Vitiligo: know the causes and treatments (medicine, ointments)

In 1993, king of pop Michael Jackson gave an interview to host Oprah Winfrey and reported to the world that he had vitiligo. The statement made the disease more talked about and known to people.

According to the Brazilian Society of Dermatology (SBD), 0.5% of the world population has the disease, characterized by the loss of skin pigments.

The origin of this condition comes from genetics, so it is not a communicable disease.

For patients, the greatest risks do not involve the health of the body, but emotional issues, due to changes in appearance.

Understand how this disease occurs in our body and how it is possible to live with it.

What is vitiligo disease?

Vitiligo is a disease characterized by the loss of melanin in the body, which is the pigment responsible for giving color to the skin, eyes and hair .

The condition manifests itself when melanocytes (melanin-forming cells) die or reproduce in lesser quantities. Then the skin starts to show white spots, characteristic of the disease.

Considered an autoimmune condition, in which the immune system itself destroys healthy cells and tissues, it is not yet known exactly what triggers the action, in addition to the genetic predisposition.

That is, when there are cases in the family, there is a greater likelihood for the disease to manifest.

In addition to the genetic predisposition, there are possibly triggering factors – such as some very stressful time in life – that serve as a trigger.

Vitiligo triggers are related to emotional issues and external factors, such as wearing very tight clothes (which attack the skin), injuries or traumas, for example, caused by falls and injuries.

Vitiligo can manifest itself regardless of age or sex, however, it is more common between 10 and 30 years.

Unfortunately, there is still no cure for this disease, but due to advances in medicine and the aesthetic area, there are different treatments to repigment the affected area.

Options may include oral medications, light therapies and skin graft surgery.

Vitiligo is not a communicable disease, but there are still people who don’t know it and are afraid.

With the aim of raising awareness among the population, June 25 was chosen as World Vitiligo Day, in which information campaigns are carried out on the disease.

In the International Statistical Classification of Diseases and Health  Related Problems ( ICD-10 ), vitiligo can be found by code L80 .

Types of Vitiligo

According to the Brazilian Society of Dermatology, there are two types of vitiligo, non-segmented and segmented. Check out the difference between them:

Non-segmental or bilateral vitiligo

Vitiligo of the non-segmental type is the most common to occur, reaching about 90% of cases.

The condition is characterized by equal spots on both sides of the body, as in both arms or feet, but it can also affect the armpit, groin and rectal area.

Depigmentation usually occurs in cycles. That is, there are times when the spots appear and grow, and other periods when they stagnate.

Segmental or unilateral vitiligo

Segmental type vitiligo, also called unilateral, manifests itself in about 10% of patients.

This type can spread quickly or remain stable in only one area, but it usually arises in areas of skin connected to the nerves, such as the spine.

In general, the segmental type has a good response to treatments.

Vitiligo: how does it affect the body?

Some authors and researchers even subdivide non-segmented vitiligo into:

Focal

It is characterized by small lesions (spots) on a region of the body, usually in a few regions, such as the hands, feet and eyelids

Target

Lesions located on the skin near the nerves of the spine, in the region of the back, usually similar to bands or lines.

 

Mucosal

Vitiligo occurs in the mucous membranes, such as the lips and the genital region.

 

Acrofacial

These spots are characterized by appearing around the mouth, fingers, eyes, anus and also genitals.

 

Mixed or common

They can usually appear on the legs, arms, necks, armpits, chest, abdomen and also on the buttocks.

 

Generalized or universal

The spots have the characteristic of being of the same size, appearing in equal places on both sides for almost the entire body, so that it is easy to notice the parts that have not yet been affected.

 

What are the causes of Vitiligo?

The cause of vitiligo has not yet been discovered by science, but studies have shown that the disease starts to manifest when the pigment-producing cells stop producing melanin (which gives color to the skin) or when they die.

There are several possibilities pointed out by specialists and researchers about the disease and its cause. In general, they occur in association and depend on emotional or traumatic triggers (such as skin lesions).

Among the possibilities are:

Autoimmune theory

One of the causes mentioned includes autoimmune factors, in which the antibodies themselves fight healthy cells in the body and the exact reason for this is not known.

In addition, studies note that the disease is associated with other autoimmune conditions, including thyroiditis , pernicious anemia and diabetes .

In general, patients with some autoimmune disease are more likely to develop other conditions of the same type.

Autotoxic theory

This theory is based on the idea that phenol (an organic and toxic compound found in foods and products) can harm melanocytes, which are responsible for producing skin pigment.

Neurogenic theory

In this case, any infection or condition that may affect neuronal functioning may be related to the onset of vitiligo.

Bacteria that cause syphilis or leprosy , for example, may be involved, as any condition that affects the skin and the nervous system could, in this theory, affect melanocytes (which produce melanin).

As a consequence, melanin is impaired in patients who have a genetic predisposition.

Is it transmissible?

No . Because it is considered an autoimmune disease, it is not possible to develop or get vitiligo through touch, sneeze or contact with a patient.

Emotional vitiligo: can stress trigger the disease?

 

It can , if there is predisposition to the condition. So, when the individual goes through a stressful fact, this can be a kind of trigger for the disease to manifest itself.

In addition to it, other emotional factors may also be associated with the manifestation, such as anxiety and depression . Therefore, the emotional condition is largely involved with the disease.

In people who already have vitiligo, it can happen that, in periods of stress or emotional difficulties, the lesions increase in size.

Risk factors

This disease can affect anyone and at any age. Although the exact cause is not known, some conditions can favor the onset of vitiligo in people who are predisposed. Are they:

  • Family history of the disease;
  • Other autoimmune diseases;
  • Damage to the skin, due to a cut or burn;
  • Exposure to chemicals;
  • Sunburn or intense exposure to the sun;
  • Infections that affect the skin (such as syphilis).

Vitiligo symptoms: how to identify?

Vitiligo is characterized by white spots that appear on the skin. They start small, irregularly shaped, and over time they can develop and increase in size.

Other signs of the disease are:

Depigmentation of the wires

The disease can manifest itself in the hair and scalp. In such cases, depigmentation may occur on part of the head (scalp) and affect the strands, causing gray or white hair to appear.

In men, the beard can also be affected.

The eyelashes and eyebrows can also be white or depigmented when vitiligo affects the region of the face.

Spots on mucous membranes

Stains may appear on the mucous membranes, affecting the lips, genital and anal areas.

Redness and inflammation

Although rare, some reports indicate that red and slightly inflamed edges may appear during depigmentation of the skin at the beginning of vitiligo.

In general, they tend to improve spontaneously and without complications for the patient.

Vitiligo itches?

The spots caused by vitiligo do not hurt, peel, itch and are not contagious. But some patients report feeling a little itching, which can occur for other reasons, such as poor skin hydration or contact with tissues.

Read more: Skin allergy: causes and how to identify symptoms

Diagnosis

The dermatologist and general practitioner can diagnose vitiligo.

To make the diagnosis, the doctor must perform the physical examination, assessing and observing the spots, and may request tests aimed at confirming vitiligo or ruling out other diseases:

Wood lamp

Wood’s lamp is part of the patient’s physical examination. In this case, the doctor uses a device that emits UV light on the patient’s skin.

In the case of a diagnosis of vitiligo, the light reflected on the skin changes the color and allows the identification of spots, especially those that are difficult to detect.

Skin biopsy

Skin biopsy can show if there is a lack of melanocytes in the areas where the spots have arisen.

This examination is done with the help of a small blade, which collects a sample of the skin, by means of a small scrape on the affected part.

The exam is usually simple and anesthesia can be used to perform the collection.

Blood collection

There is no specific blood test for vitiligo, but it is possible to rule out other diseases, infections or conditions that may be causing the skin blemishes.

In addition, it is possible to detect some autoimmune diseases that may be associated, raising the suspicion of vitiligo.

In general, the test consists of a simple blood draw, which is sent to the laboratory for analysis.

Does Vitiligo have a cure?

A cure for vitiligo has not yet been discovered. But there are treatments that can help the appearance of the affected skin, improving the patient’s quality of life.

Vitiligo Treatment

The treatments aim to repigment the areas affected by the disease. There is not only one way to treat vitiligo, so the best alternative should always be evaluated by the dermatologist. Among the options are:

Medicines

In the treatment for vitiligo, oral medications such as corticosteroids can be used, which help to stabilize the disease.

Immunomodulatory medications (substances that interfere with the immune system) also help to prevent disease progression and, in general, have less adverse effects than corticosteroids.

Light therapy (PUVA)

There is a treatment called light therapy, in which it is possible to give color to the spots that appear on the skin through ultraviolet radiation ( UVA ), UVB light or excimer light (types of radiation).

Together, a substance called psoralen is used, which is derived from plants and helps light therapy to produce results.

This procedure can be done up to 3 times a week, for 6 to 12 months.

Depigmentation

Another option is to depigment the areas of skin that have not yet been affected by vitiligo, to even out the tone.

The procedure is done with the application of an ointment, which acts slowly clearing the skin. Before, sensitivity tests are carried out to see the reaction of the product on the skin.

It is usually done in cases of generalized vitiligo, in which the disease has affected the entire body.

Depending on the person, side effects such as swelling, itching, dry skin and redness may occur.

In addition, after depigmentation sessions, the skin will be extremely sensitive to sunlight, so it will always be necessary to protect yourself more.

Read more: How to use sunscreen every day and in any situation

Micropigmentation

This procedure is very similar to the method used to make tattoos, in order to camouflage the stains, but done in a much more superficial way.

The doctor uses a special instrument (dermograph), in which a pigment is placed inside the device according to the patient’s skin tone, covering the areas affected by the disease.

Surgical treatments

Surgery may still be an option when light therapy and medication do not work. It can also be used in conjunction with these therapies, should the patient and doctor feel the need.

In general, the recommendation is that they be made in patients after adolescence (as there are physical and emotional risks involved), with stable conditions of the disease.

Among the options are:

Skin graft

The doctor removes small parts of the skin that are not affected by vitiligo and places them on regions of the body that have already lost their color.

This procedure is recommended for cases where the disease is stabilized.

As it is a surgical method, the procedure is subject to contraindications.

It is also important to consider that the procedure can generate keloid scars (excessive skin growth at the site) and even hyperpigmentation (when the area is dark).

Graft by bubbles

In this procedure, the doctor induces the formation of blisters under the pigmented skin using specific tactics.

After this reaction, the formed bubbles are transported to the places where the disease affected the skin, camouflaging the stain.

In general, the response to therapy is good and repigmentation is rapid.

Vitiligo and psychological therapy

When the first vitiligo spots appear, dealing with them is not always simple. Worry coupled with anxiety and stress can change a person’s life.

Vitiligo is a disease that has no cure, but has some therapeutic resources.

Although there is no harm to the patient’s health, vitiligo can have a very large emotional weight, especially when it affects large or very exposed areas of the body.

Therefore, psychological counseling is usually indicated and comprises a very important process in life and routine.

In this process, the patient learns to deal more comfortably with his own body. But not only that, as opting for treatment is not always an easy process as well.

Therefore, it is important that there is a progressive work in search of the patient’s awareness, so that he can choose the best resources, assessing the risks and the benefits that they will bring.

Therapy is always individualized, so the frequency or approach should always be indicated by the professional.

Vitiligo Medicines

The drugs used to treat vitiligo have the objective of stabilizing the progression of the disease and repigmenting the affected areas.

The effectiveness depends on the size of the spots and the places where they appeared and depends on a very careful and individual assessment of the patient’s condition.

They can be used:

Oral medications

Some of the drugs used are corticosteroids, which are usually used when the disease is onset. The main ones are dexamethasone,  betamesone and  hydrocortisone .

Some of the drugs used in the treatment of vitiligo, for the repigmentation of small areas are:

  • Methoxysalene ( Oxsoralen );
  • Phytotherapeutic Associations ( Vitricomin ).

Ointments and creams

There are creams and ointments that can help in the treatment of vitiligo, their function is usually to make the stains return to their natural color.

Ointments such as imiquimod ,  tacrolimus and pimecrolimus can be used , which show good results. In preliminary studies, the drugs managed to repigment at least 50% of the affected area.

Attention!

NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained on this site is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.

Prognosis

Depending on the type and size of vitiligo stains, it is possible to have stability in the condition from drug treatments or even spontaneously.

The results of therapies and procedures can vary greatly in each case. In general, it is possible to repigment the affected area and smooth out the spots with good results.

Living together

 

It is possible to have quality of life when diagnosed with vitiligo, for this it is necessary that some precautions are taken to prevent the skin from suffering damage:

Always protect yourself

As the skin with vitiligo is more sensitive than the others, care with protection is always necessary.

Therefore, use sunscreen every day, regardless of the season (summer, winter, etc.).

The indicated is to use a protector that has a sun factor of at least 30, considered a high protection product.

Read more: What does sunscreen SPF mean? How to choose?

There is also the option of colored sunscreen on the market, which helps in camouflaging white spots.

Beware of injuries

Those who have vitiligo need to be aware not only of the appearance of new spots on the skin, but also of care for those that already exist.

Patients should take care of injuries and trauma to the skin, as this can be a triggering factor for blemishes.

Moisturize your skin

It is important to keep your skin hydrated at all times. Those who have vitiligo need to redouble this care, especially in winter.

At that time, due to hot baths or cold weather, the skin may become more sensitive and dry, becoming susceptible to infections and allergies.

Opt for the cream of your choice, which contains benefits such as vitamins and minerals.

Read more: Skin Hydration: importance, how to moisturize, products and tips

Eat properly

Some foods have beneficial properties and can help with skin health.

Include in your diet foods with vitamin A (such as sweet potatoes and papaya), E (spinach, broccoli, avocado), C (orange, lemon, pineapple), and folic acid (lentils, beans , cooked okra) that help in improving from stains and injuries.

In addition, products rich in beta-carotene, such as carrots, beets, help in the formation of melanin, responsible for protecting the skin from ultraviolet rays and increasing skin immunity.

Find out how to feel good

The stains caused by vitiligo can sometimes bother to the point of affecting the person’s self – esteem , but makeup can be a resource to help.

Read more: 13 tips on how to improve self-esteem

There is, in the vast world of makeup, the technique called “camouflage”, which helps in the appearance of the skin, neutralizing pimples, tattoos, age marks and even the spots caused by vitiligo.

The ideal is to consult with your dermatologist, so that he can indicate the best option of cosmetics.

Take care of your mental health

Because it is a disease that affects appearance, vitiligo can cause stress, anxiety and even cases of depression in the patient.

In these cases, it is necessary to follow up with a specialist doctor, such as a psychologist, to work and assist in acceptance and self-esteem, improving the quality of life.

In addition, there are support groups on the internet, which share experiences on how to live with vitiligo, tips, testimonials showing that no one is alone and offering friendly support.

Model with vitiligo

In 2017, the model Winnie Harlow brought representativeness to patients, showing overcoming and self-esteem by being the first model with vitiligo to cross the catwalk of the famous brand Victoria’s Secret.

But the path to that walkway was not an easy one. Still at the age of 7, Winnie began to notice the appearance of spots on her body. At 14, due to the emotional pressure she suffered, she dropped out of school.

He went back to school at 16 and, at 19, participated in the reality show “America’s Next Top Model”, where he began to draw attention for his beauty and confidence when showing the vitiligo marks.

Winnie ended up not winning the reality show, but participating in it was enough to make her known. What ended up appearing invitations from major brands to work as a model in their campaigns.

Since then, Winnie has worked as a model and has always tried to make people aware of vitiligo, showing that there is nothing wrong with living with the spots caused by the disease.

But in addition to it, other celebrities with vitiligo are successful. Among them, Luiza Brunet, who has had the disease since she was 2 years old and has already undergone different treatments, but has not achieved much results.

Now, the model takes on the marks of vitiligo, as well as MPB singer Tiê and American actor Jon Hamm, famous for his role in the series “Mad Men”.

Complications

Vitiligo, in general, does not cause major complications to the patient’s life. The conditions that can normally occur are related to:

Sun burn

Those who have vitiligo need to be very careful when in contact with the sun’s rays. Due to the absence of melanin, which protects the skin against UV and UVB rays, exposure to the sun can cause intense burns.

Skin aging

The lack of pigmentation, which naturally protects the skin, can cause an accelerated aging of the tissue. So it is necessary to care and moisturize the skin.

Emotional complications

The main complication of vitiligo is the emotional aspect, causing depression, anxiety or social withdrawal to occur.

Self-esteem and the health of affective relationships need to be prioritized, always accompanied by a trained professional.

Prevention

Unfortunately it is not possible to prevent vitiligo because it is a disease of genetic and hereditary causes. But, especially if there are cases in the family, some precautions can be taken:

  • Avoid stress;
  • Use comfortable fabrics;
  • Avoid skin friction;
  • Lead a peaceful life;
  • Take care of mental health;
  • Apply sunscreen daily;
  • Visit the dermatologist periodically;
  • Taking care of health in general.

Photos vitiligo

These are examples of what the spots caused by vitiligo look like:

 

 

 

Vitiligo in dogs

As with people, dogs can also suffer from vitiligo.

The causes have not yet been understood, but vitiligo usually gives a clue when white spots appear on the dog’s muzzle and face.

In some cases, even the retina (inside the eyeball) and the dog’s hair may turn white over time.

The factors that can trigger it are associated with stress, neurological changes, exposure to toxins and some diseases.

Vitiligo can be diagnosed using the skin scratch test, which goes for analysis and, like humans, is not transmissible.

Some breeds have a higher risk of developing this condition, they are: rottweilers, German shepherds, Belgians and dachshunds.

Common questions

Who has vitiligo can get the yellow fever vaccine?

He can. Sometimes, it is the drugs or therapies used to treat vitiligo that can have side effects or interactions with the vaccine. Therefore, it is essential to always consult a health professional.

Can you get a tattoo on top of vitiligo?

No . It is not recommended that the person who has vitiligo get a tattoo on the spot caused by the disease, as the skin of the patient with vitiligo is more sensitive than normal. Therefore, when getting a tattoo, she may be traumatized and cause scarring, aggravating the condition of vitiligo.

How does vitiligo manifest itself?

Melanin is the pigment responsible for giving color to the skin, eyes and hair. Vitiligo manifests itself when melanocytes (melanin-forming cells) die and stop reproducing. Then the skin starts to show white spots that are characterized as vitiligo.

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