Vitiligo

• Skin that was previously normally pigmented loses its colour, usually appearing white.
• The affected areas of skin have defined borders.
• Vitiligo may be localised (confined to a certain area of the body), generalised (present in patches all over the body), or universal (affecting the entire body, with little or none of the original skin pigmentation remaining).
• Localised vitiligo often appears in a pattern that is termed segmental, in which the skin de-pigmentation follows the path of an underlying nerve. It is common for segmental vitiligo to start in childhood, spread rapidly over the affected area, and then remain unchanged for the rest of the child’s life.
• In non-segmental vitiligo, the patches of affected skin can enlarge or develop in new locations over time, spreading unpredictably.
• The first patches of vitiligo often appear on the feet, face (around the eyes and mouth), forearms and hands. In cases where the percentage of skin affected increases, the most commonly affected areas become the head (scalp and face) and neck, along with areas that are subjected to repeated trauma (for example the hands, fingers, forearms, and other prominent, bony parts of the body).
• The mucous membranes of the mouth, genitals and nipples are often involved, along with patches of adjacent skin.
• Body or scalp hair in the affected area may also lose its pigmentation and become white.
• Vitiligo may develop at any age, but most commonly starts between the ages of 10 and 20 years old.
• A significant percentage of patients with vitiligo are emotionally or socially disturbed by the disfigurement of their skin.
  

Vitiligo is a complex condition, the exact cause of which is not known. It is believed to involve multiple factors (some of which are genetic) that result in skin cells called melanocytes becoming diseased and/or destroyed, preventing them from producing melanin, the pigment that colours our skin and hair.

Although the causes of vitiligo are not fully understood, one theory is that the melanocytes of skin with vitiligo are somehow inherently abnormal, stopping them from functioning normally.

Another possibility is that vitiligo is an autoimmune disease – in other words, a disease in which the immune system turns against the body’s own cells. This theory is supported by a number of changes that are observed in the immune cells of patients with vitiligo, as well as by the fact that patients with vitiligo have an increased likelihood of later developing other autoimmune conditions (including the thyroid diseases Graves disease and Hashimoto thyroiditis).

Oxidative stress (free radical damage) is increased in the skin of patients with vitiligo, and this may contribute to the destruction of the melanocytes.

None of these issues alone causes vitiligo, so it is thought likely that a combination of them, along with others yet to be identified, leads to the condition.

• Phototherapy (UV-therapy) is often used in the treatment of vitiligo. Sometimes oral or topical medications are also prescribed. Your healthcare professional will tailor your treatment plan to your individual case.
• As free radical damage is implicated in vitiligo, it is wise to follow a healthy balanced diet containing plenty of fresh fruit and vegetables, whole grains, legumes, nuts and seeds in order to maximise your consumption of antioxidants.
• At the same time, minimise free radical activity from other sources by avoiding cigarette smoke, exposure to pollution and toxic chemicals, and the consumption of excessive quantities of alcohol.
• If your self-esteem is suffering because of your skin condition, don’t be embarrassed about talking to your healthcare professional. Help and support is available.
  

• Having vitiligo increases your risk of certain other health conditions, including diabetes and some forms of thyroid disease. Ask your doctor to explain the symptoms of these conditions to you, so that you know to seek medical advice quickly if they arise.