Vitiligo
Why is my skin changing color?
Vitiligo is a change in the pigmentation of the skin. Patients with vitiligo lose the color in their skin and it turns lighter than normal skin. It can affect any part of the body including inside the mouth and the eyes. When it affects the scalp the hair can appear to take on a white or grey color.
The cause of vitiligo is unknown. Researchers have not been able to identify a reason why this loss of pigmentation occurs for some people. It is believed to be an auto-immune disorder where our own immune cells attack our pigment cells (melanocytes) and cause them die off. People that have certain thyroid disease or alopecia areata can be at a greater risk for developing vitiligo. I may order some blood work to screen for these conditions.
Vitiligo is a chronic condition and unfortunately there is no cure. Vitiligo can be progressive, meaning that it can continue to spread and go to other body parts. There is no way to predict the course of vitligo and know if it will stay localized to one or a few small areas or if it will progress to many larger areas. Treatment is designed to help restore color back to the affected areas. Some people respond well to treatment and others do not respond at all.
- No treatment: This is a choice some people make. Instead of using medical treatments, they use cosmetics to cover and hide the affected areas. Dermablend make-up is a great product for covering vitiligo.
- Topical steroids: High potent topical steroids can be used in varying intervals to try to generate some pigment production at the affected sites. Treatment often needs to be used for many months before we can expect to see any changes in the skin. There are risks with long term topical steroid use on the skin, so you will need to be monitored closely.
- Non-steroid topical therapy: One medication that I often like to use for vitiligo is called Protopic (tacrolimus). This medication is indicated to be used for eczema, and using it for vitiligo is considered "off-label". It has shown promising results for many of my patients that I have prescribed it for.
- Light therapy: This method uses ultraviolet light to our advantage to help treat and maintain color. This is a good treatment but is sometimes a burden for patients because of the frequency needed to see results. Patients will need to do light therapy at least three times per week, if not more, to see results.
- PUVA therapy: This is light therapy combined with an oral medication called Oxsoralen which produces better results than standard light therapy alone. This medication also has it's own limitations and restrictions and makes light therapy somewhat more challenging. One major side effect and concern for any patient undergoing light therapy treatment is the cumulative exposure of UV rays and the increased risk of skin cancer as the patient ages. It can also affect the eyes and special glasses need to be worn to protect against the UV rays damaging the eyes and causing cataracts.
Vitiligo does not pose any major health risk. However, it can profoundly affect a person's self-esteem and can lead to depression and isolation. Vitiligo support groups can be a useful tool in navigating this challenging skin condition. If you suffer from vitiligo I can discuss your treatment options and help you manage and cope with this difficult disease.