Vitiligo

Vitiligo is a skin condition characterized by the presence of white patches due to the loss of pigment in the skin, and its exact cause is unknown. It can affect any part of the body, most commonly the face, lips, hands, arms, legs, and genital areas. It occurs in approximately 1% of the world’s population and affects men, women, and all races equally.

WHO GETS VITILIGO?

Vitiligo affects about 1 or 2 individuals out of 100. It can occur at any age, from infancy to old age, but it often begins before the age of 20, and about 20% of patients have a family history of the condition.

IS VITILIGO AN INTERNAL ORGAN DISEASE? IS IT CONTAGIOUS?

Vitiligo does not arise from any internal organ disease, and therefore, many patients have good overall health. Vitiligo is not contagious.

WHAT ARE THE CAUSES OF VITILIGO?

Pigment in the skin, hair, and eyes is determined by a substance called melanin, which is produced by cells called melanocytes. If these cells die or cannot produce melanin, the skin becomes lighter or completely white.

The exact cause is unknown, but there are four main theories:

1. Genetic abnormalities may cause damage to melanocytes.
2. The body’s immune system may destroy melanocytes, perceiving pigment as foreign and breaking it down.
3. Abnormal nerve cells may produce toxic substances that can damage melanocytes.
4. Cells producing pigment may destroy themselves, producing toxic byproducts during pigment production that can damage melanocytes.

HOW DOES VITILIGO OCCUR?

In vitiligo, the body produces autoantibodies against its own melanocytes, damaging them. The same autoantibodies can cause damage to other organs like the thyroid. Therefore, other autoimmune diseases may also occur simultaneously with vitiligo.

Vitiligo can be triggered by sunburn. In fair-skinned individuals, the difference between vitiligo-affected areas and normal skin becomes more noticeable in the summer, while in darker-skinned individuals, vitiligo is more easily noticed throughout the year.

HOW IS VITILIGO DIAGNOSED?

White patches on the skin can occur in conditions other than vitiligo. The differential diagnosis of these white patches is made by a dermatologist. A skin biopsy may be taken if necessary, but the diagnosis is often made clinically based on the appearance of the white patches.

IS VITILIGO A TREATABLE DISEASE?

Vitiligo is a treatable condition, but since the exact cause of vitiligo is unknown, treatment outcomes may vary from person to person. Various treatment options are available, and these treatments should be used for at least 3 months. Treatment decisions should be made in consultation with a dermatologist.

IS THERE A PLACE FOR HERBAL PRODUCTS IN THE TREATMENT OF VITILIGO?

Do not use any treatment (pill or cream) that is claimed to be herbal but does not have approval from the Ministry of Health. Always consult your doctor.

WHAT CAN BE USED IN THE TREATMENT OF VITILIGO?

1. Creams:

Corticosteroid creams: Corticosteroid creams, especially those used in the early stages, can be beneficial, tailored to the patient’s age and affected area. However, prolonged use without dermatological supervision may lead to thinning of the skin, vascularization, acne, and increased hair growth. Creams containing tacrolimus and pimecrolimus: Can be used under dermatological supervision.

1. Phototherapy (Light therapy): Treatment using ultraviolet light of different wavelengths. PUVA, local PUVA, and narrow-band UVB therapies are commonly used.Phototherapy must be performed under the supervision of a dermatologist. Tanning beds are cosmetic devices and should never be used for treatment purposes, as they can lead to various conditions from burns to skin cancer.
2. Grafting: Skin grafting from healthy skin areas to vitiligo-affected areas has been beneficial in very few patients and is not performed in many countries. Complete pigmentation does not usually occur at the treatment site.
3. Depigmentation therapy: In some patients with severe involvement, the best solution may be to remove the remaining pigment from the skin and make it completely whiter. This is done with a chemical called monobenzone. Completing this treatment takes about a year. Pigment loss is permanent.
4. Sun protection: Vitiligo-affected areas can easily burn in the sun; therefore, sunscreen with a minimum SPF of 30 should be continuously used. Applying sunscreen only when going to the beach or sunbathing is not sufficient. Sunbathing should be done at the times and for the duration recommended by your doctor. Protective clothing and sunglasses should be worn.
5. Camouflage: If no benefit is obtained from any treatment, camouflage application, covering white areas with permanent makeup, can be performed.
6. Psychological support: Since vitiligo is a condition that affects one’s appearance, it can lead to stress, decreased self-confidence, unhappiness, and depression in individuals. Therefore, patients should avoid stress and seek help from a psychiatrist if necessary.
7. Diet: Although there is no direct relationship between diet and vitiligo, as with any condition, we recommend a healthy diet.

WHAT IS THE COURSE OF VITILIGO?

The course and severity of the disease vary from person to person; it generally progresses slowly, with progression sometimes stopping and then starting again. In severe cases, it can cover the entire body. In some patients, some color may return, and very rarely, it may completely resolve on its own.