The task of our immune system is to detect and kill all bacteria, viruses, tumour cells or anything else that could invade our body. But it can make a mistake identifying harmless pollen as the worst enemy causing allergy reactions or killing pigment-producing cells that give colour to our skin.
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The result of killing pigment-producing cells (melanocytes) is a chronic skin disorder called vitiligo. Vitiligo causes an irregular pale skin or white patches on the skin. It occurs in all races and ages and can affect any part of the body from face, arms and legs to retina and genitalia. Even the hair can go grey on the scalp, as well as eyelashes and eyebrows.
There isn't a simple explanation what causes vitiligo, but there are a few theories. The first theory is about body destroying its own tissue which is perceived as foreign and potentially dangerous. The second is about pigment cells injured by abnormally functioning nerve cells and the third says the pigment cells act in a self-destructive way.
As the consequence, there is no effective cure for vitiligo, it is hard to tell how much pigment the patient will lose, why it starts with a rapid loss of pigment, why there are periods of pigment stability, and why in some cases the whole process stops without the logical explanation. Also, it is not quite clear why sometimes patches have different shades and why in some cases melanocytes start to produce pigment again.
According to the affected skin area and distribution, there are five types of vitiligo: generalized, universal, focal, segmental and acrofacial type.
Generalized vitiligo is the most common type of vitiligo connected with aggressive cells theory. It causes loss of skin colour across many parts of the body and it is often symmetrically distributed. Universal vitiligo affects more than 80 percent of the total skin area. This type progresses very slowly and in a certain number of cases it can be latent for several years. However, some patients can lose pigmentation in a very short period (in 6 to 12 months).
Focal vitiligo causes limited depigmentation to one or a few areas of the body.
Segmental vitiligo causes pigment loss on only one side of the body and it is the most resistant shape to treatments. This type occurs most commonly in children. Acrofacial vitiligo affects distal end of fingers and facial orifices in circumferential pattern.
The treatments are long lasting and their goal is to improve patient's appearance. Although this doesn't sound encouraging, when you see your skin, hair or eyes losing colouring, it is important to see the doctor as soon as possible because some of the treatments may help to stop or slow the process of depigmentation and to return some colour to your skin.
Cortisone is a hormone naturally produced by the adrenal gland. It is an active substance of topical corticosteroid creams that may reverse the process in the early stage. Weak topical steroid creams have been proven effective on the face and the neck. However, steroid creams may also show side effects so they shouldn't be used for a limited time.
Exposing the skin to the sunlight sounds like a good idea, however, do not try to do something on your own, especially to go to the solarium. Depigmented patches are highly sensitive to sunlight and you may face blisters. And if that happens, differently shaded patches would be your smaller problem.
So called topical or oral PUVA treatment is a combination of taking psoralen, photosensitive drug or cream, and exposing the skin to UVA rays in the controlled environment. This therapy is the treatment of choice when white patches cover less than 20 percent of the skin.
For much harder cases there is depigmentation. The treatment uses monobenzone, a compound that decreases the excretion of melanin. Since vitiligo is unpredictable and in some cases melanocytes may start to produce pigment again, before you decide to do depigmentation it is advisable to ask for the second even the third opinion since the treatment is irreversible. Surgical treatment is also possible. ■