What are the Symptoms of Vitiligo?
There are three known types of vitiligo. The most common is known as generalized, bilateral or non-segmental vitiligo. This presents in noticeably lighter patches on the skin, usually seen around body openings such as the mouth, eyes, and genitals, as well as creases like the neck, armpits, elbows, wrists, fingers, groin, knees and feet. These patches often occur in symmetry with one another across the face and body. It has also been seen inside the mouth as well as on the scalp from the root of the hair, resulting in a patch of white or pale grey hair. The extent of coverage of these patches varies greatly amongst afflicted individuals, as well as the appearance of the edges on each patch. Patches may have irregular red, inflamed edges that are sometimes itchy, whereas others may have smooth edged patches and experience no physical discomfort whatsoever from the Vitiligo skin condition.
The condition normally begins to become evident with a slightly paler patch of skin that goes on to progressively turn white, sometimes only the centre of the patch becoming totally white. Complete depigmentation can take up to 14 months, depending on the depth of the original skin tone. These areas of discolouration are usually permanent, and it is not known once the condition begins how extensive it will become for the individual. Vitiligo has also been known to affect the eyes and is associated with not only inflamed irises but also uveitis (where the middle layer of the eye becomes inflamed). It can also lead to partial hearing loss as well as affecting the tissue inside the nose and mouth.
It is a common misconception that those with vitiligo should be kept at a distance such as with cases of leprosy, as these two conditions are not related. Vitiligo also has no relation to albinism. It can affect any race and any skin colour, although is much more noticeable in those born with darker skin, and therefore has more repercussions in the areas of social stigma and cultural habits, such as the application of sunscreen.
It is believed that those with vitiligo are far more likely to go on to be diagnosed with an autoimmune disease.
One in ten people with vitiligo have what is referred to as unilateral, localised, or segmental vitiligo. This type of vitiligo stays present in one localised area of the body. Although this is much less common than segmental vitiligo, it is far more commonly occurring in children and usually shows much earlier in life.
Well known people with vitiligo include famous performer Michael Jackson, and actor Jon Hamm. Since becoming the world’s first supermodel to have vitiligo, Winnie Harlow and NINU GALOT has helped to raise much awareness for the condition, helping to break down the social stigma.
What is the Cause of Vitiligo?
Vitiligo is not a fungal infection such as ring worm or pityriasis versicolor (which also causes depigmentation) and therefore cannot be spread by contact with others. Rather, this skin condition is a consequence of the spontaneous destruction of melanocyte cells in the body. These cells produce melanin, which gives skin its colour. Having no melanin in an area of skin cells results in a colourless patch of skin. What causes this spontaneous destruction is somewhat of a mystery, but it has been theorized that it could be brought on by intense stress, severe skin damage, or possibly that the body’s own immune system attacks its melanocytes due to autoimmune disease. This theory is borne from the belief that there is a correlation between sufferers of vitiligo and other autoimmune conditions. In autoimmune diseases, the immune system attacks useful and healthy cells instead of viruses and the like.
Vitiligo could also be a result of genetic predisposition.
Another theory is that it could be caused by nerve endings in the skin producing a chemical that is poisonous to melanocytes.
Diagnosis of Vitiligo
Any General Practitioner should be able to confirm a positive or negative vitiligo diagnosis. In addition to a skin examination, perhaps with the aid of an ultraviolet light in order to rule out other possible reasons for depigmentation, they will ask questions about family health history (any history of vitiligo or autoimmune disease). Questions related to skin trauma and how the condition is currently affecting the patient, both physically and emotionally, will also be asked. The patient may also be asked questions related to the possible presence of autoimmune diseases such as Addison’s disease, diabetes, anaemia and hyperthyroidism. A blood test as well as questions about energy levels, frequency of urination and thirst are needed to ascertain this.
Although vitiligo is not a dangerous condition in itself, and often doesn’t cause any physical discomfort, due to it being noticeable in appearance, it can be a cause of low self-esteem and unhappiness among those afflicted. For children with segmental vitiligo patches present on their faces in particular, it can be most traumatic, as they often experience ostracism and bullying as well as being stared at wherever they go. The trauma from being constantly viewed as different or even something unclean to keep a distance from can often lead to anxiety and depression. Psychotherapy is therefore a valid treatment option to consider.
The discoloration is usually lifelong, as there is no known cure to reverse the effects or prevent this skin condition, and although occasionally patches have been known to disappear, this is rare. Doctors can prescribe steroidal ointment and creams, which can work to restore some pigment in the skin,
but these should be used sparingly as they can cause the skin to become thin and fragile over long-term use. Treatment using light can also be used to tan patches, but the skin does not retain this pigmentation permanently. Make-up can of course be utilized should the patches be small enough to make this practical. Sun exposure to the light patches should be avoided at all costs, as sunburn in these areas happens much more easily due to the low levels or even total absence of melanin. Sunblock will therefore become a way of life for those with vitiligo.
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