This skin disease has had great social significance throughout history. There are references to it in Indian holy books, 1,400 years BC. The stigma associated with vitiligo, in some cultures, dates back to those times, when it was mistaken for leprosy or other contagious or disfiguring disorders. It causes a great aesthetic and psychological repercussion for people who suffer from it.
Vitiligo is a disease of unknown cause, with a certain genetic predisposition, which appears in all races. It affects between 1 and 2% of the population and both sexes equally; and, although it can occur at any age, it is more frequent between 10 and 30 years, explains the dermatologist in Rajouri Garden.
Despite the great scientific advances, it has not yet been possible to elucidate the reason why melanocytes (melanin-producing cells) are not present in white spots. However, various factors are postulated, such as genetic, autoimmune, and neurogenic mechanisms (nearby nerve endings release a neurochemical mediator toxic to melanocytes). According to the skin specialist in Rajouri Garden, many patients attribute the onset of the disease to some specific circumstance in their lives, a crisis or a certain illness: the loss of a job, the death of a close relative, an accident or a serious systemic pathology.
Clinical picture
The clinical manifestations of vitiligo are very specific and, in general, asymptomatic. The characteristic lesion is a chalk or milky white spot with well-defined boundaries, ranging in size from pinpoint to large spots, in different ways. Their number is variable, since it can present as a single injury or in such a quantity that it is uncountable, explains the dermatologist in Shastri Nagar.
Types of vitiligo
a) Focal: isolated spot or a few scattered spots.
b) Segmental: unilateral spots with distribution of a metamera (field or area associated with a nerve that leaves the spinal cord). It tends to be of an early start and more stable than the generalized one. It usually appears in the area of the trigeminal nerve, neck and trunk.
c) Generalized: it is the most common type and is characterized by scattered spots. It is usual for these spots to be arranged symmetrically on the extensor surfaces of the extremities, mainly in the joints of the fingers, elbows and knees. Other involved surfaces are the wrist, the navel, the lumbosacral zone, the anterior tibia and the armpit. They can be periorificiales, being located around the eyes, the nose, the ears, the mouth and the anus. It can also affect the mucosa (lips, distal part of the penis and nipples). It can be associated with premature gray hair, says the skin specialist in Shastri Nagar.
d) Universal: it affects practically the entire body surface.
Associations
As per the dermatologist in Vishnu Garden, it can be associated with alopecia areata, pigmentary abnormalities of the iris and retina, thyroid diseases (hyperthyroidism, hypothyroidism, toxic goiter and thyroiditis), diabetes mellitus, diseases of the adrenal glands (Addison) and pernicious anemia (due to vitamin B12 deficiency).
Diagnosis
It is easy, although in light-skinned people the exploration with Wood's light can be useful.
Treatment
Four aspects of the disease should be considered:
1) Protect the pigment-free areas with clothing or sunscreen to avoid sunburn, frequent due to the absence of melanin.
2) Try the repigmentation of the white areas, from the regeneration of the surrounding healthy skin melanocytes or the healthy hair follicles of the affected area. This is a difficult task that can be used for: powerful topical corticosteroids when the lesions are small, topical immunomodulators (tacrolimus), and photochemotherapy (PUVA). Healthy skin grafts or melanocyte cultures can also be performed on the affected skin areas, says the skin specialist in Vishnu Garden.
3) Try depigmentation of healthy pigmented areas with 20% hydroquinone monobenzyl ether. It is used if repigmentation fails.
4) Conceal injuries with makeup.
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