Summary

Vitiligo causes the skin to lose its natural color. Loss of color can affect hair, eyes, and mouth. Segmental vitiligo is a subtype of vitiligo with a specific unilateral distribution. What causes this color loss is still a mystery. We do know that vitiligo is not contagious. It is not life-threatening. The treatments can be useful for stop disease progression, inducing re-pigmentation, and decreasing the risk of relapses. Cosmetics, sunscreens, topical corticosteroids, topical and oral PUVA therapy, and narrow-band UVB radiation are some of the medical treatment modalities used for patients with vitiligo. Different surgical techniques have been devised over the years, including tissue grafts—best results obtained in segmental subtype vitiligo. Combining two or more treatments often gives the best results. There are advantages and disadvantages to each method of treatment, and not all procedures are ideal for every patient. It is not possible to predict how a patient will respond to treatment. It is crucial to keep in mind that no one treatment works for everyone. Results can vary from one part of the body to another.

What is vitiligo (white spots)?

Vitiligo (vit-uh-lie-go) causes the skin to lose its natural color. Patches of lighter skin appear. Some people develop a few spots. Others lose much more skin color. Vitiligo can also affect other parts of your body. A section of hair can turn white. Some people lose color inside their mouths. Even an eye can lose some of its colors. What causes this color loss is still a mystery. We do know that vitiligo is not contagious. It is not life-threatening.

But vitiligo can be life-altering. Some people develop low self-esteem. They may no longer want to hang out with friends. They can produce severe depression. Most people have vitiligo for life, so it’s crucial to develop a coping strategy that helps many people is to learn about vitiligo. Another helpful approach is to connect with others who have vitiligo.

Vitiligo types and subtypes

If you are diagnosed with vitiligo, your dermatologist may tell you what type and subtype you have. Today, most doctors recognize two types of vitiligo:

Segmental vitiligo (Unilateral)

It appears on 1 segment of the body, such as a leg, face, or arm. About half of people lose some hair color, such as on the head, eyelash, or eyebrows. Often begins at an early age. It often progresses for a year or so and then stops.

Non-segmental vitiligo (Vitiligo Vulgaris)

Most common type. It appears on both sides of the body, such as both hands or both knees. Often begins on the hands, fingertips, wrists, around the eyes or mouth, or on the feet. Often begins with rapid loss of skin color, which then stops for a while. Color loss often starts up later. This start-and-stop cycle usually continues throughout a person’s lifetime.  Color loss tends to expand, growing more noticeable and covering a larger area. Appear. On a rare occasion, the skin may regain its lost color without treatment. The subtypes tell you how much vitiligo appears on the body. The vitiligo subtypes are Localized: A few spots or patches appear, but these are limited to one or a few areas of the body. Generalized: Most people develop this subtype, which causes scattered patches on the body. Universal: Most pigment is gone. This is rare. There is no way to predict how many colors a person will lose. Color loss can remain unchanged for years. Some people see patches enlarge, and new spots appear. On a rare occasion, the skin may regain its lost color without treatment.

What are the signs and symptoms of Vitiligo?

Vitiligo causes loss of your natural color. Your dermatologist may call this “loss of pigment” or “depigmentation.” We can lose pigment anywhere on our bodies, including our: skin, hair(scalp, eyebrow, eyelash, beard), mouth (inside), and genitalia. Most people who get vitiligo lose color on their skin. The affected skin can lighten or turn completely white. Many people do not have any other signs or symptoms. They feel completely healthy. Vitiligo can progress: With time, some people see their vitiligo cover a large area. A few people say that the skin affected by vitiligo itches or feels painful. Living with vitiligo can cause other symptoms, such as low self-esteem and depression that are hard to beat. This can happen regardless of the amount of color loss or type of vitiligo.

How do dermatologists diagnose vitiligo?

If your dermatologist suspects that you have vitiligo, your dermatologist will: Review your medical history and ask specific questions, such as whether anyone in your family has vitiligo. Perform a physical exam, looking carefully at the affected skin. You also may need a blood test to check the health of your thyroid gland. People who have vitiligo often have thyroid disease. A blood test will tell whether your thyroid is healthy. If you have thyroid disease, treatment can successfully control it.

If you have vitiligo and want to treat it, you should discuss treatment options with a dermatologist. There are many treatment options. The goal of most treatments is to restore lost skin color. The best treatment for you will depend on your preference, overall health, age, and where the vitiligo appears on your body. Some people choose not to treat vitiligo. Here are some key facts about treatment options to help you start a conversation with a dermatologist.

No Medical Treatment (use cosmetics to camouflage lost color)

• Cosmetic options include makeup, self-tanners, and skin dyes.
• It offers a safe way to make vitiligo less noticeable.
• I have often recommended it for children because it avoids possible side effects from medicine.
• Must be repeatedly applied, can be time-consuming, takes practice to get a natural-looking result.

Medicine Applied to Treat Vitiligo (white spots)

• Several different topical (applied to the skin) medicines can add color to your skin.
• It is prescribed for small areas.
• The most commonly prescribed medicine is a potent or super-potent corticosteroid that you apply to your skin. About half, 45%, of patients regain at least some skin color after 4 to 6 months.
• A corticosteroid that you apply to your skin may be combined with another medicine to improve results.
• This option works best in people with darkly pigmented skin.
• These medicines are most active in some regions of the body, such as the face. They are least effective on the hands and feet.
• Some of these medicines should not be used on the face because of possible side effects.
• These medicines have possible side effects, so patients must be carefully monitored. A possible profound side effect of using a topical corticosteroid for a year or longer is skin atrophy. This means the skin becomes paper thin, very dry, and fragile.

Light Therapy for Vitiligo (white spots) Treatment

• Uses light to restore lost color to the skin.
• The patient may sit in a lightbox or receive excimer laser treatments.
• Lightboxes are used to treat widespread vitiligo; lasers are used to treat a small area.
• Works best on the face; least active on hands and feet.
• Beneficial for many patients; about 70% see results with an excimer laser.
• Results can disappear. About half, 44%, see effects go within one year of stopping treatment. After four years, about 86% lose some color restored by treatment.
• May cause patients with darkly pigmented skin to see areas of darker skin after treatment, but treated skin usually matches untreated skin within a few months.
• Requires a time commitment. Patients need 2 to 3 treatments per week for several weeks.
• I may combine it with another treatment, such as a corticosteroid that you apply to your skin.

PUVA Light Therapy for Vitiligo (white spots) Treatment

• It uses UVA light and a medicine called psoralen to restore skin color.
• Psoralen may be applied to the skin or taken as a pill.
• Can treat widespread vitiligo.
• About 50% to 75% effective in restoring pigment to the face, trunk, upper arms, and upper legs.
• Not very useful for the hands or feet.
• Time-consuming, requiring treatment at a hospital or PUVA center twice a week for about one year.
• Psoralen can affect the eyes, so this treatment requires an eye exam before and after finishing treatment.
• To help prevent serious side effects, patients are carefully monitored.

Surgical Approach for Vitiligo (white spots)  treatment

• Maybe an option when light therapy and medicines applied to the skin do not work.
• For adults whose vitiligo has been stable (not changed) for at least six months.
• Not for children.
• Not for people who scar easily or develop keloids (scars that rise above the skin).
• Different surgical procedures are available. Most involve removing the skin with your natural color or skin cells and placing these where you need shade.
• It can be valid for 90% to 95% of patients.
• Possible side effects include failure to work, cobblestone-like skin, and infection.

Unconventional Treatment for Vitiligo (white spots)

• Some vitamins, minerals, amino acids, and enzymes have been reported to restore skin color in people who have vitiligo.
• Most have not been studied, so there is no evidence to support these treatments and no knowledge of possible side effects.
• Ginkgo biloba, an herb, has been studied in a clinical trial. Results from this trial indicate that the herb may restore skin color and stop vitiligo from worsening.
• In the ginkgo Biloba trial, ten patients given ginkgo Biloba had the noticeable or complete return of skin color. Two patients taking the placebo (contains no active ingredient) also had a great or total replacement of skin color.
• Because some patients taking the placebo regained their skin color, more study is needed.

Depigmentation for Extensive Vitiligo (white spots)

• This treatment removes the remaining pigment from the skin.
• Very few patients opt for this treatment.
• Removing the rest of the pigment leaves a person with completely white skin.
• It may be an option for an adult with little pigment left, and another treatment has not worked. Removing the remaining pigment can be an effective way to even out the skin color, giving the person white skin.
• To remove the remaining color, you’d apply a cream once or twice a day. This cream gradually removes the remaining color from your skin.
• Depigmentation can take 1 to 4 years.
• Once treatment is finished, some people see pigment spots on their skin from being out in the sun. To get rid of these spots, you can use the cream to remove this color.

The Outcome of vitiligo (white spots) Treatment

It is not possible to predict how a patient will respond to treatment. It is crucial to keep in mind that no one treatment works for everyone. Results can vary from one part of the body to another. Combining two or more treatments often gives the best results.