Noticing white patches on your skin can be a distressing experience. But how do you know if it's a sign of vitiligo?
We asked dermatologist and Professor at the Cranley Clinic Dr Nick Lowe for his expert advice from everything ranging from what it is to its symptoms to what to do next. Here’s what we found out...
GTG: What is vitiligo and what are its causes?
NL: It’s a condition where you lose the ability to produce normal skin colour or pigment. It is thought to be an autoimmmune disease where some event or agent has brought about some abnormality directed against the pigment cells (called melanocytes), that then stops them from functioning. The white patches can disappear though in response to treatment and start to produce pigment again.
Four main theories exist:
1. Abnormally functioning nerve cells may make toxic substances that injure melanocytes.
2. The body’s immune system may destroy melanocytes. Researchers think pigment may be destroyed as the body responds to a substance it perceives as foreign.
3. Pigment-producing cells self-destruct. While pigment is forming, toxic by-products could be produced and destroy melanocytes.
4. There is a genetic defect that makes the melanocytes susceptible to injury.
There are a few skin conditions that look like vitiligo but are not. There’s a superficial yeast infection that occurs in hot humid summer weather called tinea versicolor, where the yeast causes temporary reduction in the skin pigment. However, this doesn’t cause as severe a loss of pigment as vitiligo does. It can sometimes be hard to identify, so a dermatologist would need to see it and take skin scrapings to see if the yeast is present.
Some patients who have olive or darker skin could have other skin diseases which could be mistaken for vitiligo. Skin conditions like eczema could result in loss of pigment too.
GTG: What are the symptoms of vitiligo?
NL: Sufferers will notice that they’ve got lighter patches on their skin and it then proceeds from there. It can spread and in many cases, it can slowly progress to loss of pigment in certain areas. It can occur on the elbows, knees, hands, backs of feet and sometimes on the face.
There are two main types: it can be localised or segmental in one area of the body such as the side of the face or around the eyes, or there is the other more common type - generalised vitiligo that can occur on any part of the body.
GTG: Is there a cure to vitiligo?
NL: Unfortunately it is not curable, as even if you improve it with treatment it can come back. Improvement and control would be the best term rather than ‘cure.’
GTG: What treatments would fall under the term ‘improvement and control?’
NL: The main treatments would involve ultraviolet light if it’s being used to target a more generalised, scattered form of vitiligo. Either UVB is used (a sunburn narrow band treatment) or a combination of medicine (called psoralen) and UVA called PUVA which stimulates the pigment cells to produce more pigment. The only snag is that you need several sessions over 6 to 12 months and it may not re-pigment all of the affected areas uniformly. Some re-pigment is often darker. These are all things that the patient has to consider.
If the vitiligo is localised (i.e. white patches) you can consider using one of the creams available. Creams that sometimes work best are ones that reduce autoimmune damage such as Elidel cream, protopic ointment or some of the stronger cortisone creams which are available via prescription through a dermatologist. A GP may be able to help as some have extra training in dermatology, but if they don’t have the necessary knowledge they can refer you to a dermatologist.
The findings in the latest studies for treating localised areas have been very interesting. Lots of research has been done on it in India and the results were presented recently at a British dermatology meeting. Very tiny skin grafts from an area of the skin that had pigment were grafted onto the affected areas. However, it’s a question of how extensive the selection of areas you want to treat are, as it is obviously very time-consuming.
We'd recommend camouflage makeup brands such Dermablend, Veil and Keromask which offer a wide range of products with the requisite texture to help even skin tone effectively and seamlessly. If you suffer from vitiligo, you’re not alone. This inspiring video released by Dermablend Pro as part of its Camo Confessions campaign shares vitiligo-sufferer Cheri’s story and challenges attitudes towards makeup.