Vitiligo: what causes it and how to treat it

By Cristiano Antonino On Jun 26, 2022

Vitiligo is an acquired skin pigmentation disorder that causes the appearance of hypopigmented or achromic patches of varying size on the skin

The disease has a complex pathogenesis that has not yet been fully clarified: among the theories proposed is that of an autoimmune origin, due to an incorrect response of the immune system that reacts to melanocytes, the cells responsible for melanin production.

The appearance of vitiligo spots can cause social and relational insecurities in sufferers that may require psychological support.

Vitiligo affects approximately 0.5-2% of the world’s population, both men and women, and particularly those over 20 years old (but in 50% of cases it begins in childhood).

What are the causes of vitiligo

The causes of vitiligo have not yet been fully clarified.

However, it is known that the risk factors for this disease include autoimmune responses of the body and familiarity with the disorder.

Vitiligo, in fact, involves a loss of melanin (due to the disappearance or inactivation of melanocytes), the pigment that gives our skin its natural, more or less dark colour: the areas in which melanin is not produced are therefore completely white to the eye.

In individuals with a predisposition to autoimmune diseases, perhaps already suffering from conditions such as autoimmune thyroiditis or type 1 diabetes, the body does not recognise melanocytes, the cells responsible for melanin production, and attacks them.

Another factor behind melanin loss could instead be of metabolic origin, in which case the loss of melanin is linked to metabolic disorders, e.g. of the endocrine glands.

Finally, other risk factors for the development of vitiligo are psychophysical stress, skin damage caused by sunburn and skin trauma such as cuts or wounds.

In any case, these are causes that must be investigated by the specialist during diagnosis.

Vitiligo: What are the symptoms?

It is very easy to recognise vitiligo: the hypopigmented patches it causes are very characteristic, with smooth or jagged edges and the central area is noticeably whiter than the rest of the skin.

The area surrounding the vitiligo patch, moreover, may in some cases be slightly hyperpigmented compared to the rest of the skin.

Vitiligo is mainly of two types: non-segmental / bilateral or segmental / localised

Non-segmental vitiligo is the most common, affecting 90% of vitiligo patients and is characterised by symmetrical patches on both sides of the body: the most common areas where it occurs are the hands, eyes and mouth, knees, elbows, arms and feet, as well as the genital area.

Segmental vitiligo, on the other hand, manifests on a single part of the body and particularly affects paediatric patients. Usually this form of vitiligo does not tend to progress, but remains confined to that skin segment.

Vitiligo can also manifest as premature discolouration of hair and beard, but also eyelashes or eyebrows, discolouration of the mucous membranes of the mouth and nose, or changes in the colour of the retina.

How is vitiligo treated?

Vitiligo cannot be eliminated; it can, however, be treated on areas of the skin that are already affected.

Those with mild vitiligo can use topical corticosteroids, topical calcineurin inhibitors (such as tacrolimus and pimecrolimus), or vitamin D analogues (calcipotriol).

For purely aesthetic purposes, cosmetic foundations can be used to even out the skin colour (always on the advice of the dermatologist specialist).

On the other hand, for those with more severe vitiligo, phototherapy or pharmacological intervention with immunosuppressants can be used, which help to pigment the areas of skin affected by the disease, but this is a non-resolving intervention and does not prevent the disease from progressing.

Finally, in certain cases selected by the specialist, depigmentation of the healthy skin can be used, if this disease is present on most of the body, so that the complexion is uniform.

In general, it is important that the depigmented patches do not take direct sunlight, so a sun cream with a high protective factor should be used, as the areas affected by vitiligo, not having the correct amount of melanin, are more sensitive to sunburn.

Another piece of advice may be to supplement vitamin D, in addition to that obtained from diet, as lack of sun exposure to the skin can lead to a decrease in the body’s levels of this important vitamin, which is crucial for the health of our bones.

Several clinical trials are currently underway to evaluate the efficacy and safety of new specific drugs against vitiligo, which could lead to better management of this disease in the coming years.

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