Vitiligo
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Vitiligo (Latin: vitiligo) is a chronic, acquired skin disease of autoimmune origin, characterized by the formation of depigmented patches resulting from the loss or a marked reduction in the number of melanocytes – the cells responsible for the production of melanin. Melanin is the pigment that determines the color of the skin, hair and the iris of the eye and plays an important protective role against ultraviolet radiation. The disease can occur at any age, although it most often manifests before the age of 30. It is estimated that vitiligo affects about 0.5–2% of the world’s population. The course of the disease is very varied – from small, stable lesions to progressive loss of pigment affecting large areas of the body.
Vitiligo – what is it
Vitiligo is a disease associated with destruction of melanocytes, leading to the formation of characteristic depigmented patches on the skin. The mechanism of this process is not fully understood, however it is currently considered an autoimmune disease in which the body's immune system mistakenly recognizes melanocytes as foreign cells and leads to their destruction.
Other factors also play an important role in the pathogenesis of vitiligo:
- genetic predisposition – in about 20–30% of patients there is a family history of the disease
- oxidative stress – an excess of free radicals damaging melanocytes
- environmental factors – skin injuries, intense exposure to UV radiation, contact with certain chemicals
- neurogenic disorders – related to the influence of neural mediators on melanocytes
Vitiligo often coexists with other autoimmune diseases, such as:
- Hashimoto's disease
- Graves' disease
- type 1 diabetes
- alopecia areata
- pernicious anemia
From a dermatological point of view, several forms of the disease are distinguished:
| Type of vitiligo | Characteristics |
|---|---|
| Non-segmental vitiligo | the most common form, symmetric patches on various parts of the body |
| Segmental vitiligo | unilateral lesions along dermatomes |
| Generalized vitiligo | extensive loss of pigment |
| Focal vitiligo | single or few patches |
Vitiligo – Beginnings
The onset of the disease is usually slow and difficult to notice clearly. The first lesions most often take the form of small, light spots a few millimeters in diameter. Initially they may be mistaken for post-inflammatory depigmentation or hypopigmentation associated with other skin diseases.
The most common locations of the first lesions are:
- backs of the hands
- around the eyes and mouth
- elbows and knees
- genital area
- feet
In many cases the appearance of lesions is preceded by the so-called Koebner phenomenon, i.e. the formation of disease foci at the site of a previous skin injury. Factors that may initiate the depigmentation process include:
- sunburns
- mechanical injuries (abrasions, cuts)
- chronic stress
- hormonal disorders
- infections
The process of pigment loss occurs in stages. Initially there is lightening of the skin, followed by complete loss of melanin. Within the lesions, graying of hair (leukotrichia) is also often observed, which indicates involvement of the melanocytes of the hair follicles.
The course of the disease may be:
- stable – lesions persist for years without enlarging
- slowly progressive
- rapidly progressive
Vitiligo – symptoms
The most characteristic symptom of vitiligo is well-demarcated, milky-white patches on the skin, which arise as a result of a complete loss of pigment. These lesions usually have a round or irregular shape and may gradually enlarge and merge with each other.
Typical clinical features of the lesions:
- clear borders between healthy and depigmented skin
- no scaling or inflammation
- symmetric distribution (in non-segmental vitiligo)
- tendency for the patches to enlarge
Most commonly affected body areas:
- face (especially around the eyes and mouth)
- hands and fingers
- elbows and knees
- underarms and groin
- genital area
- scalp
Additional symptoms may include:
- graying of hair within the lesions
- depigmentation of hair, eyebrows, or eyelashes
- depigmentation of mucous membranes
- changes in the retina (rare)
Unlike many other dermatological diseases, vitiligo usually does not cause pain or itching. The problem is primarily aesthetic and psychological.
Vitiligo – is it dangerous?
Vitiligo is a disease mild from a systemic point of view, because it does not constitute a direct threat to life. It is also not an infectious or cancerous disease.
However, this does not mean that it is completely harmless to health. Patients may experience certain medical and psychological consequences.
Key clinical aspects:
1. Increased sensitivity to UV radiation
The lack of melanin causes the skin within the lesions to be more susceptible to:
- sunburn
- DNA damage to skin cells
2. Association with autoimmune diseases
Patients with vitiligo are more frequently diagnosed with conditions such as:
- thyroid diseases
- type 1 diabetes
- rheumatoid arthritis
Therefore, periodic laboratory testing is recommended in many cases.
3. Psychological burden
Visible skin changes may lead to:
- reduced self-esteem
- anxiety disorders
- depression
This particularly affects young people and patients with an extensive form of the disease.
Vitiligo – treatment
Treatment of vitiligo is a long-term and often multi-stage process, because there is currently no therapy that guarantees a complete and permanent cure of the disease. The goals of treatment are primarily:
- to halt disease progression
- to stimulate repigmentation of the skin
- to improve the appearance and psychological comfort of the patient
The therapeutic methods used include both pharmacological treatment and dermatological procedures.
Pharmacological treatment
Most commonly used:
- topical corticosteroids – reduce the autoimmune reaction
- calcineurin inhibitors (tacrolimus, pimecrolimus) – especially for lesions on the face
- antioxidant therapies – limiting oxidative stress
Phototherapy
One of the most effective treatment methods is 311 nm UVB phototherapy, which stimulates melanocyte proliferation and melanin production.
Dermatology also uses:
- PUVA therapy (psoralen + UVA)
- 308 nm excimer laser
Dermatological and aesthetic medicine procedures
In the case of a stable form of the disease, procedures supporting skin regeneration and repigmentation are used, including:
- dermatological laser therapy
- skin microneedling (micro-needle mesotherapy)
- regenerative therapies stimulating melanocytes
In clinical practice, surgical techniques are also used, such as:
- melanocyte transplantation
- skin grafting
The effectiveness of therapy depends on many factors, including:
- duration of the disease
- location of the lesions
- patient's age
- activity of the autoimmune process
The best results are usually observed on the face, whereas lesions on the hands and feet are more difficult to treat.
