Vitiligo

Vitiligo is a fairly common condition that causes pale, white patches to develop on the skin. This is because that particular area of skin has little or none of a type of pigment called melanin. This is the dye-like substance in the skin cells (melanocytes) that gives skin colour and protects it from the sun's rays.

Any area of the skin can be affected by vitiligo, but it is most commonly seen in parts that are exposed to the sun, such as the face, neck and hands. It is more noticeable on people with dark or tanned skin.

The condition varies from person to person. In some people only a few small, white patches will appear and progress no further, whereas in others the patches may get bigger and join up across large areas of the skin. There is no way to predict how much of the skin will be affected, and the white patches are usually permanent.

About 1 in 100 people in the UK develop vitiligo. The condition can occur at any age, but begins before the age of 20 in about half of all cases. Both men and women are equally affected.

The exact cause is unclear, however, vitiligo is not infectious and you cannot catch it from contact with an affected person.

Vitiligo occurs when the skin cells located in the top layer of our skin (melanocytes) stop producing melanin. It is not properly understood what causes this, although there is growing evidence to suggest that some cases of vitiligo may run in the family, as about 1 in 3 people with vitiligo have a relative who is also affected.

Other possible causes include:

- the immune system (our defence against harmful substances, like bacteria and viruses) destroying the melanocytes cells by mistake,
- the melanocytes cells destroying themselves by mistake,
- hyperthyroidism - an overactive thyroid gland , which controls growth and metabolism (the process that turns food we eat into energy), and
- a case of very severe sunburn.

Vitiligo is first noticed when flat, white spots or patches appear on the skin. The areas most commonly affected include the hands, arms, face, neck, elbows and knees. In some cases vitiligo can develop on the scalp, and the lack of melanin will cause the hair growing from that area to turn white or grey.

There is no way to tell if the condition will spread from the original patch or how fast. However, it is fairly likely you will notice other white patches appearing. For some people this happens quickly, whereas in others the patches may remain the same for months or years.

Vitiligo has no affect on a person's physical health, and will not cause any physical discomfort to the affected skin, such as itching. However, people with the condition may feel very distressed and unhappy by the appearance of their skin, and it may seriously affect their self-confidence.

Vitiligo can usually be identified by its appearance. However, in some cases, your doctor may use the following methods to confirm diagnosis:

- check for a family history of vitiligo,
- check for any previous trauma to the affected area, such as sunburn or a severe rash,
- blood tests to check skin cell count - little or no melanocytes cells suggests vitiligo, and
- take a small sample (biopsy) of the affected skin for testing.

There is no known cure for vitiligo, but many people use treatment to help improve the general appearance of their skin. There are several recognised NHS treatments that can sometimes restore colour and control the spread of the vitiligo.

Treatments generally fall into three categories: medical therapy, surgical therapy and adjunctive therapy (which can be used alongside surgical or medical treatment).

Medical therapies

- Topical steroid therapy: Early on in the condition, your doctor can prescribe a mild steroid cream to apply to the white patches. This can sometimes stop the spread of patches, and may restore your original skin colour. Steroid cream can only be used for a limited amount of time, as long-term use can cause side effects, such as skin striae (when the skin streaks or lines).
- PUVA (Psoralen and Ultra Violet A light) treatment: This involves taking a medicine (psoralen) to make the skin sensitive to light. The skin is then exposed to ultraviolet A light from a special hospital lamp. In almost half of all cases, this treatment works well and the original colour is returned to the skin. However, this treatment can increase the risk of skin cancer because of the extra exposure to UVA rays, and is not advised for children or pregnant women.
- Depigmentation: This involves fading the unaffected skin so that it matches the white areas. A special drug is applied to the white patches twice a day, for about a year to remove the pigment. Depigmentation is permanent and cannot be reversed, but may be the best option for people who have vitiligo on more than 50% of their bodies.

Surgical therapy

- Skin grafting: Doctors remove a very thin layer of normal skin from one area of your body and attach it to the white area with no pigment. This treatment is very time-consuming, not always successful and has a risk of scarring.
Adjunctive therapies

- Skin camouflage: Coloured creams that match your natural skin colour are put on the white patches to disguise them. Some colour creams can be prescribed on the NHS. Also, self-tanning lotion (fake tan) may help to cover vitiligo. It is available from most pharmacies and can last several days before it needs to be reapplied.
- Counselling and support groups: People with vitiligo may find it helpful to speak to a psychologist or join a vitiligo support group, to help them to come to terms with the appearance of their skin. Your GP should be able to refer you to someone who can help in this area.
Also, sunburn is a real risk to people with vitiligo because of the lack of melanin in their skin. So people with the condition, especially those with fair skin, should always apply high factor suncream (factor 20 or above) to their skin to protect themselves from sunburn and long-term damage. This will also minimise tanning and make the vitiligo much less noticeable.

No info

No info NHSDEC07