Vitiligo, or white spot disease, is a skin disease in which the skin turns white in different parts of the body. This complete loss of color in vitiligo is caused by the malfunction of the cells responsible for pigment formation.
What is vitiligo?
Pigmentary disorders in the form of white, pigment-free skin patches are typical of white spot disease. Click to enlarge. Vitiligo refers to a skin disorder that is particularly noticeable in dark-skinned patients. Natural pigmentation occurs as a result of pigment formation in cells that are specially adapted for this purpose. In vitiligo, the pigment melanin is no longer formed in sufficient quantities in these melanocytes. White patches appear on the skin, which do not show any pigmentation. Vitiligo is a chronic, non-contagious disease with an as yet unexplained cause. There is an increased risk for people with autoimmune diseases and occurrence of white spot disease in the family. Among skin diseases, vitiligo is considered harmless and does not necessarily require treatment. However, in the absence of the main protective pigmentation, the risk of sunburn and skin cancer from vitiligo is increased with increased sun exposure.
Causes
Vitiligo occurs when the cells of the skin responsible for pigment formation can no longer produce enough pigment. Hydrogen peroxide levels are elevated in these melanocytes, which is why melanin cannot be produced. However, it is not known for what reasons this detectable increase in hydrogen peroxide content occurs. The trigger for Vitiligo is thus unexplained. It is assumed that it is an autoimmune disease similar to rheumatism. According to this theory, the body reacts to its own cells with defensive reactions due to a misjudgement of the immune system and triggers the destructive process. Another theory suspects that vitiligo is caused by a congenital genetic defect, although the genes involved have not yet been identified. Isolated events such as a sunburn as a particular trigger or psychological stress are also discussed as causes of vitiligo.
Symptoms, complaints, and signs
The symptoms of vitiligo, or white spot disease, are due to a pigmentary disorder on the skin. The otherwise pigmented skin turns white in places. The leading symptom also gave the disease its name. The white pigmented skin patches are usually remarkably symmetrical and clearly demarcated. In some cases, they are asymmetrical. In this case, they may also appear more washed out or blend into each other. Potentially, all parts of the body are affected by the leading symptom in white spot disease. The darker the skin of the affected person, the more clearly vitiligo stands out. In addition, this pigment disorder can also discolor the hair on the affected areas of the body. Occasionally, depigmentation of the lips or oral mucosa occurs. Even with such symptoms, vitiligo is more noticeable in people with dark skin than in lighter skin types. More rarely than other areas of the body, inner ears or eye areas are affected by the white spot disease. In some of the patients, newly developing spots are announced by strong itching. In most vitiligo sufferers, however, the disease progresses without further symptoms. Vitiligo (white spot disease) usually produces only the visually visible leading symptom. However, this can put a great strain on the psyche of those affected. Therefore, complaints such as inferiority complexes or depression can arise from it. The danger of a suicidal tendency exists after all in some affected persons.
Diagnosis and course
A particular characteristic of vitiligo is white patches in areas of the skin that are particularly exposed to the sun. Diagnosis involves a comprehensive skin examination by the dermatologist. For this purpose, it is important to interview the patient, which may reveal a family predisposition to vitiligo. The patient’s questioning in vitiligo includes investigations as to whether an event such as a severe sunburn occurred before the first appearance of the white spot disease. If with this anamnesis the diagnosis by the physician is not yet possible with certainty, a biopsy and blood tests are performed. Vitiligo can spread in such a way that a previously dark-skinned person appears to outsiders to undergo a change in skin color due to the white spots merging together.In some cases, the white patches in vitiligo remain unchanged for years. It is also possible that after some time the production of melanin in the melanocytes resumes and vitiligo disappears by self-healing.
Complications
Vitiligo is harmless and, from a purely medical point of view, does not even need to be treated. Complications, however, often present themselves in the form of severe emotional distress. Many, especially still young, patients feel disfigured by the disease. This is especially true when the disease is pronounced in the face and attempts at therapy do not lead to a visible improvement. Those affected then very often lose their self-confidence in dealing with others and begin to isolate themselves. As a result, serious psychological disorders may develop, especially depression requiring therapy. Physical complications usually result exclusively from the fact that the depigmented skin areas react extremely sensitively to UV light and must therefore never be exposed to the sun or a solarium without protection. Painful and itchy burns can occur very quickly. For those affected, it is particularly stressful at the beginning of the disease not to be allowed to venture out of the house without sun protection. Initially, this is often simply forgotten. Since the consequences do not become apparent immediately, but usually only several hours later, those affected often suffer from pain and itching. If the already highly irritated skin in this situation is then further irritated by constant scratching, inflammation can occur that leaves scars after healing. In addition, the risk of developing skin cancer increases.
When should you go to the doctor?
If changes in skin appearance are noticed during the child’s developmental process or growth, a doctor should be consulted to determine the cause and make a diagnosis. Often, skin changes are an indication that a disease is present and action is needed. In particular, pigmentation associated with white patches on the skin should be discussed with a physician. If there is itching, swelling or open wounds, consultation with a physician is recommended. Visual changes of the lips or mucous membrane in the mouth are other signs of a health disorder. A visit to the doctor is necessary in case of overreaction to exposure to sunlight, pain or constant scratching. For the best possible treatment success, therapy is advisable at the first signs of irregularities. If scenes of emotional distress occur in addition to the physical abnormalities, the affected person also needs help and support. Withdrawal from social and community life, lowered self-confidence, and general malaise should be presented to a physician. If there are abnormalities of behavior, expressions of a premature self-imposed demise, and a depressive demeanor, a therapist should be consulted. A visit to the doctor is necessary in case of inner restlessness, decreased mental performance level and loss of zest for life.
Treatment and therapy
Treatment of vitiligo consists of stimulating the affected cells to produce melanin again, preventing damage caused by the lack of protection in sunlight, and alleviating psychological consequences of white spot disease. Vitiligo is not a disease associated with pain or lasting functional impairment. Nevertheless, the consequences for a patient are significant, as white spot disease mostly affects visible areas of the body. As a psychological burden that can exacerbate vitiligo, this involuntary display of the skin disease becomes part of the treatment. Cosmetic aids are used to equalize the difference between the unpigmented and normally pigmented areas of skin. UV irradiation can stimulate melanin production, but is only advisable for a limited time. Smaller patches of vitiligo can be treated by autologous skin grafting. Tattooing is advised as an alternative if the area of skin affected by vitiligo is not too large. Treatment depends on the individual severity of vitiligo and the level of suffering that patients experience from white spot disease.
Prevention
Prevention is not possible for vitiligo.A healthy diet and avoidance of excessive sun exposure are recommended to eliminate risk factors for vitiligo. Since stress can be a trigger, regular rest periods help to reduce the risk of developing vitiligo in hereditarily predisposed individuals.
Follow-up
Since vitiligo cannot be cured with the current state of medicine, there are no aftercare methods in this regard. The only option medical professionals have for vitiligo is to slow and/or stop its progression. To do this, the patient’s lifestyle must be optimized. Stress must be reduced, as it is a trigger for the spread of white spots. The affected areas should be protected from direct sunlight and, if necessary, treated with special medicinal creams. Patients should therefore aim for a decelerated lifestyle, and people with a demanding job or personal life should take measures to reduce stress. This can be done by learning certain relaxation techniques such as, progressive muscle relaxation, meditation, yoga, autogenic training or breathing techniques. Sunscreen products with high SPF (at least 50+) should be used regularly. Affected individuals should eat a healthy diet. An anti-inflammatory diet rich in vitamins, minerals and antioxidants supports the immune system. Adequate hydration and sufficient sleep contribute to well-being. If the doctor has prescribed medication, it should be taken or applied as directed. Regular check-ups with the dermatologist should always be attended. The intervals at which these take place are decided by the doctor.
What you can do yourself
Affected people should take very special care of their skin, because the disease makes the skin much more sensitive than normal skin. At all times, patients should use a sunscreen with a very high sun protection factor. This should be applied to the affected skin half an hour before sun contact. Wearing hats and sunglasses, as well as appropriate clothing that covers the skin, can also protect against sunburn. Patients should especially avoid the sun in the midday heat. This is because patients burn more quickly. Sunburn would only further damage the sensitive skin. Tattoos should also be avoided. Although there is a special tattooing technique, called micropigmentation, with the help of which it is possible to hide the white spots. However, it is possible that tattooing can lead to further progression of the disease and thus to the appearance of new spots. There are natural substances that are able to take care of the skin suffering from vertigo and even possibly significantly delay its progression. A proven home remedy is red clay, which can be used mixed with water as a healing skin pack. The clay pack contains copper, which can support diseased skin. Besides, red clay improves blood circulation from the skin, making it look much healthier.
