsen your vitiligo, and other relevant information can help you make informed decisions about your care, allowing you to feel more in control.
• Connect with other people with vitiligo. The emotional aspects of having vitiligo are often overlooked, but the struggle is real. Talking to others with the same condition can help you feel less alone. Supporting others can also be empowering, regardless of the cause.
• Eat the right kind of diet. Incorporate vegetables, fruits, nuts, seeds, and spices that are high in antioxidants. Foods rich in omega-3 (but lower in omega-6) may also help improve your symptoms. These include oily fish, nuts, seeds, and algae. Consider a gluten-free diet, as gluten can worsen inflammation, and include fiber and probiotics in your meals. Avoid inflammatory foods such as processed meats, sugary drinks, trans fats, and processed snack foods.
• Take supplements. Although it is preferable to consume nutrients through whole foods, certain supplements can aid repigmentation in vitiligo patients. These include:
  • Ginkgo biloba
  • Alpha lipoic acid
  • Vitamin C
  • Vitamin E
  • Vitamin D
  Meet all your nutritional requirements from our wide range of supplements.

Vitiligo in kids: Tips for parents

Children usually cope better with vitiligo, and your own over-consciousness as a parent may create more problems for your child than the actual condition. Here are a few things to keep in mind:

• Let your child know that vitiligo is not a serious skin problem.
• Teach your child how to respond to friends, teachers, and relatives who inquire about vitiligo.
• Communicate with close relatives, informing them about vitiligo and requesting that they refrain from discussing it with your child.
• Avoid discussing your child’s vitiligo repeatedly.
• Examine the spots when your child is asleep.
• Encourage your child to engage in activities or hobbies they love.
• Do not allow vitiligo to interfere with your child’s joy and self-esteem.
• Help your child boost their self-confidence.