Vitiligo

Key features

Patchy depigmentation

The primary symptom of vitiligo is the development of white or depigmented patches on the skin. These patches can occur anywhere on the body, but they are commonly found on areas exposed to the sun, such as the face, hands, arms, feet, and areas around body openings (mouth, eyes, nostrils, genitalia). The patches may start small and gradually enlarge over time.

Hair and eye involvement

In addition to affecting the skin, vitiligo can also cause depigmentation of hair and eyebrows, resulting in white or gray hair. It can also affect the color of the iris, leading to changes in eye color.

Symmetrical patterns

Vitiligo often exhibits a symmetrical pattern, meaning that if a patch develops on one side of the body, a similar patch will typically appear on the corresponding area of the other side.

Emotional impact

Vitiligo can have a significant psychological and emotional impact on individuals. The visible changes in appearance may cause self-consciousness, low self-esteem, and social or emotional distress. Support from healthcare professionals, support groups, or counseling can be beneficial for coping with the emotional aspects of living with vitiligo.

Variable progression

The course of vitiligo can be unpredictable. Some individuals may experience rapid depigmentation, while others may have a slower progression. In some cases, the spread of vitiligo may halt or even reverse, resulting in repigmentation.

Treatment

Topical
treatments

These medications are applied to the affected areas to help reduce inflammation and repigment the skin. They are most effective when used on small, localized patches of vitiligo.

Depigmentation

In cases of widespread vitiligo that does not respond to other treatments, depigmentation may be an option. This involves using topical medications to lighten the remaining pigmented skin, resulting in a more uniform appearance.

Topical calcineurin
inhibitors

These medications, such as tacrolimus and pimecrolimus, can be applied to the skin to suppress the immune response and help repigment the affected areas.

Narrowband ultraviolet B
(NB-UVB) therapy

This treatment involves exposing the affected skin to a specific wavelength of ultraviolet B (UVB) light. NB-UVB therapy is generally considered safe and effective for vitiligo and is often used for widespread or generalized cases.

Topical corticosteroid and calcineurin
inhibitor combination therapy

Using a combination of corticosteroids and calcineurin inhibitors may provide better results than using either medication alone.

Topical
Immunomodulators

JAK inhibitors (Opzelura) cream developed to modulate the inflammatory proteins associated with vitiligo.

Topical psoralen plus
ultraviolet A (PUVA) therapy

Psoralen is a medication that makes the skin more sensitive to ultraviolet A (UVA) light. The affected areas are first treated with psoralen, followed by exposure to UVA light. This combination helps stimulate repigmentation of the skin. PUVA therapy is often used for more extensive vitiligo or when other treatments have not been successful.

Excimer laser
(XTRAC)

This targeted laser therapy delivers a concentrated beam of UVB light to repigment small areas of vitiligo. It can be effective for localized vitiligo patches.

Recommendations

Here are some recommendations for managing vitiligo:

Sun
protection

Protect your skin from excessive sun exposure, as sunburn can worsen vitiligo and increase the risk of developing sunburned skin patches. Apply sunscreen with a high SPF to the exposed areas of your skin, wear protective clothing, and seek shade during peak sun hours.

Embrace self-care and
stress management

Adopt stress management techniques, such as relaxation exercises, meditation, or engaging in activities that bring you joy and relaxation. Taking care of your overall well-being and mental health can positively impact your quality of life.

Camouflage
techniques

Consider using cosmetics, such as specially formulated cover-up creams or makeup, to temporarily camouflage the depigmented areas and make them less noticeable. This can help improve your self-confidence and reduce self-consciousness.

Maintain a
healthy lifestyle

Engage in regular exercise, eat a balanced diet, and get enough sleep to support your overall health and well-being. While lifestyle changes won’t cure vitiligo, they can contribute to your overall wellness.

Moisturize
regularly

Keep your skin well-hydrated by applying moisturizers or emollients. This can help prevent dryness, itching, and potential complications from dry skin.

Educate
yourself

Stay informed about vitiligo by seeking reliable sources of information and staying up-to-date with research and advancements in treatment options. This can empower you to make informed decisions and actively participate in your treatment journey.

Support groups
and counseling

Connect with support groups or seek counseling to meet others who share similar experiences with vitiligo. Sharing experiences and emotions can provide valuable support and help you cope with the psychological and emotional aspects of living with vitiligo.