What is vitiligo?
Vitiligo is a skin pigment disorder due to destruction of melanocytes, the cells that produce skin pigment; it causes changes in the color of parts of the patient’s skin. Many people will remember the skin changes Michael Jackson had from this condition. It affects up to 1 in 100 people in the U.S., with typical onset between the ages of 10 and 30.
Vitiligo will commonly start on areas of the body exposed to the sun, such as the hands/arms or feet/legs, but can affect anywhere on the body. The affected skin areas can become milky/chalky white, or there can be multiple different shades of skin — called trichrome, a three-color/shade variant or even quadrichrome, a four-color/shade variant. The areas of skin discoloration are usually well demarcated and round, oval or linear in shape. In some people, the condition progresses rapidly, and in some, it seems to stabilize or progresses more slowly. The condition may affect small areas of someone’s skin or very large areas. The areas of skin discoloration may be segmental — covering areas innervated by certain nerves, so in these patients, the discoloration does not cross the midline of the affected area — or non-segmental.
Although vitiligo itself causes cosmetic concern, there is also a strong association with several autoimmune disorders, where the body “attacks” itself; up to 20% of vitiligo patients have an autoimmune disorder with thyroid abnormalities being the most common — in up to 12% — and alopecia areata, psoriasis, type 1 diabetes, rheumatoid arthritis, inflammatory bowel disease, pernicious anemia, linear morphea, myasthenia gravis, discoid and systemic lupus erythematosus and Sjögren syndrome also associated with this condition.
The exact cause of vitiligo is not known, although there are many theories. The strong association with certain autoimmune disorders suggests that there may be an autoimmune component.
The diagnosis of vitiligo is made based on the physical findings, although if there is uncertainty — unusual — a skin biopsy can be done. Because of the association with other disorders, blood tests may be done to screen for them — for example, thyroid function tests, etc.
The treatment of vitiligo should be personalized for each individual patient depending on the areas affected, their skin tone, the impact it has on the quality of their life and the patient’s specific preferences. Treatments are usually aimed at minimizing the spread of this condition and may include steroid medications — not surprising as these are common medications used for certain autoimmune disorders, and these may be used topically or as oral medications — skin phototherapy, narrowband UV-B is thought to be the most effective phototherapy; laser treatments; or other medications — whether topical or oral, including a class of medications called JAK inhibitors which are typically used in conjunction with phototherapy. In some cases tattooing or treatments to depigment the non-affected areas may be utilized to improve the cosmetic appearance, or in rare cases surgery may be considered. Very importantly, the psychosocial aspects of this condition should be addressed.
Jeff Hersh, Ph.D., M.D., can be reached at DrHersh@juno.com.