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VITILIGO


Vitiligo is an acquired skin depigmentation disorder. However, not all white skin patches are Vitiligo.
Beginning from its manifestation it plays a vital part in day-to-day life. The unvarying apprehension of the increasingly apparent spots on the skin makes it psychologically painful for the individual to live with the disease. Though a harmless skin disease, Vitiligo can cause immense stress in the affected, especially in those with dark skin. People of all ages and ethnic backgrounds can develop the disease, but infrequently evident in infancy or old age. Almost all cases of vitiligo are acquired pretty early in life.
 
Symptoms of Vitiligo
 
People initially develop white patches on their skin. It may commence as a small pale dot which subsequently manifests as white or hypopigmented macules or patches due to loss of melanocytes over affected areas.

The lesions are usually well demarcated, in circles, elliptical or linear in nature. The margins may be convex. Patches can also emerge on the mucous membranes, genitalia and umbilicus. Some lesions have hyperpigmentation around the edges.

Scalp involvement is typically seen as localised patch of white or grey hair but total loss of colour may also occur.

Although patches are small at the onset, they often widen and alter shape. Lesions range from millimetres to centimetres in size. In several patients, it may start as a solitary spot and may not spread for years or for all over the life. In contrast, some patients spreading may be hasty, as fast as from one spot too many, in a few months period. The swiftness of spread is unpredictable. Also, some patients may show discontinuous spread. It is also noted that individuals affected areas such as fingertips, are at a high threat of having an aggressive spread; even though it is not a rule. It is impossible to forecast how much colour a person will lose. Colour loss can remain unaffected for years. Some people see patches extend and new patches appear. On a rare instance, the skin resumes its lost colour.
 
Causes for Vitiligo falls under either of the followings

  • By patchy loss of skin pigmentation due to immune attacks on melanocytes
  • Malfunctioning of the melanin synthesis, thus, skin colour development is arrested.
     
Type of Vitiligo

Vitiligo is categorised into two types 
Segmental Vitiligo or Unilateral Vitiligo
It tends to affect areas of skin that are associated with dorsal roots from the spine and is most often unilateral. Often seen on a leg, face or arm, about half of the affected lose some hair colour, such as on the head, an eyelash or an eyebrow. It generally has an early onset, often advances for a year or so and then stops.

Non-segmental Vitiligo
It could be focal or generalised. Focal Vitiligo can be the abortive type of Segmental or Generalized Vitiligo. Generalised Vitiligo or vitiligo Vulgaris has a bilateral origin, such as both hands and knees. Usually begins on the hands, fingertips, wrists, around the eyes or mouth, or on the feet. Individuals experience rapid loss of skin colour in the beginning, which then stops after a while, eventually leading to repeated colour loss. This start-and-stop cycle usually continues all through a person's lifetime. Colour loss tends to propagate, covering larger vicinity, thus increasing visibility. Acrofacial and Mucosal vitiligo are types of generalised vitiligo.
 
Vitiligo Diagnosis
Vitiligo detection is not very complicated, but the challenging part of diagnosis is to understand and analyse the risk factors and rule out other associated serious disease. Prior to finalising the therapeutic course of an individual, the age of onset of the disease, family history, precipitating events, work-related exposure, the level of the disease and area association say whether hair is affected, earlier prescribed treatments and their effects have to be assessed.

First and foremost is the physical examination by the skin specialist which involves examination of white patches of skin, especially on the body parts exposed to suns, such as the hands, feet, arms, face, and lips. The white/lighter colour patches of Vitiligo are more easily seen in the dark skinned individuals but are difficult to diagnose in white race. At times, the specialist may make the use of a Wood's lamp. The depigmented areas of skin shine intense white with this handheld ultraviolet light.

In suspected cases of Vitiligo, the specialist would enquire regarding your past history of Vitiligo and its treatment. Significant factors in the analysis consist of a family history of Vitiligo; a rash, suntan, or other skin trauma that happened at the site of Vitiligo 2 to 3 months prior to the development of depigmentation, premature greying of the hair (before age 35), stress or ill health. In addition, the familial incidence of any autoimmune diseases and the person’s sensitivity to the sun would be enquired.

It is important to understand if the patient has other autoimmune diseases. For that, the doctor may ask you to take a blood test to check for the presence of antinuclear antibodies (a type of autoantibody).

Thyroid peroxidase antibody (TPOAb) -Thyroid antibody testing is primarily ordered to help diagnose an autoimmune thyroid disease and to separate it from other forms of thyroiditis.