FAQs About Vitiligo
Below are a few of the many questions we receive about vitiligo.
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What is vitiligo?
Vitiligo is a genetic, autoimmune skin disease causing loss of pigment from areas of the skin, resulting in irregular white spots or patches. Vitiligo affects about 0.5% to 1% of the population and can start at any age, but about half of those with vitiligo develop it before the age of 20, and about 95% before age 40. It affects both genders, and all races and ethnicities. Generalized vitiligo is a progressive disease resulting in somewhat unpredictable cycles of spreading and cycles of stability throughout life.
Vitiligo is not contagious in any way. The precise cause of vitiligo is not well-understood, though it seems to be the result of a combination of genetic and environmental factors. Some people have reported a single event, such as sunburn or emotional distress, to trigger the condition. Heredity may be a factor because there is an increased incidence of vitiligo in some families. About 30% of affected individuals may report a positive family history (i.e. aunt, uncle, cousin, grandparent). The risk for children of affected individuals to develop vitiligo themselves is thought to be about 5%. Though the condition is not usually physically painful, the psychological and social effects are well-documented. It can be especially devastating to children and those with darker skin.
Today there is still no cure for vitiligo, but more worldwide research is being conducted than ever before, and treatment options are improving. New technologies and research are changing physicians’ approaches to the condition, and recent mapping of the human genome has paved the way for advanced genetic research.
How do you pronounce vitiligo?
Vitiligo is pronounced “vittle-eye-go.”
What causes vitiligo?
The likelihood of developing vitiligo results from different combinations of susceptibility genes, even in the same family. Different family members inherit different genetic combinations, just as they do for height or intelligence. Even among identical twins, both develop vitiligo only one-fourth of the time. Identical twins share all their genes in common, but they don’t share their environmental exposures and other life-events. While it is known that environmental triggers are involved, it is still uncertain as to what they are, with stress (physical and emotional), skin trauma, and exposure to certain chemicals being possible triggers.
How is vitiligo diagnosed?
The doctor usually begins by asking the person about his or her medical history. Important factors are a family history of vitiligo or other autoimmune diseases; a rash, sunburn, or other skin trauma at the site of vitiligo 2 to 3 months before depigmentation started; stress or physical illness. The doctor may take a small sample (biopsy) of the affected skin, and/or a blood sample to do lab work that checks for thyroid antibodies/disease, vitamin D levels, and other conditions that may affect general health or autoimmune status. The doctor may also use a Woods light (specialized black light) to confirm vitiligo, as even when undetectable by the eye alone, the depigmented areas will glow under this light.
What are the symptoms of vitiligo?
The most obvious sign or symptom of vitiligo is loss of pigment on the skin, resulting in milky-white, irregularly-shaped patches on the skin. Vitiligo typically occurs first on sun-exposed areas (face, hands, feet, arms, legs) or areas where clothing or shoes consistently rub on the skin.
Less common signs include pigment loss or graying of hair on scalp, eyebrows, eyelashes, or other affected areas. Some may also experience loss of pigment on the tissues that line the inside of the mouth (mucous membranes) and the retina of the eye.
Some of those affected by vitiligo experience intense itching at the site of depigmentation during active stages.
Will the vitiligo patches spread over time? Will they get larger?
Generalized vitiligo is a progressive disease resulting in somewhat unpredictable cycles of spreading and cycles of stability throughout life. For some, it begins slowly with only a few areas of the body affected; for others, it begins rapidly, with many areas affected by both large and small patches of pigment loss. Many patients report going many years without new patches developing, then experience pigment loss years later. Others report spontaneous repigmentation, with no treatment at all.
Is vitiligo associated with any other diseases?
Vitiligo may be associated with other autoimmune diseases. The most common is thyroid disease, which occurs in about 15% of patients. Other autoimmune diseases like juvenile diabetes mellitus and pernicious anemia are much less common (less than 1%). There is no increased risk for cancer, including cancer of the skin.
Laboratory studies for detection of autoimmune diseases associated with vitiligo may include:
Thyroid profile: especially TSH (to rule out thyroid disease) and thyroid autoantibodies;
Fasting blood sugar (to rule out diabetes);
Complete blood count (to rule out pernicious anemia).
What is depigmentation?
While some people totally depigment through the natural progression of their vitiligo, others make the choice to depigment. For patients considering this option, doctors may request they begin with a psychological screening to determine that this decision is one they fully understand and are emotionally prepared for. It is generally only used in cases of advanced vitiligo, where there is more than 50% loss of pigment, though some physicians may allow its use with a lower percentage when a great deal of the vitiligo is located in the more visible areas.
If a physician determines that a patient is a candidate for this treatment, they begin the fairly simple process by using a topical prescription called monobenzyl ether of hydroquinone (MBEH). It is important to understand that this is a systemic treatment, meaning that once the cream is applied to the skin, it will cause depigmentation in remote areas away from the site of application.
This prescription is a compounded cream for use only by those with extensive vitiligo and is available in strengths of 10%, 20% (most often), 30% or 40%. This cream has been around for at least 30 years, and was formerly manufactured with the trade name of “Benoquin,” but is now most commonly known by its generic name “monobenzone.”
The patient will apply the cream twice daily, perhaps increasing the strength of the active ingredients and/or the coverage area, over a period of a year or more, until the normally pigmented skin has faded to match the vitiligo spots, creating an overall pale appearance. The skin of those who have depigmented looks quite normal, just fair. The paleness is not a stark white, as many fear, but rather a slightly pink tone. Protection from the sun is important after depigmentation is completed in order to prevent sunburns and return of pigmentation from hair follicles.