Vitiligo is a mysterious skin disease that makes the skin lose its pigmentation, leading to white or discolored patches to appear in some areas. It can affect people of all races, ages and sexes and the real cause of this disease remains unknown.

Vitiligo is not connected to skin cancer, can't be transmitted to others and is not a form of skin infection such as MRSA. Despite the very unpleasant look, it seems to be a harmless condition without any severe consequences. People can live with it and be perfectly healthy, since there are no additional symptoms.

The skin discoloration happens because of an anomaly in the activity of melanocytes, which are the cells that protect our skin from the action of sunlight by providing its color. Melanocytes are located in the outer skin layers and their role is to produce melanin, the actual pigment. Contrary to popular belief, all people have the same number of melanocytes in their skin. However, some produce more melanin than others and this is the actual reason that influences skin color. Melanocytes in the skin of whiter people are less active and produce lower amounts of the pigment compared to the ones found in dark-skinned individuals.

For some unknown reason, melanocytes can simply stop their pigment production. Initially, this creates a macule, which is a spot that is visibly lighter than the rest of the skin. The macule can grow in time and ends up expanding over a larger area. The evolution of the patch can't be predicted. In some cases it expands slowly but steady in time, while other people experience periods of stagnation followed by outbursts of rapid expansion.

Vitiligo is usually classified by specialists based on the number of patches and their location on the body. When only one area is affected by a few patches, it is named focal vitiligo. Segmental vitiligo is quite rare and has a curious pattern, since the discolored areas only emerge on one side on the body. The most often encountered form of the disease is generalized vitiligo. It is also the most severe variant of the condition and the patches affect most of the skin surface. These tend to be symmetrical, just like a mirror pattern on both sides of the body.

No area of skin is immune from vitiligo but some parts have a higher risk of being affected. The most vulnerable areas are those exposed to direct sunlight, like the head and the face, as well as zones where the skin is folded, for example the groin, knees or elbows. The areas surrounding body openings are also at risk, like the nostrils, eyes, genital parts or the belly button.

What causes vitiligo?

Scientists have been unable to find the exact cause of vitiligo. Some of them suspect it can be one of the poorly understood autoimmune diseases, which start when the body's immune system attacks its own healthy tissues by mistake. In this case, it is possible that melanocytes are killed by the immune system by mistake. Some genetic factors might also increase the risk of developing vitiligo.

Another hypothesis advanced by some researchers is that the cells kill themselves for some reason. There have also been attempts to connect the disease with strong stress or the action of sunlight but no actual proof has been found yet.

What are the clinical features of vitiligo?

Vitiligo can appear anywhere on the skin, without any clear pattern. Sometimes the patches are small, also known as macules, and look like confetti. In other cases, the skin only changes its color in one large area of skin.

While the exact mechanism of the condition is unknown, a number of common features have been identified. It is sometimes triggered by period of strong emotional stress and can initially emerge as multiple halo naevi. The most affected areas are the ones commonly exposed to UV radiation, like the face, neck, finger tips, toes, eyelids or nostrils. Other zones with high risk are the genitals, lips, nipples, navel and any area where the skin folds, such as the groin or armpits. The Koebner phenomenon is a medical terms that describes vitiligo's tendency to appear in places where the skin is injured, by various causes. These include scratches, cuts, sun damage or other types of burns.

Besides the skin, the condition can make other parts of the body lose their color, especially the hair, a situation known as poliosis or leukotrichia. Not only can the scalp hair be affected but also the body one, as well as eyebrows or eyelashes. It can also cause the eye retina to lose its color but this will not change the actual color of the iris.

The patches of vitiligo can have edges with various appearances. In most cases, it looks the same as healthy skin but it can also be darker or lighter than normal. Sometimes, the affected areas have red borders, consisting of inflamed tissue. In other cases, the skin can have three different colors (a condition known as trachoma vitiligo) or even four distinct ones at the same time: normal, white, pale brown and dark brown.

It is currently impossible to estimate how the disease will progress. Both the speed of depigmentation and the area of affected skin are variable and every person has a specific evolution.

The progress of the condition is unpredictable and any outcome is possible. Sometimes, it expands quickly for several months then becomes stable for no apparent reason. After some time, the expansion can restart. Some people only experience one outbreak and then vitiligo stagnates, while others can be affected in cycles during their entire life. In the most severe cases, the entire surface of the body loses its natural color. However, in other cases it is possible for the pigments to recover in time. Darker areas initially emerge around hair follicles and can eventually eliminate some parts of the white patches.

The condition is a lot more visible on people with dark skin. It can be hardly noticeable on light-skinned individuals, except during the summer. Tanning can increase the contrast between normal and discolored skin, which becomes more obvious.

Treatment options

The disease itself can't be treated or cured but there are a number of options available to balance the skin color and hide the condition.

Many of the possible treatments for vitiligo are lengthy and might not be effective at all. Some of them have bad side effects and some people respond to them better than others. Most of the current options aim to repair the white skin patches and give them back their original color. Doctors can choose between surgery, medical cures and alternative forms of treatment. The final decision depends on the patient's choice, as well as the number of patches and their location on the body.

Surgeons usually detach parts of skin from healthy areas of the body and use them to replace patches of vitiligo, a procedure known as a skin graft. This can be very effective if the affected areas are relatively small. It is also possible to tattoo patches in order to restore their normal color by artificial means.

The most common medical options are oral pills as well as creams and other products that are applied directly on the skin. It is also possible to combine these methods with ultraviolet A (UVA) light (PUVA) therapy. Another tactic is to leave the patches untouched but actually discolour normal skin areas, in order to get a uniform look.

Finally, other treatment methods include the use of sunscreen to prevent tanning as well as covering the white patches with makeup, dyes or other cosmetic products. Therapy and counselling can help people cope with the emotional stress caused by vitiligo.