By Aizah Faisal
Edited By Brianna Xiao and Lucy Thomas
Vitiligo is a unique skin condition that creates patches of skin with lost colour, leading to lighter or even white spots on the body. The extent of vitiligo can vary widely among individuals — while some might see only small patches, others could experience larger areas of discoloration. Areas of the skin that lose their pigment are called macules.
Vitiligo typically begins with a few small white macules or patches that may gradually spread across the body. It often starts on areas like hands, forearms, feet, and face, but it can appear anywhere, including on mucous membranes (like those in your mouth, nose, genital, and rectal areas), as well as the eyes and inner ears.
Predicting the progression of vitiligo can be challenging. The patches may spread slowly over weeks or remain stable for months or even years. This unpredictability adds to the complexity of managing the condition, making ongoing observation and treatment a key part of living with vitiligo.
Vitiligo affects skin colour by disrupting melanin production, the pigment responsible for skin colour. Everyone is born with a similar number of melanocytes, but the amount of melanin they produce varies. Dark-skinned individuals have melanocytes that produce more melanin, while light-skinned people produce less. In vitiligo, the skin suddenly stops producing melanin in certain areas.
Vitiligo may arise from several factors. It could be an autoimmune condition where the immune system mistakenly attacks and destroys melanocytes, the cells responsible for skin colour. Genetic changes also play a role, as mutations or alterations in DNA can impact melanocyte function, with over 30 genes linked to a higher risk. Additionally, stress—both emotional and physical, especially following an injury—can affect melanin production. Environmental factors such as ultraviolet radiation and exposure to toxic chemicals can further disrupt melanocyte activity, contributing to the development of vitiligo.
Another important aspect of vitiligo is its photosensitivity. This means that the lighter patches are more susceptible to sunburn and damage from sunlight compared to unaffected skin. As a result, sun protection is especially crucial for those with vitiligo.
Vitiligo can be classified into several types. Generalised vitiligo, the most common form, causes white patches to appear in various areas across the body. Segmental vitiligo affects only one side of the body or a specific region, such as the hands or face. Mucosal vitiligo involves the mucous membranes, including those in the mouth and genitals. Focal vitiligo is rare, characterised by small, localised patches that typically don’t spread beyond their initial area within one to two years. Trichrome vitiligo features a bullseye pattern with a white or colourless centre, surrounded by lighter pigmentation and then normal skin tone. The rarest form, universal vitiligo, affects more than 80% of the skin with widespread loss of pigment.
While vitiligo itself is not harmful and primarily affects appearance, many seek treatment if the condition is widespread or impacts their emotional well-being. Several effective options are available. Medications, including topical creams and ointments, can help restore pigment or manage symptoms. Light therapy, using UVB light or lasers, stimulates pigment production and may require multiple sessions for noticeable results. Depigmentation therapy, which uses the drug monobenzone, lightens the remaining pigmented skin to match the white patches, creating a more uniform skin tone. Surgical treatments such as skin grafts or blister grafting can also be considered, aiming to replace or restore pigment in affected areas. Additionally, counselling can support emotional health by helping individuals cope with the psychological impact of vitiligo.
Vitiligo is more than just a skin condition; it’s one of the most emotionally devastating diseases in dermatology due to the significant cultural emphasis on skin colour. While the stark contrast of white patches is especially noticeable in people with darker skin, the psychological impact affects everyone with vitiligo. Physicians need to be acutely aware of how vitiligo can undermine self-esteem and the overall quality of life. It’s essential for doctors to address not just the physical aspects of vitiligo but also the emotional and psychological toll it takes on patients. This means going beyond viewing vitiligo as merely a cosmetic issue and focusing on dispelling myths while offering effective treatments for repigmentation. By recognizing and addressing both the emotional and physical challenges of vitiligo, healthcare providers can offer more comprehensive and empathetic care to patients.
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