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Definition of Vitiligo disease
Vitiligo – a condition of hypopigmentation in which melanocytes die in patches of skin, leaving macules that are pale and depigmented.
Dermatologists believe vitiligo is an autoimmune disorder in which the immune system produces antibodies that attack melanocytes, the skin cells responsible for producing pigment.
Vitiligo affects people of all races and ethic backgrounds, though is more conspicuous in people who have darker skin.
There appears to be no pattern to the presentation of vitiligo, which may affect small areas or nearly the entire skin surface. The depigmented areas have no other symptoms—that is, they do not cause itching or pain. Vitiligo occurs more frequently in people who have other autoimmune disorders such as alopecia areata.
Symptoms and Diagnostic Path
In most people who develop vitiligo, the areas of depigmentation generally appear slowly and start with small patches of skin. Some people do not develop more than a few such patches, while other people eventually develop large and numerous patches of depigmentation.
In most people, the depigmentation is roughly symmetrical on both sides of the body, though in some people it affects only one side. The appearance of the depigmented areas is generally diagnostic as this is a unique symptom of vitiligo. The most common sites for depigmentation are the face, hands, arms, legs, and genitals.
Often there was a precipitating factor, such as a severe sunburn or other trauma to the skin, within several months of the start of symptoms. Serious physical injury or illness may also precipitate symptoms. The dermatologist may biopsy a representative lesion to rule out other causes. Sometimes blood tests will show the presence of antibodies, which strongly supports the diagnosis of an autoimmune disorder.
Treatment Options and Outlook
The cosmetic aspects of vitiligo are often the most disturbing feature of vitiligo for people who have the disorder, and most treatments target cosmetic improvement. Most aim to slow the progression of the depigmentation or to darken the appearance of depigmented areas and include topical corticosteroid medications, micropigmentation (therapeutic tattooing), and psoralen plus ultraviolet A (PUVA) phototherapy. Skin grafts are sometimes an option for small areas of depigmentation, though are expensive and entail numerous risks. Cosmetics to cover depigmented areas work well for some people.
Another therapeutic approach is to create hypopigmentation consistently, lightening all of the skin using topical bleaching agents such as monobenzone to make the depigmented areas less conspicuous. Such lightening is permanent, and establishes heightened sensitivity to sun exposure with the risk for severe sunburn. The functional disturbances to the skin also have significant implications for health, as the depigmented areas cannot protect from sun damage. Protective, fullcover clothing and high sun-protection factor (SPF) sunscreens are necessary to provide this protection.
In most people, vitiligo progresses despite treatment. One of the most challenging dimensions to vitiligo, as with other dermatologic conditions that have similarly conspicuous symptoms, is the sense of social isolation and embarrassment many people who have the condition feel. Vitiligo is especially difficult for adolescents and young adults to manage. Support groups are often helpful for coping.
Risk Factors and Preventive Measures
Because dermatologists do not know what causes vitiligo to start, there are few known preventive measures. It does appear that significant trauma to the skin, such as a sunburn that blisters and peels, can trigger vitiligo. Most dermatologists believe gene mutation is the underlying cause, as is the case with many autoimmune disorders, though researchers have yet to verify this. Limiting sun exposure by wearing protective clothing and sunscreen may slow the progression of vitiligo.
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