Vitiligo is a common condition in which the skin loses the pigment that determines its color. Also commonly known as Leucoderma (leuco= white and derma= skin), this condition is characterized by irregular pale or milky white patches on the skin. Before we get to understand about the loss of color from the skin in Vitiligo, let us first see how the skin gets its normal color. A pigment called melanin imparts the skin (as well as hair) the native color. This pigment is produced in cells called 'melanocytes'. When the melanocytes die or are unable to function, it results in loss of melanin causing color-less, white patches on the skin.

Alternative Names of Vitiligo are: Leucoderma

Complications of Vitiligo

The list of complications for Vitiligo includes:

• Embarrassment
• Depression
• Anxiety
• Uveitis -Inflammation of the inner eye, which includes the iris, the ciliary body that holds the lens of the eye
• Premature graying

Complications of Vitiligo from the Diseases Database include:

• Rash
• Poliosis -A patchy absence or lessening of melanin in hair of the scalp, brows, or lashes, due to lack of pigment in the epidermis; it occurs in several hereditary syndromes but may be caused by inflammation, irradiation, or infection such as herpes zoster.
• Hypo pigmentation
• Photosensitivity of skin

Causes of Vitiligo

The underlying mechanism which causes Vitiligo is loss of melanin. This occurs due to destruction of existing melanocytes and defective formation of new melanocytes. However, the precise reason why the melanin is lost and what causes the destruction of these pigment-forming cells is not completely understood. A combination of auto-immune, genetic & environmental factors has been seen in most cases. Recent studies have demonstrated that Vitiligo may also be caused by stress which affects the immune system, leading the body to react and mistakenly destroy the melanocytes by releasing antibodies against them. Heredity has been strongly proposed as a cause since many cases with Vitiligo do report incidence of this condition (or other auto-immune disorders) in their family. Possible things that can trigger Vitiligo in an individual who is genetically prone include:

• Skin trauma
• Sun burn
• Emotional stress
• Skin rash
• Exposure to de-pigmenting chemicals - the disease can later spread beyond areas of contact via immune-mediated mechanism. Phenolic/catecholic derivatives are the prime chemicals causing this.

Signs & Symptoms of Vitiligo

A sudden onset is seen in most cases where the patient notices a single, few or many milky white patches of irregular shapes and sizes on the skin. Small areas of de-pigmentation gradually start spreading to involve larger areas of the body. The patches appear more prominent in dark-skinned people and can be quite disfiguring at times. As far as the progress of the condition is concerned, it is highly unpredictable. Some cases experience an extremely fast advancement with quick involvement of large areas of the body whereas in some cases there may be few small patches that don't change much with time. The active phase of development of new patches can be followed by a phase where there are no new patches. The affected areas retain the normal sensitivity to touch and pain; however sun-sensitivity is seen to be increased in many cases. The hair over the affected parts such as skin, scalp, beard, eyebrows, eyelashes, etc. may also lose color. Over a period of time, some of the Vitiligo patches may re-pigment by themselves. The patches of Vitiligo can affect any part of the body though sun-exposed regions, body folds (e.g. groins, armpits), areas around body orifices or sites of previous injury are commonly affected. Following are some of the common patterns of body affection seen in Vitiligo patients:

• Focal: The patches are limited to particular areas of the body
• Segmental: The distribution of the patches is usually asymmetrical affecting one side of body
• Symmetrical: Bilaterally symmetrical patches over the body
• Generalized: Widespread patches spread all over the body
• Over Bony Prominences: The skin near the joints is affected by the patches
• Lip-tip Vitiligo: Vitiligo that is limited to the lips, tips of the fingers and toes, fingertips
• Genital Vitiligo: The private parts of the body are affected

Diagnosis of Vitiligo

The look of Vitiligo is typical enough to diagnose it on the first look. In addition, your medical and family history will enable your physician to make sure of his diagnosis. However, certain tests may be conducted to confirm the condition as well as to ascertain the cause if possible:

• Biopsy of the affected area can confirm the diagnosis of Vitiligo
• Blood tests may be done:
  • To check the thyroid functions
  • To look for the presence of anti-nuclear antibodies (that would point towards auto-immune cause)
  • To rule out pernicious anemia
• Examination of the spots under Wood's lamp can be used to diagnose and evaluate Vitiligo especially when the changes are not appreciated with the naked eye.

Treatments of Vitiligo

Treatment is a long process that may take between 6 to 18 months. Treatments will be tailored to meet the individual's needs.

Common treatments are:

• cosmetics
• sunscreens
• skin creams
• oral medications
• transplantation of skin

Prevention of Vitiligo

Self-care steps, usage of B-complex multivitamin, Folic Acid, Vitamin E, Vitamin D ointment also help some people with vitiligo, Tacrolimus ointment, Cortisone ointments and ascorbic acid may improve the color of your skin.

There are some other certain precautions and vitiligo preventions which can help to stop the onset of the vitiligo.

1. Maintain good general health and immunity.
2. It is a non communicable disease.
3. Any patch should be thoroughly examined first.
4. Application of any unconfirmed tropical medication on skin should be avoided.
5. Use of synthetic clothes should be restricted.
6. Avoid excess intake of Sour things.
7. Avoid Steroids.

When to seek Medical Advice

See your doctor if areas of your skin, hair or eyes lose coloring. Although there's no cure for vitiligo, treatments exist that may help to stop or slow the process of depigmentation and attempt to return some color to your skin.