Vitiligo

Overview:

Vitiligo is a condition characterized by the loss of skin pigmentation. It is an acquired disorder that often has a familial tendency. The main feature is the depigmentation or complete absence of melanin pigment. It can occur in localized areas or affect large portions of the body. About 50% of individuals develop vitiligo before the age of 20, and 25% experience onset before the age of 10. The exact cause is unknown, but it is believed to have an autoimmune nature. Vitiligo is more commonly observed in individuals with endocrine disorders, such as thyroid disease.

Diagnosis:

The diagnosis of vitiligo can typically be made based on clinical evaluation, identifying well-defined areas of depigmentation symmetrically found over bony prominences like the knees or around body openings such as the mouth, eyes, perianal, or periurethral areas. In cases where the diagnosis is uncertain, a skin biopsy may be necessary.

Management:

Patients with vitiligo should be advised to practice strict sun protection. The affected skin areas cannot tan and are prone to sunburn, which increases the risk of skin cancer. Additionally, the loss of pigment becomes more noticeable when the surrounding skin is tanned. Since vitiligo can be associated with endocrine disorders, such as thyroid disease, blood tests may be required to rule out any underlying conditions.

Treatment and Medication:

The choice of treatment depends on the extent and location of the affected skin. Typically, a trial of treatment with topical corticosteroids is the initial approach. Topical immunomodulators like Protopic Ointment or Elidel Cream have also shown effectiveness and are suitable for use on delicate areas for extended periods. Narrowband ultraviolet light treatments (NB-UVB) have been found to be highly effective. The excimer laser delivers NB-UVB specifically to targeted skin areas without affecting the surrounding healthy skin. Ringpfeil Advanced Dermatology offers excimer laser treatment as a preferred option, surpassing older light treatment methods such as PUVA. Excimer has advantages such as shorter treatment times, reduced risk of phototoxic reactions, and suitability for children, pregnant women, and individuals with kidney or liver disease, as it does not involve oral medication. In cases where extensive depigmentation occurs due to vitiligo, complete removal of the remaining pigment may be considered for cosmetic purposes.

Coping:

For individuals who feel self-conscious about vitiligo affecting visible areas like the face and hands, cosmetic products like Covermark or Dermablend are available for camouflage. The National Vitiligo Foundation can serve as a resource for educational materials and support groups.