Somewhere between 0.5 and 2.0 percent of the global population has vitiligo, a disorder that affects pigmentation of the skin. With this condition, the cells that make the skin’s pigment, called melanocytes, are destroyed. This results in white blotchy patches.
For some, vitiligo may occur on the face, neck or hands, causing a dramatic and traumatizing change in appearance. For others, it may strike mucous membranes like the mouth, nose and genitals, as well as the retinas. If a patch appears on an area with hair growth, the hair will turn white or very light gray. (1)
While researchers have not pinpointed a universal cause, autoimmune disorders seem to be the most prevalent vitiligo cause; however, a deficiency in certain vitamins and minerals, as well as exposure to some industrial chemicals, also can cause this disorder.
Finding the right vitiligo treatment therapy takes time; even the most common conventional treatments can take weeks, months, or even years before appearance improves. Conventional vitiligo treatment such as topical creams, light therapy, photochemotherapy, permanent depigmentation treatments of healthy skin, surgery, and cosmetics are often prescribed. And they all come with some significant adverse side effects.
Research continues. Currently, there are over 75 studies listed on clinicaltrials.gov looking for answers and solutions to this disfiguring condition. As vitiligo often causes severe emotional distress, self-consciousness, anxiety and depression, counseling and support group participation is highly recommended.
What Is Vitiligo?
Vitiligo is a pigmentation disorder where melanocytes, the cells responsible for providing the color of our skin, hair, and eyes, are destroyed. The result is white patches of skin intermingling with normal skin tones. It may resemble the random pattern and patchiness of a severe sunburn when the skin peels.
Often, if affects more visible areas like the face, neck, hands, elbows, knees and feet. But, it can appear anywhere on the body. Vitiligo is not contagious and it’s non-infectious; however, it may have hereditary or genetic markers. Researchers are still examining causes, risk factors and effective treatments.
There are three recognized types of vitiligo:
Generalized Vitiligo. White patches of skin progress symmetrically on both sides of the body, affecting the same body parts at the same time.
Segmental Vitiligo. Typically appears in younger children where the white patches appear only on one side of the body.
Localized Vitiligo. The white patches appear in one or two areas of the body, progress and spread for a short period of time, and then stop.
Vitiligo Signs & Symptoms
The hallmark of vitiligo is white patchy areas of skin; however, other areas of the body may be affected too: (2Premature whitening or graying on the scalp
- White or gray eyelashes or eyebrows
- Whitening of a beard
- Loss of color in the mucous membranes
- Loss of color in the retinas
Vitiligo Causes & Risk Factors
Autoimmune diseases including Addison’s disease, thyroid disease, pernicious anemia and diabetes are believed to be root vitiligo causes. (3) However, some studies indicate people diagnosed with this condition are often deficient in certain vitamins like B12, folic acid, copper and zinc.
Additionally, heredity and genetics may also play a part in this condition, as do stress, severe sunburns, and exposure to some chemicals. In some cases, immunotherapy for melanoma and other skin cancers may cause vitiligo. However, researchers note that this is a good sign that the cancer treatment is working. (4)
In Ayurveda practice, where vitiligo has been identified for over 2,000 years, it is often referred to as “white leprosy.” Vitiligo causes include consumption of contradictory foods, eating too much grain, curd, fish, or sour substances, and a variety of other physical and emotional traits. (5)
As this condition is not infectious nor is it contagious, conventional vitiligo treatments work to restore the skin color, or even-out the overall tone of the skin. However, results are unpredictable and, according to the Mayo Clinic, have serious side effects. In addition, it may take weeks, months or over a year to see results and judge the effectiveness of the chosen treatment. The most common conventional treatments include: (6)
1. Makeup and Dyes. These compounds conceal the discoloration temporarily. They are temporary and must be reapplied often. There are a few relatively new products that are waterproof and are designed specifically for vitiligo sufferers. One application may last as long as four or five days.
2. Corticosteroid Creams. A dermatologist may prescribe a corticosteroid cream soon after diagnosis, which is when it tends to work best. However, results are often not seen for several months or up to a year. A common side effect is thinning of the skin, and in some individuals corticosteroid creams may cause streaks or lines that may become permanent.
3. Tacrolimus or Pimecrolimus Ointments. These ointments are a conventional vitiligo treatment commonly prescribed for individuals with small areas of depigmentation. While research indicates that they may cause fewer side effects than corticosteroid creams, the FDA warns that these drugs are possibly linked to lymphoma and skin cancer. The long-term safety is just not known, and the FDA recommends the use of this drug only if no other medications are working. (7)
4. Psoralen and Light Therapy. PUVA therapy was initially developed to treat psoriasis and is now often prescribed for treating vitiligo. The combination of oral medication in addition to exposure to UVA may help repigmentation of the white patches caused by vitiligo. Multiple sessions are necessary and in some cases treatments may be required three times a week for up to a year. As there is a relationship between UVA exposure and certain types of skin cancers, making an educated decision about this therapy is vital. (8)
5. Depigmenting Agents. If the white patches are widespread, and other treatments have failed, a dermatologist may recommend depigmenting unaffected areas, lightening them to match or blend with the discolored areas. This vitiligo treatment is often done once or twice a day for nine months or longer, and the end result will be permanent. When considering this traditional treatment, it is important to understand that permanent depigmentation may result in extreme sensitivity to sunlight.
6. Surgery. When other vitiligo treatments have failed, skin grafting, blister grafting, and tattooing may be recommended. These are significant surgeries and side effects for these procedures can be serious including permanent scarring, a cobblestone appearance and infection. The trauma of the surgery may even cause additional patches of vitiligo. (9)
7. JAK Inhibitors. Down the road, JAK Inhibitors, now only approved by the FDA for rheumatoid arthritis and certain bone marrow disorders, may be used to treat vitiligo, alopecia, and atopic dermatitis. Large-scale clinical trials are necessary to determine safety and efficacy for the FDA to approve this treatment. (10)