Vitiligo: symptoms and causes

Vitiligo (white spot disease) is a disease of the skin characterized by long-term spotted depigmentation.

The color of human skin is created due to melanin, a pigment formed in skin cells called melanocytes.
If these cells are unable to produce melanin or are destroyed, white spots (depigmentation) develop in the affected skin areas.
Depending on the severity of the disease, these white spots can:

  • small or
  • be big.

Skin tanning is a process related to the melanin present in the cells.
People suffering from white spot disease will observe the following:

  • the light skin spots remain unchanged under the influence of the sun,
  • the rest of the body becomes darker.

The most affected areas are those where skin lies directly on the bone:

  • Hands
  • Feet
  • Face
  • Genitalia
  • Knee
  • Forearms.


When does vitiligo occur?

Vitiligo begins in childhood, it usually manifests itself in children and adolescents and usually occurs bilaterally.
In about half of patients, it occurs before the age of 20.
This condition can:

  • start quickly,
  • in the further course show phases of deterioration, which are followed by stabilization.

Vitiligo is a disease that can persist throughout life.

Forms of vitiligo

years for the first time. It usually occurs in one of three patterns:

  • Bilateral or generalized. In this very common subtype, pigment loss (often symmetrically) is distributed over many parts of the body.
  • Segmental. The loss of pigment occurs only on one side of the body. This type occurs in adolescence, continues over a year or two, and then ends.
  • Focal. Depigmentation is limited to one or a few areas of the body.

It is difficult to predict the natural course of vitiligo.
Sometimes the spotting breaks off without therapy.
In many cases, the loss of pigment spreads and can eventually affect most of the skin’s surface.

Causes of vitiligo

The exact reason for vitiligo is unclear, two possible causes are:

Autoimmune diseases
Non-segmental vitiligo is the most common type and is believed to be of autoimmune origin.
This means that the immune system (the body’s natural protective system) is not functioning properly.
Instead of attacking foreign cells like viruses, the immune system creates antibodies (proteins that fight infections) that attack the body’s healthy cells.
If you have a non-segmental vitiligo, the immune system develops antibodies that destroy the melanocytes (cells that produce melanin).
Those who suffer from vitiligo are also more likely to develop other autoimmune diseases, such as:

According to some authors, vitiligo is caused by certain chemicals released into the skin by nerve endings.
These chemicals are toxic to melanocytes.

Risk factors for vitiligo

The risk of developing vitiligo can be increased by:

  • Heredity: about 20% of people with vitiligo have another affected family member.
    A family history of other autoimmune diseases: for example, one parent has pernicious anemia (an autoimmune disease that affects the stomach).
  • Another autoimmune disease.
  • Melanoma (a type of cancer of the skin) or cutaneous T-cell lymphoma (a type of cancer of the lymphatic system).
  • Trauma – in the case of trauma or skin abrasion, a white spot may appear in this area after scarring.
  • Stress – stressful phases, such as after the death of a relative.

White spot disease is not contagious and is not considered a serious disease.

Symptoms of vitiligo

The main sign of vitiligo is:
loss of pigment, which causes cream-colored spots on the skin (depigmentation).

Possible appearance of the spots:

  • of different sizes,
  • smooth – there are no dandruff or changes in consistency with respect to the rest of the skin,
  • milky white,
  • with prominent or blurred edges.

Other and less common signs:

  • Hair and hair turn white or gray prematurely.
  • Loss of color of the tissue lining the mouth (mucosa).
  • Loss or change of color at the inner layer of the eye (retina).
  • Some people experience itching in the lighter areas.

Even though any area of the body can be affected by vitiligo, it usually develops depigmentation first in the areas of skin exposed to the sun, such as:

  • Hands
  • Feet
  • Arms
  • Face
  • Lips.

The external genitalia and area may also be affected.
Although vitiligo can occur at any age, it usually shows up between the ages of 10 and 30.

Emotional and psychological aspects of vitiligo

Even though vitiligo is usually not dangerous, the emotional and psychological effects can be severe.
The white spots of vitiligo can affect:

  • Self-esteem
  • emotional and psychological well-being.

People with white spot disease may experience emotional stress, especially if the condition develops:

  • visible areas of the body (such as the face, hands, arms and feet),
  • on the genitals.

Adolescents who are often worried about their outward appearance may be severely affected by diffusely distributed vitiligo.
Some people who suffer from vitiligo feel:

  • Embarrassment
  • Shame
  • Depression
  • Worry about other people’s reactions.

Diagnosis of vitiligo

The dermatologist checks the white spots with the Wood lamp, which shows a milky white fluorescence.
This characteristic allows the exclusion of other diseases that provoke white spots.

Since vitiligo is often associated with other autoimmune diseases, the doctor may also prescribe the following blood tests to measure the levels of:

Differential diagnosis
The doctor must exclude the following diseases:

  1. Eczema or atopic dermatitis
  2. Pityriasis alba and versicolor
  3. Lichenoid pityriasis
  4. post-inflammatory or post-infectious hypopigmentation
  5. Lichen sclerosus
  6. Morphea
  7. Mycosis
  8. Lichen striatus
  9. Achromatic nevus

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