Vitiligo is a skin condition that affects millions of people worldwide. It causes loss of skin colour and creates white patches. Although it is not life-threatening, it can have a profound impact on a patient’s self-confidence and self-esteem, and can significantly affect their daily life and quality of life in general.

Many people with vitiligo try to cover up the patches with the help of makeup, clothing, or accessories, while their psychological well-being can be affected to such a degree that it becomes truly impossible for them to leave the house without thorough preparation. Monitoring of the condition by a specialised dermatologist can substantially improve patients’ lives, as they can be guided toward the ideal treatment for them.

What is vitiligo?

Vitiligo is a chronic skin disorder characterised by loss of melanin — the pigment responsible for the colour of our skin, hair, and eyes. This results in the development of white patches in various parts of the body. While the exact causes of vitiligo remain the subject of ongoing research, it is clear that it is neither contagious nor caused by any form of infection.

Vitiligo is an autoimmune disorder, characterised by white patches/plaques. The formation of these patches is due to the destruction of melanocytes. The age at which the disease usually appears is the second decade of life, and it predominantly affects women.

There are four different types of vitiligo. The distinction is made based on where exactly the patches are located on the body. They are:

  • The localised form, with asymmetrical appearance of patches within a dermatome.
  • The generalised form, where the face, the genital area, and the dorsal surfaces of the hands are affected. This is the most common form of vitiligo.
  • The universal form, where there is depigmentation of the entire surface.
  • The acrofacial form, which affects the distal parts of the fingers and the natural orifices of the face (around the eyes, mouth, nose, ears).

What are the causes of vitiligo?

Although what exactly causes it is not entirely clear, various causes may play a significant role in its appearance, including:

  • Heredity: There is evidence to suggest that genetics plays a role in the development of vitiligo. If you have a family history of the condition, you may be at higher risk of developing the disease.
  • Autoimmune disorders: In some cases, vitiligo is associated with autoimmune disorders, where the body’s immune system mistakenly attacks and destroys melanocytes — the cells responsible for producing melanin.
  • Environmental factors: Certain environmental factors, such as exposure to chemicals, toxins, or skin injury, may trigger or worsen vitiligo in susceptible individuals.

What are the symptoms of vitiligo?

Vitiligo presents with a range of symptoms, the most fundamental being the development of depigmented patches on the skin. The symptoms of vitiligo include:

Loss of skin colour

The hallmark symptom of vitiligo is loss of skin colour, leading to the formation of white patches. These spots can appear anywhere on the body and vary in size and location. They may initially be small and gradually spread over time.

Premature greying of hair

Vitiligo can also affect hair colour, causing premature greying or whitening of hair in areas where the skin has lost melanin.

Sensitivity to sunlight

Depigmented areas of the skin due to vitiligo may be more sensitive to sunlight. As a result, patients are prone to sunburn. Protecting these areas from UV radiation is essential

What treatments are available for vitiligo?

Managing vitiligo is challenging, with no more than 15–20% of cases showing repigmentation. As the main concern is psychological — with patients experiencing depression and difficulties in interpersonal relationships — various brands of make-up have been suggested for the temporary concealment of patches.

Pharmacologically, vitiligo is managed in various ways. There are several treatment options for managing the condition and improving its appearance. Dermatologists can recommend and administer the following treatments:

  • Use of topical corticosteroids: These anti-inflammatory creams or ointments can help reduce inflammation and enhance skin pigmentation.
  • Topical calcineurin inhibitors: These medications can be used on the face and neck to help restore skin colour without the side effects associated with corticosteroids.
  • Phototherapy: This treatment involves exposure to a controlled spectrum of light, which activates the cells that produce melanin. Phototherapy can be applied either alone or in combination with medications to stimulate pigmentation.
  • Skin grafting: In severe cases, where large areas of skin are affected, dermatologists may recommend skin grafting, where healthy skin is transplanted to depigmented areas.

Why is phototherapy considered the ideal solution for vitiligo?

Phototherapy is now the most modern method for treating vitiligo. It is performed through controlled exposure of the affected skin to ultraviolet (UV) light. Treatment aims to stimulate the skin so that melanin is produced in areas where the vitiligo patches exist, thereby enhancing their repigmentation, as well as to suppress the immune system’s attack on melanocytes.

Phototherapy can be the sole method of treating vitiligo, or it can be combined with medication for more direct results. This is determined according to the patient’s specific needs and the extent of their vitiligo. Even if a patient undergoes phototherapy alone, they can usually see the first significant results 3 to 4 months after the start of sessions.

How does phototherapy for vitiligo work?

Phototherapy uses narrowband monochromatic light, which leads to:

  • Stimulation of melanocytes: Exposure to UV light can stimulate the activity of melanocytes — the cells that produce melanin. In vitiligo, these cells are either missing or do not function in affected areas. Phototherapy helps activate these cells, leading to repigmentation of the skin.
  • Immunomodulation: Phototherapy has been shown to have immunomodulatory effects. This means it can influence the immune response, potentially reducing the autoimmune cause associated with vitiligo.
  • Migration of melanocytes: Phototherapy can encourage the migration of melanocytes from healthy areas of skin to depigmented areas, resulting in a more uniform skin tone.

What are the advantages of phototherapy?

The benefits of this treatment are many — beyond the obvious fact that it shows high success rates for skin repigmentation. It is a treatment that does not burden the patient, since sessions last just a few minutes. It is also painless and absolutely safe. Skin exposure to light is controlled, thus avoiding any irritation or redness.

It is also worth noting that phototherapy is suitable for all skin types and can be applied even to children. Finally, its action is targeted, presents no side effects, and is characterised by immediate recovery.

Who are the ideal candidates for phototherapy?

Phototherapy can not only improve vitiligo but also produce dramatic results. Higher success rates are seen in patients whose vitiligo is in its early stages and is located on the face and around the eyes.

For people who have had vitiligo for many years or whose vitiligo has appeared on the hands, feet, or covers more than 25% of the total skin surface, a larger number of sessions may be required.

What should patients undergoing phototherapy for vitiligo be careful about?

Phototherapy is considered an absolutely safe treatment. However, it must always be administered by a specialised dermatologist. Some important precautions should be taken by both patients and physicians:

  • Eye protection: Both patients and dermatologists must wear protective eyewear during phototherapy sessions to prevent eye damage from UV exposure.
  • Skin type: Phototherapy may be less effective in individuals with darker skin due to higher levels of melanin, which can interfere with UV light absorption.
  • Side effects: Common side effects of phototherapy may include irritation, itching, and redness. These adverse effects are temporary and can be easily and immediately addressed with topical treatments.
  • Long-term maintenance: After achieving repigmentation, some patients may require periodic maintenance sessions to keep results.
  • Combined treatment: In some cases, phototherapy is used in combination with other treatments such as topical corticosteroids or calcineurin inhibitors to enhance its effectiveness.

What should people with vitiligo be careful about?

Regular monitoring of vitiligo by a specialised dermatologist and the choice of an appropriate treatment plan are two of the basic actions a patient should take. Skincare, however, does not stop there.

If someone has vitiligo, they should consider the following tips:

  • Sun protection: Daily use of sunscreen, hat, and clothing to cover the various parts of the body affected by vitiligo is considered essential. Protecting your skin from the sun helps prevent sunburn of depigmented skin. Sunscreen also minimises tanning, which makes vitiligo marks more pronounced.
  • Avoiding tanning beds: Patients with vitiligo need to avoid tanning beds and all forms of artificial tanning.
  • Using special make-up: Many patients decide to cover the patches with make-up. Make sure the products you use are suitable for the skin of people with vitiligo. Ideally, ask your dermatologist.
  • Avoiding tattoos: Tattoos can worsen vitiligo symptoms.

Why is it important to consult a dermatologist?

Although vitiligo is not life-threatening, it can significantly affect a person’s mental and emotional state. Dermatologists are experts in diagnosing and treating a wide range of skin conditions, including vitiligo.

Access to advanced treatment options: Dermatologists have access to the latest advances in vitiligo treatment. They stay informed about cutting-edge therapies and can recommend the most appropriate options for each patient.

Personalised treatment plans based on individual needs: Each case of vitiligo is unique, and what works for one person may not work for another. Dermatologists create personalised treatment plans tailored to the specific needs of each patient, taking into account factors such as the extent of depigmentation, age, and the patient’s general health.

Conclusions

Vitiligo is a complex skin condition that requires specialised care and attention. A dermatologist can provide comprehensive diagnostic and treatment options. If you or someone you love is dealing with vitiligo, don’t hesitate to seek medical care.