© by aha! Swiss Allergy Centre - Info on allergies - Eczema and skin reactions - Vitiligo - woman with patchy discolouration of the skin

The loss of pigmentation is due to the inhibition or destruction of the cells that produce melanin. The disease occurs in approximately 1% of the global population. It can occur in infancy, but in approximately half of all cases usually first appears from the age of 20.

Causes and triggers

As there is a family history of the disease in approximately one third of all cases, it is likely that a predisposition to vitiligo can be inherited. However, exactly how the disease develops is still unclear. Three hypotheses are currently being discussed:

  • the autoimmune hypothesis: the premise here is that the body itself is responsible for the destruction of pigment cells.
  • the autoaggression hypothesis: the hypothesis that pigment cells destroy themselves (autoaggression hypothesis) is based on the premise that an imbalance in the metabolism of melanin-producing cells (melanocytes) causes them to self-destruct. 
  • the neurogenic hypothesis: the premise here is that melanocytes are destroyed by substances released by skin nerves. This might explain, for example, why vitiligo progresses rapidly under stress, as these nerves are known to release more of these substances into the skin in times of stress.

It is also conceivable that all three hypotheses may be involved.

Mental stress, exposure to intense sunlight and injury to the skin may have a negative effect on the course of the disease. Hormonal changes, pregnancy and puberty are other possible trigger factors.

Symptoms

Vitiligo is characterised by round, white, well-defined patches on the skin (depigmentation), which may measure several millimetres to centimetres in size. In rare cases, the patches may be darker or reddish in colour at the edges. The skin itself, however, remains intact. Vitiligo most commonly appears on the face, neck, in the underarms, on the back of the hand and in the groin. Vitiligo is painless and is not contagious. It may nonetheless adversely affect sufferers’ quality of life.

Forms of vitiligo

Generalised vitiligo

In generalised vitiligo, depigmentation occurs on both sides of the body. Sufferers may experience flare-ups and these may cause the white patches to cover virtually the entire body surface.

Localised vitiligo

In localised vitiligo, the patches appear on only one side of the body. In most cases, the vitiligo is less pronounced.

Therapy and treatment

Vitiligo is incurable and the course is unpredictable. However, various individual treatment approaches are available, which are variably successful, depending on the type of vitiligo and where the depigmentation occurs. The face and neck often respond to treatment better than other parts of the body.

The following treatments are available for vitiligoand and can also often be combined:

  • conventional phototherapy: treatment of affected areas of skin with UV light over several months to stimulate the formation of melanocytes
  • phototherapy with laser: use of xenon chloride excimer laser for even more targeted irradiation of affected areas of skin, also to stimulate the formation of new melanocytes
  • PUVA therapy: a combined treatment involving the application of a substance (psoralen) to the skin prior to UVA irradiation to increase the skin’s sensitivity to light
  • cream treatment: application to the skin of active ingredients such as cortisone, calcipotriol or pseudocatalase
  • surgery: grafting of the sufferer’s own healthy cells onto diseased cells and use of melanocytes from the sufferer’s normal skin. There is currently no long-term exeprience with these surgical procedures and they cannot therefore be recommended at the moment.

Tips and tricks

  • It is extremely important to avoid exposure to UV radiation from the sun; use suntan lotions and wear comfortable and loose-fitting clothing
  • Use camouflage – a make-up technique – to disguise conspicuous patches.

Information

Editors: aha! Swiss Allergy Centre in cooperation with the Scientific Advisory Board.
 

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