VITILIGO

General Information

DEFINITION--Loss of skin pigmentation in patches. This can affect persons of any race or ethnic group.

BODY PARTS INVOLVED--Skin on the back of the hands, face and armpits.

SEX OR AGE MOST AFFECTED--Late childhood (9 to 12 years) to mid-adulthood.

SIGNS & SYMPTOMS--

Macules (small areas of different skin color) or patches with the following characteristics:

• They are flat, white and can't be felt with fingers.
• They spread to form very large, irregularly-shaped areas without pigmentation.
• They are usually on both sides of the body in approximately the same place.
• Their size varies from 2mm or 3mm to several centimeters in diameter.
• They don't hurt or itch.
• Disorder also causes premature graying of hair.

CAUSES--Probably autoimmune disease. The pigment-producing cells (melanocytes) don't function normally, allowing destruction of pigment. Once pigment has been destroyed, melanocytes can't produce more pigment.

RISK INCREASES WITH

• Family history of vitiligo.
• Thyroid or adrenal disease.
• Diabetes mellitus.
• Addison's disease.
• Pernicious anemia.
• Hyperthyroidism and hypothyroidism.
• Myasthenia gravis.
• Unusual physical trauma.

HOW TO PREVENT--Cannot be prevented at present.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and physical exam by a doctor.
• Microscopic examination of skin scraping.

APPROPRIATE HEALTH CARE

• Self-care.
• Doctor's treatment.
• Skin grafting may be recommended for patients who do not benefit from other therapy.

POSSIBLE COMPLICATIONS--Disorder may never disappear completely, causing permanent disfigurement.

PROBABLE OUTCOME--Treatment is prolonged and often unsatisfactory. Complete and permanent repigmentation is rarely possible. Treatment consists of using an oral medication called psoralens. When discontinued, most of the regained pigmentation is usually lost. It is impossible to predict how much improvement will occur with treatment. Younger individuals (under 30) and those who obtain treatment early usually respond best. Allow 1 year to evaluate results.

How To Treat

GENERAL MEASURES--

• The disorder is benign and usually just a cosmetic problem. Some patients with limited disease may choose to use a make-up product.
• Cover the lesions with waterproof, opaque makeup.
• Apply sunscreen with sunscreen protective factor (SPF) of 15 or greater to protect areas without pigment from sun damage.

MEDICATION--Your doctor may prescribe:

• Psoralens (drugs) along with exposure to ultraviolet A (UVA), which stimulates pigmentation from healthy pigment cells bordering damaged cells. The combination of psoralens and UVA is called PUVA. Results may be disappointing and adverse effects are frequent.
• High-potency topical steroids.
• For extensive vitiligo, application of hydroquinone cream.

ACTIVITY--Avoid excess sun exposure while undergoing any therapy.

DIET--No special diet.

Call Your Doctor If

• You have symptoms of vitiligo.
• New, unexplained symptoms develop. The drug used in treatment may produce side effects.