It is not known exactly what causes vitiligo. However, autoimmune origin (the body accepts its own cells as foreign) thyroid gland diseases, pernicious anemia (a kind of anemia) can be seen in some of the patients. When these diseases are treated, vitiligo also improves. The most common cause in our country is psychological sadness, distress, separation, family or work problems, which develop due to sensitive personality structures of people.
WHAT IS VITILIGO ?
Vitiligo is observed in approximately 1 or 2 of every 100 people today, and the risk of this disease increases 7-10 times in people with a family history of vitiligo. Although it can be seen at any age, vitiligo, which starts to show symptoms before the age of 20, occurs because the cells called melanocytes, which are responsible for the production of pigments that give the skin its unique color, are damaged for any reason and adversely affect pigment production.
Depending on the lack of pigment, some white spots of various sizes appear on the surface of the skin. Although the exact cause of the damage to pigment production is unknown, one of the most important factors responsible for the development of the disease is the 'autoimmune' mechanism. In other words, the body's immune system sees its own pigment-producing cells (melanocytes) as a threat and develops a defense against them and destroys its own cells. Apart from this, it is thought that many causes such as anemia, diabetes, psoriasis, goiter, stress, sunburns and feverish diseases may be factors, even if not specified.
The main symptom of vitiligo is the patchy loss of skin color. Usually, the discoloration first appears on sun-exposed areas such as the hands, feet, arms, face, and lips.
Vitiligo signs include:
Irregular loss of skin color
Premature graying or graying of hair, eyelashes, eyebrows or beard
Discoloration of the tissues lining the inside of your mouth and nose (mucosa)
Discoloration or discoloration of the inner layer of the eyeball (retina)
Vitiligo can start at any age, but usually occurs before the age of 20.
Depending on the type of vitiligo you have, discolored patches may include:
With this most common type, called generalized vitiligo, discolored patches often progress (symmetrically) on similar body parts.
The other type, called segmental vitiligo, tends to appear at a young age, persist for a year or two, then stop.
Another type is localized (focal) vitiligo; It is difficult to predict how your disease will progress. Sometimes the patches stop forming without treatment. In most cases, the loss of pigment spreads and eventually involves most of your skin. Rarely, it regains skin color.
WHAT ARE THE CAUSES OF VITILIGO ?
Although the exact cause of vitiligo is not known, there are some issues that are known to increase the risk of developing the disease. It is known that more than one of these factors coexist in most patients and cause the disease. The autoimmune mechanism is one of the most important factors held responsible for the development of the disease. This mechanism can be defined as the body's immune system sees its own cells as a threat and develops a defense against them and destroys its own cells. The autoimmune response developed against melanocytes may damage the cells and cause pigment production to be adversely affected, which may lead to the formation of vitiligo disease. Apart from this, other factors thought to play a role in the formation of vitiligo can be listed as follows;
Autoimmune thyroid diseases (goiter)
HOW IS VITILIGO DIAGNOSED?
The diagnosis of vitiligo can be made by detecting white spots during a physical examination by a dermatologist. In order to confirm the diagnosis, an examination with a light called Wood's light is required. During the examination with Wood's light, the visibility of the spots increases, and skin differentiations and small white spots that cannot be seen under normal light can be easily detected with the help of this light. It is usually possible to diagnose vitiligo disease with clinical examination and examination under Wood's light. However, in some cases where it is deemed necessary by the physician, different diagnostic tests such as skin biopsy and pathological examination are also used. It is also possible to use some blood tests to investigate whether the disease is of autoimmune origin. Individuals diagnosed with vitiligo as a result of examinations and diagnostic tests should act carefully in line with the recommendations given by their physicians in the next stages of their lives, and should take care to fully fulfill the treatment requirements.
HOW IS VITILIGO TREATED?
Creams applied to the skin surface are generally preferred not to be used alone, but together with other treatment methods. The purpose of these drugs used is to restore the skin tone. If cortisone creams are used after early diagnosis, skin color may return. However, it is possible that there will be no change in color for 1-2 months. These creams should be used under dermatologist control. Because uncontrolled use of cortisone creams can cause skin conditions such as hair growth, acne, vascularization and thinning. Another drug used in treatment is drugs that affect the immune system. Creams containing tacrolimus and pimecrolimus are particularly effective for areas of the face and neck. However, the US Food and Drug Administration (FDA) warns that these types of drugs can cause lymphoma and skin cancer if they are used outside of dermatologist control or if they are used excessively.
Light Therapy (Phototherapy)
Phototherapy, developed from ultraviolet rays in sunlight, is a treatment method used in other skin diseases such as psoriasis as well as vitiligo. However, it is not possible to say that light therapy completely destroys the white spots caused by vitiligo. With phototherapy, which is a supportive treatment method, only a certain level of improvement is seen in white spots. When the sufficient level is reached, the treatment is terminated.
In the depigmentation treatment used in patients who do not respond to treatments and have widespread spots, other pigments in the skin are also completely destroyed and the skin becomes white. In this treatment method made with chemicals containing monobenzylether, pigments are lost permanently. Although this method is approved by the American Food and Drug Administration (FDA), it may show side effects such as pigment change, premature skin aging, burn development, itching and skin cancer in a remote location.
Treatment methods that fall into the field of aesthetic surgery can be applied to vitiligo patients who do not respond to other treatment methods for many years. In the grafting method, which is one of these methods, the skin is taken from the areas that preserve its color and this skin is transplanted to the area where vitiligo is present. Although this method of transplantation is not applied in many countries, it has been effective in a small number of vitiligo patients. Cellular suspension transplantation is another surgical treatment method used. In this method, tissue is taken from the area without vitiligo and the cells are placed in the solution and transferred to the area where the white spots are. In some cases, areas with vitiligo improved 4 weeks after suspension transplant.
Although it is not a health-threatening disease, cosmetic camouflage can be used in vitiligo disease, which can affect the person psychologically. There are high-concealing foundations to cover white spots that may bother the person, especially in areas such as the face, neck, hands and arms. These foundations generally do not have side effects, and it has been observed that some people with vitiligo help increase their self-confidence. Some foundations are water resistant; however, it should be known that the permanence of foundations is low in areas that are frequently exposed to friction, such as hands. These products have no therapeutic effect.
Since vitiligo is a disease that affects the appearance, it is recommended that some people receive psychological support. Although vitiligo is not a health-threatening condition, it is necessary to explain the importance of treatment to people who want to get rid of white spots and to provide psychological support for the patient to comply with the treatments. Emotional effects such as anxiety, depression and embarrassment have been observed in some patients with vitiligo. Therefore, it is important to get psychological support for vitiligo disease, which may progress due to stress.
White areas caused by vitiligo can easily burn if exposed to the sun for a long time. Sunscreen with a factor of at least 50 should be used to reduce the long and short-term effects of ultraviolet rays and to prevent the increase in color difference between areas with and without vitiligo. Sun protective clothing should be worn and sunglasses should be used by people with vitiligo, especially in the eye area.
FREQUENTLY ASKED QUESTIONS
Is vitiligo a hereditary disease?
Vitiligo may show genetic transmission. It is possible to see vitiligo in the family or close relatives in up to 20% of the patients. Therefore, it would be appropriate to examine close relatives in patients with vitiligo.
Is vitiligo seen in children?
20% of vitiligo begins in childhood and adolescence. In this period, especially in my adolescence, children can be psychologically affected by this disease. For this reason, a dermatologist examination should be done as soon as possible.
In which parts of the body is vitiligo most common?
They are most commonly seen on the face, upper hand and fingers, arms, legs and genital area in our body. The fact that the disease is especially in the visible areas affects the relations of the patient in the society and causes the isolation of the person from the society.
Does vitiligo cover all over time?
Up to 80% of vitiligo is seen only in mobile areas such as hands, elbows, wrists, ankles, and sometimes in the face area. That is, the disease often remains limited and does not progress.
Can a patient with vitiligo go out in the sun?
When vitiligo is common, it may be necessary to use sunscreen before going outside, especially when it appears on sun-exposed areas of the arms, face and legs. However, due to the use of sun rays (Ultraviolet) in the treatment, natural UV rays are also beneficial under the supervision of dermatologists. The doctor can decide this.
Why is Wood's light examination done in vitiligo?
In vitiligo disease, it is necessary to examine with a special lamp, Wood's Lamp (365 nm), in a dark environment. In this examination, the borders of the whites in vitiligo appear more prominent. Wood's light can also be used to monitor treatment.
Can vitiligo be treated?
Vitiligo is a treatable disease. But the duration of treatment should be at least 3 months. The success of a treatment becomes evident after the medication or treatment method is used for the period determined by the physician. Because the time required for the melanocytes, which give color to the skin, to produce pigment (color) again for treatment is 3 months.
In the treatment of vitiligo, most of our patients stop their treatment before the 3-month treatment period. This means that patients cannot respond to treatment due to inadequate treatment. It leads to loss of hope.