Vitiligo: Causes, Prevention, Diagnosis and Treatments

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Almost 1% of the world population has vitiligo. When there is vitiligo, the cells responsible for your skin color are destroyed. These cells, called melanocytes, no longer produce skin pigment called melanin. If the cells no longer produce melanin, the skin area will lose color or turn white.

Areas of lost pigment can be seen anywhere in the body, including:
  • Areas exposed to the sun, such as hands, feet, arms, and face
  • Other mucous membranes in the mouth
  • Nostril
  • vulva
  • Back of eye
  • Within your hearing system

If there is a hair in the relevant area, the hair may turn gray or white.

Although vitiligo can affect different parts of the body, it is not contagious.

What are the symptoms of vitiligo?

The primary symptom of vitiligo is a white patch on the skin. And it can affect any part of your body, even around your eyes. Patches can be large or small and appear in one of the following patterns:

Split or Focused: White patches are small in size and tend to appear in one or some areas. When vitiligo appears in focus or segmental pattern, it tends to stay on one side of the body in one area. Several times it lasts about a year and then stops. It is also slower than generalized vitiligo.

Non-split or generalized: A broad white patch appears symmetrically on both sides of the body. This is the most common pattern and can affect pigment cells anywhere in the body. Often people start and stop several times during their lifetime. There is no way to determine when, how fast, how fast a patch will be developed.

According to one study, 75% of patients with vitiligo lost pigments to their hands and face. Another common area is in the body wrinkles, such as the skin around the arm and the skin around the groin.

What are the risk factors or causes of vitiligo?

I do not know exactly the cause of vitiligo. The condition does not appear to be inherited. Most people do not have a family history of disability. However, family history of vitiligo or other autoimmune conditions can increase the risk even if it does not cause vitiligo.

Another risk factor may be having genes associated with vitiligo, including NLRP1 and PTPN22. Most researchers believe that vitiligo is an autoimmune disease because it attacks its own cells. But it is also unclear how your body attacks your pigment cells. A known fact is that about 20% of patients with vitiligo have other autoimmune diseases. Depending on population, these disorders can include, from the most common to the least,

  • Rheumatoid arthritis
  • Scleroderma, Disorders of connective tissue in the body
  • Lupus
  • Type 1 diabetes
  • Thyroiditis due to thyroid dysfunction
  • Psoriasis
  • Alopecia areata, or baldness
  • Malignant anemia, unable to absorb vitamin B-12
  • Addison's disease

Some experts also report that vitiligo can be seen after the following events.

  • Severe sunburn or burns
  • Exposure to toxins and chemicals
  • High stress level

What are the Complications of Vitiligo?

The good news is that vitiligo has little physical side effects on the body a lot of times. The most serious complications can affect your ears and eyes, but they are not common. The main physical effect increases the risk of exposure to sunlight due to loss of complexion. If you apply SPF 30 sunscreen, you can protect your skin with sunscreen.
Psychological effect
Studies show that vitiligo can have a psychological impact. According to scientific reviews more than 50% of patients with vitiligo reported a negative impact on their relationship. Some people reported that they were thinking about their condition all day. Some avoid physical activity, feel their condition is malformed, get depressed,worried with emotional burden

If you have vitiligo and feel any of these negative effects, tell your doctor or someone who cares about you. It is also important to learn as much as possible about disability. This may help to alleviate stress on your condition or treatment options.

Diagnosis

What doctors do to test vitiligo? 
During your visit, your doctor will perform a physical examination, ask about your medical history, and perform a laboratory test. Please report events that may be recent factors such as sunburn, premature speech in your hair, or an autoimmune disorder you may have. Also tell your doctor if someone in your family is suffering from vitiligo or other skin conditions.

Other questions your doctor may ask are:

Where did you start your body?
Do you have vitiligo among your family?
Do you have any autoimmune diseases in your family?
Have you already been treated?
What areas are better or worse?

Doctors can also find patches of vitiligo using ultraviolet lamps. Lamps, also known as wood lamps, help your doctor find the difference between vitiligo and other skin conditions.

Sometimes your doctor may want to take a skin specimen known as a biopsy. The lab will look at this sample. Skin biopsy shows that there are still cells producing pigment in the affected area of ​​the body. Blood tests can help diagnose other problems that can go along with vitiligo, such as thyroid problems, diabetes or anemia.

What are treatment options?

Treatments for vitiligo aim to restore the color balance to the skin. Some treatments add pigments while other treatments aim to add pigments. Here are the different consideration before the type of treatment is chosen
  1. Severity of condition
  2. The location and size of the patch
  3. Number of patches you haveThe patch widespread
  4. How do you respond to treatment?
There are two types of treatment: medical, surgical, or both. However, not all treatments are effective for everyone, and some can cause unwanted side effects.
Always consult a physician if any side effects from the treatment start to occur. They can rebalance doses or provide alternatives.

Medical treatment

It usually takes more than three months to see the effect. 
Topical Creams: Some creams, including corticosteroids, can be returned to white patches at an early stage. Others help slow growth. For stronger creams, a prescription is needed, but long-term use may cause side effects. Side effects can include: Skin contraction, Thinning, Excess Hair Growth and Skin rash

Oral medication: Some medications, such as steroids and certain antibiotics, may be effective in treating vitiligo. These are available only as a prescription.

Psoralen and Ultraviolet A (PUVA) Therapy: To use this treatment, use psoralen as a pill or cream on skin. The doctor then exposes it to UVA light to activate the drug that restores color to the skin. After that, you should minimize sun exposure and wear protective sunglasses. PUVA has the following side effects; Sunburn, nausea, Itching, and Hyperpigmentation

Narrowband UVB light: This is an alternative to traditional PUVA therapy. This treatment provides a more concentrated type of phototherapy, often reducing side effects. It can also be used as part of a home care program under the supervision of a doctor.

Excimer Laser Therapy: This treatment is helpful in small patch areas and takes 2-3 weeks, less than 4 months per week.

Depigmentation: If more than 50% of your body is affected and you want to maintain skin balance, your doctor may recommend decolorization. This is often the solution when the treatment that returns the pigment to the skin fails. Depigmentation focuses on weakening the rest of the skin to match the color loss. It can take up to two years for the treatment to be effective. As directed by your doctor, administer drugs such as monobenzone. The biggest side effect of discoloration is inflammation. This treatment has a permanent tendency and is more sensitive to sunlight.

Surgery


Surgical options can be used when medication and phototherapy are ineffective. If you have not had any new or worsened alveoli during the past 12 months and you did not have vitiligo due to sun damage, your doctor may recommend surgery options.

The types of surgery are as follows;
Skin transplant
: The surgeon removes the healthy, pigmented skin and moves it to the discolored area. The risk of skin transplantation includes infection, scarring or pigmentation. Skin transplantation using blisters is another low-risk option. For this procedure, your doctor will blister the uninfected skin and move the top of the blister to another area.

Melatonin transplantation
: Your doctor removes melanocytes and grows them in the lab. The cells are then transplanted into the skin's discolored areas.

Micropigmentation
: Your doctor has a complex tattoo on your skin. This is best for the lips area, but it can be difficult to match the skin color.

Other therapies and management 
Sunscreen: Reducing daylight exposure helps keep your skin even. Tanning adds contrast to the skin, making ctthe affeed area more visible. The higher the SPF, the higher the protection. It is important to use a sunscreen because there is a risk of sunburn and sun damage in areas without pigment.
Cosmetics: Makeup or self-tanning lotion can keep skin tone even. You can prefer a self-tanning lotion because the cleaning effect lasts longer. 
Mental health care: We study ways to improve the quality of life through medication and psychotherapy. Talk to your doctor if you have a negative mental health effect.

To Overcome the Emotional Side Effect of vitiligo

Studies show that people with vitiligo tend to develop issues surrounding emotional stress and self-esteem. One study also found that parents of children with vitiligo report lower for quality of life. However, vitiligo is not contagious and has no negative physical effects. vitiligo people can live a healthy and active life.

It is important to find a therapist who understands this skin condition and its impact on mental health. Early studies on personal cognitive behavior therapy (CBT) and vitiligo are limited and suggest that it can be helpful as follows.
  • Maintain pride
  • Prevention of depression
  • Improve overall quality of life
The vitiligo support group with your family and friends is a great support circle. These groups offer patients the opportunity to express themselves and meet others in the same conditions. You can also see the stories of people embracing their looks through social media #vitiligo hashtags.

What is new for vitiligo treatment?

Research for vitiligo has increased over the past few years. The latest technology allows advances in genetic research to help us understand how vitiligo occurs. Understanding how vitiligo is triggered and how it interacts with other organ systems can help researchers develop new therapies.
Other studies on vitiligo investigate how trauma or stress induces vitiligo, how genetics affects vitiligo, and how chemical signals in the immune system work.

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