Vitiligo is a skin disease characterised by discoloured patches, pale white spots on the skin. . It usually becomes apparent after summer, when healthy skin tans, making the difference more noticeable. The first changes most often appear on exposed parts, like the face, especially around the lips and eyes, neck, knees, elbows and hands. The size of the change varies from a few millimetres to ten centimetres. In most cases, this condition occurs between the ages of ten and thirty, although it can also appear in early childhood. In vitiligo areas, the hair can be normal or depigmented, however, depigmented hair can also be found on normally pigmented skin – leukotrichia, which is a sign of exhaustion of melanocyte reservoir of the hair bulb. The natural course of vitiligo is characterized by the expansion of discoloured patches and the appearance of new ones. Spontaneous repigmentation is also possible, but is often cosmetically unsatisfactory.
What causes vitiligo?
The exact cause of vitiligo is not fully understood. Scientists have been trying for years to resolve the dilemma whether vitiligo is an autoimmune disease that occurs when an organism begins to develop antibodies to melanocytes, its own pigment-bearing cells or caused by oxidative stress of the cells and the release of large amounts of free radicals that damage melanocytes. Stress can exacerbate an existing disease, but it cannot be the only cause of vitiligo. Vitiligo is also often associated with other autoimmune diseases, such as Hashimoto’s thyroiditis, diabetes mellitus, pernicious anemia, and alopecia areata. In addition, there are indications that this disease is genetically determined and that vitiligo is a polygenic disease.
When smaller areas of the skin are affected by this disease, it is usually recommended to apply corticosteroid and immunomodulatory creams. The affected area must be treated for several months, with compulsory dermatological control exams. Often this therapy is not enough, so it is combined with UVA radiation, and UV radiation is applied at the beginning of the treatment, in cases where the disease is extended over large area. When the disease affects more than half of the skin surface, it is treated by causing depigmentation of the skin that has not been affected yet. However, it should be noted that there is currently no reliable cure for vitiligo and that repigmentation can be expected in areas where the follicles are present (melanocytes are often preserved), but it is always slow and often incomplete. It is also important to have in mind the risk of sunburn in these areas.