Vitiligo is a disorder due to depigmentation of the skin. This is an acquired disorder characterized by patches of hypo pigmented patches on the skin and mucous membranes. This disorder is commonly linked to autoimmune conditions such as abnormalities of the thyroid. In this condition, the melanocytes, the cells responsible for manufacturing melanin are destroyed and unable to produce adequate melanin. Melanin is the pigment that produces skin color. This causes white patches and de-pigmented macules to occur in different parts of the body including mucous membranes and the retina. The hair growing in areas affected by vitiligo also tend to lose their pigment and become discolored since it is the same pigment required for hair color. The exact cause of this condition is unknown, a situation that has led many doctors and researchers to advance many different theories. There has been great evidence in recent times that suggests that people with vitiligo have an inherited triad of recessive genes that increase their susceptibility to this condition. The most widely accepted concept though is that vitiligo results from an autoimmune disorder as described above. In this context, an autoimmune disorder results in the body’s immune system reacting against its own cells and tissues.
The human body produces a set of biological messengers called pigment. These cytokines, in vitiligo cause the melanocytes to die and alter their pigment producing ability. Another theory suggests that vitiligo is caused by melanocytes destroying themselves. Some people have gone further to suggest that vitiligo can be caused by single events such as emotional distress and sunburn which tend to alter the body metabolic processes may cause vitiligo. However, these theories have yet to be proven scientifically as other causes of vitiligo. Vitiligo is rarely if ever painful besides being emotionally and psychologically disturbing. This condition has been associated with a variety of general signs and symptoms. The skin and hair patches in the affected areas is white or hypo-pigmented. These areas seem to be sharply demarcated with a variety of shapes varying from oval, linear to round. The borders of these demarcated patches may have a convex orientation. They vary in size as this can either be in millimeters or range to a few centimeters. In some cases, the patches tend to have an advancing margin that makes it advance centrifugally in an unpredicted rate over a period of time.
Initial lesions in vitiligo tend to have a predilection in certain areas of the body. This includes most commonly the feet, face and forearms causing it to have a unique form of distribution which has been termed as peri-ocular, if it is distributed around the eyeball or perioral if it favors distribution around the mouth cavity. Scientists and doctors have described various variants of this condition. Trichrome vitiligo is the variant often described by many doctors. In this variant, an intermediate area of hypo-pigmented skin tends to be located between the area of no pigment, alternatively termed achromic and the peripheral skin that is not affected. The area of hypopigmentation evolves and progresses to become fully de-pigmented and becomes achromic. This results in three different shades of color of the skin including tan, brown and white
Marginal vitiligo that may be inflammatory have red lesions with a raised margin that presents from the onset of this condition. This inflammatory variant of vitiligo may also present with mild pruritus. A more conspicuous variant of this condition is described as blue vitiligo which causes blue discolored macules of the skin. A striking variant termed as the Koebner phenomenon is characterized by vitiligo occurring in areas of the skin associated with trauma such as a burn or a cut, with a specific form of distribution. This condition has been variously classified clinically. Localized vitiligo tends to be located in one area with lack of progression. This form of localized vitiligo may occur as segmental which constantly distributes along dermatomes and constantly occurs in children. Other forms of localized vitiligo such as mucosal or focal have also been described. Generalized vitiligo, yet another form may be described as either vulgaris, acrofacial or mixed. In this mixed form, both acrofacial and vulgaris forms present. A rare form of this condition termed as universal vitiligo occurs with nearly or complete depigmentation. This form is often associated with various endocrinopathies and their associated symptoms.
Diagnosis of this condition is generally based on clinical presentation and general observation of the patient. However, a biopsy is useful in isolating this condition from other disorders characterized by hypopigmentation of the skin. Microcopy of the affected skin areas tends to constantly indicate the absence of pigment producing cells, the melanocytes. Other histologic findings such as thickening of the basement membrane are associated with this condition. Vitiligo is clinically managed in a variety of ways. Both surgical and non-surgical interventions can be employed. Non-surgical interventions include phototherapy and various other forms of therapy including laser and steroid therapy which may lead to significant repigmentation. Surgical intervention is a more definitive alternative of therapy and involves grafting of the various affected areas. However, surgical intervention is preferred in situations of localized forms of this condition. Tattooing has come to be a more preferred and simple form of management of various forms of this skin condition. It involves tattooing of the specific areas affected by this loss of pigment.
Unknown terminology
Vitiligo: A skin condition characterized by total or partial loss of pigment leading to patches of white skin
Depigmented: Total loss of pigment
Hypopigmente: Partial loss of pigmentation
Periocular: Area around the oral cavity
Repigmentation: Recovery of the process of melanin formation
Endocrinopathies: Disorders of the body metabolic processes
Melanocytes: Pigment producing cells.
Cytokines: Body’s biological messengers made up of protein.
Known terminology
Mucous membranes
Retina
Pigment
Autoimmune
Lesions
Diagnosis
Biopsy
Marginal
Works Cited
Cunliffe, W. J. "Vitiligo: Thyroid disease and autoimmunity." British Journal of Dermatology (2008): 135-139.
Handa, Sanjeey and Inderjeet Kaur. "Vitiligo: Clinical findings in 1436 patients." The Journal of Dermatology (2006): 653-657.
Wiete, Westerhof and Ludmila Nieuweboer-Krobotova. "Treatment of vitiligo with UV-B radiation v topical psoralen plus UV-A." Archives of dermatology (2000): 1525-1539.
