Introduction

There are certain medical conditions that not just affect the physical health of an individual but also negatively impact their confidence. Diseases that involve changes in appearance can also deteriorate mental health.

It makes it crucial to identify such ailments at the earliest and start the treatment as soon as possible. Vitiligo is one such condition that affects about 0.77% of adults in the United States[1].

The disease is marked by the appearance of white spots on skin, which are progressive, but each individual has a different pace of progression. Let’s learn more about it.

What Is Vitiligo? – What Are The White Spots On The Skin?

Vitiligo is a skin condition that produces white spots on skin owing to depigmentation. Melanin is a pigment that gives a brownish or blackish look to our skin. It is also responsible for the color of our hair. When the skin loses melanin, it begins to change its colors.

The condition produces white spots on skin that are more noticeable in people of color because of the contrast.

The disease may affect all parts of the body, including hands, legs, scalps, face, and even hair. Sometimes it is symmetrical, which means it affects both sides of the body in equal manners.

Whereas some cases can be asymmetrical when white spots on skin are isolated.

Who Gets Vitiligo? – Populations At Greater Risk Of Acquiring Vitiligo

Acquiring Vitiligo

Vitiligo can affect people of all ages and races. The prevalence of the disease is the same in all races around the world. About half of the Vitiligo cases are reported before the age of 20. In this population, the disease typically starts in their childhood.

Certain populations are at higher risks of acquiring the disease because of genetic factors, autoimmune diseases, and environmental conditions. Individuals that have at least one known case of Vitiligo in the family make up about 20% of the total patients.

How Does Vitiligo Start? – Pathogenesis Of Vitiligo

The white spots on skin appear when the melanin, a pigment that provides color to the skin, begins to disappear. Several factors are responsible for the reduction of melanin, but the most important of them is an autoimmune response.

Because of certain abnormalities in the body, the immune system starts to treat melanin pigment as a foreign body.

The attack of the immune system on melanin decreases its production and leads to the production of white spots on skin. Experts have not concluded why exactly our own body attacks melanin, but there are a few theories. Some believe it is because of environmental factors, while others link it with metabolic deficiencies.

What Causes Small White Spots On Skin? – The Etiology Of Vitiligo

etiology of Vitiligo

The etiology of Vitiligo has been established with the following factors:

1. Autoimmune Response

An autoimmune response is when the body’s cells start attacking the melanin consequently producing the white spots on skin. The risk of such reactions is higher in individuals that already have an autoimmune disease. It can include rheumatoid arthritis, cellulitis, inflammatory myositis, connective tissue disease, and lupus.

2. Genetics

Vitiligo affects about 1% of the total population, but the risk of a patient’s siblings having about a 6% chance of acquiring the disease. The risks increase even more for the identical twin at 23%. It shows that genetics play a role in the development of Vitiligo[2].

3. Environmental Factors

Environmental factors can produce oxidative stress in the melanin cells that leads to their necrosis and consequently give rise to white patches on skin. Some chemicals can also initiate an autoimmune response in susceptible individuals and can even increase the progression of the disease. Besides the chemicals, direct sunlight can also contribute to the development of Vitiligo in select patients.

4. Metabolic Deficiencies

Some studies have linked Vitiligo with metabolic deficiencies as well. A study[3] found that patients with Vitiligo had low concentrations of high-density lipids and higher amounts of triglycerides compared to the control group.

Types Of Vitiligo

Types Of Vitiligo

Non-Segmental and Segmental are the two main types of Vitiligo. Cases that affect the entire body are known as Universal or Complete Vitiligo, but these are quite rare.

1. Non-Segmental Vitiligo

Non-Segmental Vitiligo affects both sides of the body symmetrically. The pattern of the white spots on skin remains the same on either side. The condition can affect both hands, arms, and skin around cavities such as ears, nose, feet, and elbows. It is the most common type of condition, as it makes up 9 out of 10 Vitiligo cases. The pace of Non-Segmental Vitiligo’s progress is slower than other types. Non-Segmental Vitiligo can be further divided into Generalized, Acrofacial, Mucosal, Universal and Minor Vitiligo.

2. Segmental Vitiligo

As the name suggests, Segmental Vitiligo can affect any segment of the body in isolation. Patients can get light spots on skin at any part of the body. It can affect the face, arm, hand, and even elbows of the patients. Adults are at lower risk of acquiring Segmental Vitiligo, but it affects about 3 out of 10 children with the ailment. Furthermore, the progression of Segmental Vitiligo is faster than other types, which warrants quick diagnosis and treatment.

What Are The Symptoms Of Vitiligo?

  • Some symptoms of Vitiligo are generalized, while others can vary in different patients. The general sign and symptoms include:
  • Asymptomatic depigmented macules and patches that are milky in appearance and lack signs of inflammation.
  • The lesions or white patches can appear at any part of the body at any age.
  • The spots may vary in size, ranging from a few millimeters to many centimeters.
  • The white patches have convex borders that are well-demarcated from the normal skin.
  • Some patches have more than one shade of color. Trichrome lesions have zones of white, light-brown, and normal skin color. These are typically observed in patients that have dark-pigmented skin.
  • Quadrichrome lesions have four colors with marginal hyperpigmentation, and Pentachrome lesions are characterized by five colors, including a blue hue.
  • Hearing loss owing to structural abnormalities of the inner part of the ear.
  • Loss of color inside nose and mouth.
  • Discoloration of part of the eye.

Specific Signs And Symptoms

Signs And Symptoms Vitiligo

Some signs are symptoms that are unique to a particular population. It includes:

1. Koebner Phenomenon

This condition is marked by repeated trauma, such as scratch, chronic pressure, or an accident on the same spot, and it is often coupled with an allergic reaction. This phenomenon usually produces white spots on the areas like ankles, elbows, and neck. It is also known as Isomorphic Response.

2. Depigmented Hair

In some patients, the hair of the affected area also turns gray owing to a lack of melanin. It is a sign that there is not enough melanin in the reservoir for the repigmentation of hair. That said, lack of depigmented hair from the white patches does not affect the diagnosis of Vitiligo.

3. Halo Nevi

Halo Nevi is a condition that is characterized by a mole surrounded by a white ring known as a halo. About 6 to 26% of children affected by Vitiligo develop this sign as well.

Medication Options For Vitiligo – Is There A Cure For Vitiligo?

The choice of treatment is dictated by the age, involvement of skin, pace of progression, and effects of ailment on the quality of life. Certain medications and light-based therapies can restore skin color, but the results can be unpredictable. The results with either of these therapies take months to show the result, and it is also possible that they do not work at all. Medications that are typically used for Vitiligo include:

1. Corticosteroids

Corticosteroid is a class of medication that controls inflammation by blocking the pathways that are responsible for the production of inflammatory markers. By reducing inflammation, these medications limit the progression of the disease. Most patients get prescribed topical steroids, but patients with severe conditions might have to take oral steroids as well. Common medicines in this class include Prednisolone, Hydrocortisone, and Dexamethasone. That said, this medication can lead to a range of side effects that include thinning of skin to osteoporosis.

2. Immunosuppressants

Immunosuppressants are prescribed to patients that have acquired the ailment because of an autoimmune reaction. These drugs shut down the body’s immune system and prevent the disease from progressing. The topical preparations of these medications are also available. However, these medications are associated with potentially fatal side effects like cancer, infections, and increased hair growth. Common medicines of this class include Methotrexate, Tacrolimus, Cyclosporine, and Cyclophosphamide.

How To Prevent Vitiligo?

Prevent Vitiligo

Unfortunately, there are no preventive measures that individuals can take when Vitiligo is produced because of genes. There are strategies to mutate the genes, but those are too expensive, and their harms exceed their benefits for patients with vitiligo, but other cases of Vitiligo can be prevented by the following:

1. Protect The Skin For UV Light

UV rays can produce mutations in genes, which can lead to diseases like Vitiligo and even cancer in vulnerable populations. The risk can be mitigated by wearing broad-spectrum and water-resistant sunscreens. It is important for individuals that live at high altitudes. You can also wear full clothes to protect against exposure to UV rays directly with the skin.

2. Avoid Getting Tattoos

Getting repeated tattoos can irritate the skin, and damage can cause the appearance of white spots on the skin. Furthermore, the trauma to the skin may help increase the progression of the disease in already affected patients.

3. Avoid Fat-Rich Foods

Some studies have indicated that patients with Vitiligo have higher concentrations of triglyceride in the serum. It shows that people with lipid disorders are at higher risk of developing Vitiligo. Hence, individuals that have a genetic predisposition to disease should avoid fat-rich foods to reduce the chances of acquiring the disease.

Is Vitiligo Hereditary?

The chances of acquiring Vitiligo may increase if someone in the family already has the disease. Genetics play a role, but family genetics are not strictly associated with it. The chances of acquiring the disease from the parent are about 30% which is low to classify it as a hereditary disease.

Vitiligo Genetic

Is Vitiligo Genetic?

Yes, genes play an essential role in the development of vitiligo. 50 Vitiligo[4] loci have been discovered with genomewide studies, which establish the involvement of genes in the disease. Furthermore, the chances of an identical twin acquiring the disease become much higher if the other sibling is affected by the disease.

Celebs With Vitiligo

There is a decent number of celebrities who have coped with the Vitiligo, and some even reached the point of superstars. It shows this disease can affect personal confidence when patients can overcome it to follow their passions. Some of the celebrities with Vitiligo include:

  • Michael Jackson
  • Holly Marie Combs
  • Jon Hamm
  • Dudley Moore
  • Steve Martin
  • Joe Rogan
  • Rasheed Wallace
  • Thomas Lennon
  • Richard Hammond
  • Sisqo
  • J. D. Runnels
  • Tamar Braxton

FAQ's

Direct exposure to sunlight, fat-rich food, and repeated trauma to the skin can increase the risk of acquiring Vitiligo. Hence, these should be avoided to prevent the progression of the disease.

Genes play an active role in the development of Vitiligo, but environmental factors and trauma to the skin can also contribute to it.

Stress alone does not produce Vitiligo, but if it is coupled with environmental factors, the chances of acquiring the disease certainly grow.

Vitiligo is a severe disease that can affect other organs besides the skin if not managed properly. It can also lead to hearing disorders and make the patients more prone to autoimmune disorders, like pernicious anemia and autoimmune thyroiditis.

Unfortunately, there is no cure for Vitiligo, but developments are being made in the research. The available treatments can stop the progression of the disease.

Vitiligo starts with the appearance of white patches on the skin, which is coupled with inflammation that can produce a great deal of discomfort. It can involve both sides of the body equally and may also develop in isolated areas.

Conclusion

Vitiligo is a serious medical condition that can affect other organs if not treated accordingly. Patients must take necessary prevention and comply with the prescribed treatment to reduce the risks of further complications. Unfortunately, there are no Vitiligo treatments, but some research has shown promising results. Furthermore, there are a variety of cosmetic products which can conceal the signs of disease to boost the patient’s confidence.