What Is Vitiligo & What Causes It?

Vitiligo is not infectious and cannot be spread to other people.

Vitiligo can remain localized and stable indefinitely or can either increase in size slowly or rapidly. Unfortunately, there is no way to predict how vitiligo can progress. Risk factors that precipitate progression of vitiligo are speculative with emotional distress, physical illness, severe sunburn, and pregnancy often implicated. Depigmented areas may sometimes spontaneously repigment. How vitiligo appears and spreads may also be dependent on the different types or patterns of vitiligo. Here are some examples of the different types of vitiligo: • Generalised vitiligo: affects large areas of the skin all over the body • Universal vitiligo: this term is used when ≥80% of the skin is affected • Focal vitiligo: small, localised area/s are affected • Acrofacial vitiligo: areas of the mouth or face and the hands and/or feet are affected • Mucosal vitiligo: mucosal areas such as the lips, inner nose or genital areas are affected • Segmental vitiligo: this form of vitiligo is distinct from the other types in that it only affects one side of the body and can initially spread very quickly over 6-12 months then remains mostly unchanged later.

The diagnosis of vitiligo is usually based on clinical examination. A doctor may use a special lamp called a known as a Wood’s lamp to examine the skin and may consider blood tests to check for other autoimmune conditions which are associated with vitiligo.

For people with vitiligo, 10% have another family member with vitiligo. Many people do not realise that anyone in their family has had vitiligo. Children have a higher probability of developing vitiligo if their parents or family have vitiligo. It is important to remember that the condition is not 100% hereditary.

Current research does not appear to demonstrate that people with vitiligo are at increased risk of skin cancer. In fact, recent studies have suggested that people with vitiligo are at decreased risk of developing cancer overall. Further research into this is required for further understanding.

Unfortunately, currently there is no cure for vitiligo however there are treatments that are effective in inducing repigmentation to the skin that has been affected by vitiligo as mentioned above. Ongoing research into vitiligo is being carried out globally, hopefully as the scientific field improves there will be new treatment therapies for vitiligo.

Everyone is unique and therefore a dermatologist is the best person to assess and manage vitiligo. Earlier treatment commencement is ideal to help prevent further spread of vitiligo and may involve a combination of treatment modalities as listed below as well as providing ongoing psychological support. However, as vitiligo predominately affects the skin without causing other health risks, some people choose to embrace their vitiligo and opt for no treatment. Camouflage Camouflage can be achieved with make-up and topical dyes to conceal the areas affected by vitiligo as well as reduce the stark contrast between the white depigmented skin and the surrounding skin. Camouflage including specialised medical camouflaging products designed to conceal skin conditions, a range of cosmetic make-up or foundation and self-tanning lotions (sunless tanners).

Microtattooing/micropigmentation is a procedure which involves implanting pigment under the skin to camouflage it with the surrounding skin (like a tattoo) can be useful for small stable areas of vitiligo such as face, lips and hands. Medical treatment To re-pigment the skin, new pigment cells must be produced from existing ones. These pigment cells come from the base of hair follicles, from the edge of the lesion or from the patch of vitiligo itself if depigmentation is not complete.

Treatment includes topical corticosteroids, light therapy with photosensitising psoralen drugs applied topically or given systemically in conjunction with sunlight exposure or UVA phototherapy (PUVA ), narrow band UVB phototherapy, and other topical agents-calcipotriol, pimecrolimus and tacrolimus. Approximately 75% of patients who undergo light therapy respond to some extent. Even for these individuals, complete repigmentation rarely occurs. Patients initially look worse with light treatment since the contrast between light and tanned skin increases.

With time, repigmentation begins, and the appearance of the skin will improve. If patients stop the treatment, most will retain the achieved repigmentation. Surgical treatment Surgical treatments should only be considered when medical therapies fail. They should only be performed on patients with stable non- progressive vitiligo, ideally localized or segmental. These procedures can be used in combination with medical therapies.

A number of surgical techniques for repigmentation of vitiligo have been developed. They involve transfer of a patient’s own melanocytes from unaffected skin into vitiligo affected skin (autologous melanoycte transplantation). Techniques available include mini-grafting using for example punch grafts, non-cultured epidermal suspension, cultured melanocyte suspension and cultured epidermal grafts Very good results can be achieved with these procedures.

Lasers such as the 308nm xenon chloride excimer laser have been used to treat vitiligo. Excimer lamps producing UV light at 308nm (such as VTRAC, Excilite-µ and Quantel) are also being used which provides phototherapy via a hand held device. Depigmentation Treatment with monobenzyl ether of hydroquinone can be used in patients with extensive vitiligo, involving more than 80% of the skin. This process may take 6 months to 2 years to achieve. Strict sun protection is required after depigmentation. Pigment removing lasers can also be used.

Generally speaking, treatment for vitiligo can take at least 3-6 months for you to see some effects and up to 12-18 months for the satisfactory results.

Due to the visible nature of vitiligo and the change in the appearance that it brings about, it can have a profound psychological effect and cause low self-esteem, embarrassment, depression/anxiety and social stigma. It is very important to have an open discussion about mental health with the impacts of vitiligo with friends and family as well as GPs and dermatologists who can provide additional support Some patients need help with the emotional and psychological aspects of vitiligo and referral to either a psychologist or psychiatrist should be considered. Vitiligo support groups and other patients with vitiligo can also offer support. Contact the Vitiligo Association of Australia if you are interested in joining in a support group. Friends and family are also a good source of support.