Vitiligo - causes, symptoms and treatments

Answerbank reader saturnspeak asks: 'Does anybody know a cure that actually works for the skin condition vitiligo '

We review the disorder - but we haven't been able to uncover a cure.

Vitiligo is a pigmentation disorder that leaves blotchy white patches on the skin and hair. It affects melanocytes, the cells that make pigment in the skin, as well as the mucous membranes (tissues that line the mouth, nose, genital and rectal areas) and the retina - the inner layer of the eye.

Affected skin is particularly sensitive to sunlight. It can be a difficult disorder to live with, especially for children and young people for whom appearance is often so important.

This is what Michael Jackson has, isn't it
That's certainly what's been claimed by (or for) the all-singing, all-dancing King Of Pop (TM).

Michael Jackson

There is lots of debate about whether he really does or not, a debate fuelled by the suggestion that he lightens his skin because he wants lighter skin rather than to hide or manage his vitiligo. His sometimes contradictory appearance and statements have been pounced on by both sides of the debate. The debate has, at least, heightened awareness of the disorder.

Who gets vitiligo What causes it
There are more theories than concrete answers: that people develop antibodies that destroy the melanocytes; that the melanocytes simply destroy themselves; that stress, sunburn or emotional distress can bring on vitiligo.

Youare more likely to develop vitiligo if your parents have it, though most children will not, and most people with the disorder do not have a family history of it.

You are more likely to develop vitiligo if you have a pre-existing autoimmune disease (such as hyperthyroidism, adrenocortical insufficiency, alopecia areata or pernicious anemia) though, again, most people with vitiligo have no other autoimmune disease.

Diagnosis may involve the taking of biopsies, blood tests or an eye examination.

Are there different forms of vitiligo

Yes there are:

• focal pattern: limited to one or two areas of the body
• segmental pattern: limited to one side of the body only
• generalized pattern: depigmentation occurs on different parts of the body (this is the most common form).

In addition, the depigmented patches will progress in some cases, but not in others. The speed of the spread also varies from person to person.

Is it treatable

Within limits, and it can take months if not years. The aim is two-fold: to restore the function of the skin and to improve the patient's appearance.

Medical treatments include

• steroids and corticosteroid creams that can sometimes return the colour to whitened skin if treatment starts early enough;
• psoralen photochemotherapy (a.k.a. PUVA) combines chemicals (psoralen) with exposure to ultraviolet A light; it can be effective but the side-effects can be severe;
• depigmentation - using drugs to whiten unaffected areas of skin to match those affected by vitiligo. This treatment is more common for those with extensive depigmentation due to the disorder. Again, there are notable side-effects.

Surgical therapies are still at the experimental stage. They include the use of skin grafts, tattooing (usually of patches on or around the lips) and melanocyte transplants, in which cells are removed from unaffected skin, treated in laboratory conditions, and then transplanted to depigmented skin.

What else can be done
Sunscreen and cosmetic make-up and lotions can both protect and enhance the skin for people with the condition. And the support of family and friends, sympathetic medical staff and others who understand or have the disorder is a great benefit.

Are there more 'alternative' treatments

Any and all treatment should be entered into after discussion with appropriate, trained medical staff.

At least one study in the Soviet Union (1989) saw marked repigmentation as the result of hypnotherapy and psychotherapy to help control the emotional stress associated with vitiligo.

Another study has suggested that vitamin supplements (folic acid and/ or vitamin B12 and vitamin C) can result in repigmentation in some cases.

Other treatments have included a pharmaceutical form of vitamin D, called calcipotriol, the amino acid L-phenylalanine and extracts of a herb called khella.

Others suggest making some hard and fast lifestyle changes - food supplements, antioxidants, detoxification, clean water, toxic-free cleaning products and the like.

See also

• The UK Vitiligo Society
• Vitiligo Support