Vitiligo (white spot disease) is a harmless skin disease that primarily affects young people. Vitiligo, the white spot disease, is a harmless and painless, but often very stressful skin disease for those affected. It is a pigment disorder that leads to permanent white spots on the skin – and an emotional burden for many sufferers. Vitiligo cannot yet be cured. However, with the right treatment, you can prevent it from progressing any further. Read everything you need to know about Vitiligo here.
If you are suffering from Vitiligo you must read our post “Natural Vitiligo Treatment – The Vitiligo Cure That Doctors Don’t Want You To Discover“
- What is Vitiligo: Non-contagious, harmless skin disease (“white spot disease”). Mostly affects young people under the age of 20. Sometimes accompanied by autoimmune diseases such as neurodermatitis, Hashimoto’s thyroiditis, or type 1 diabetes mellitus.
- Symptoms: sporadic or extensive white (depigmented) patches of skin everywhere on the body or only in certain areas (face, hands, feet). Sometimes the hair growing on the affected areas of the skin also turns white. Sometimes itching when new spots appear.
- Causes: Vitiligo is caused by the death or at least inactivation of those skin cells (melanocytes) that are responsible for the production of the skin pigment. The white areas usually arise over the joints, on the head, or around the anus and genitals. Mucous membranes, eyes, or inner ears are less affected. When the scalp is attacked by Vitiligo, white hair forms ). The white spots can grow in increments. We distinguish a non-segmental, symmetrical Vitiligo type (e: non-segmental vitiligo NSA, approx. 85%, slowly increasing, often with autoimmune disease) from a segmental, asymmetrical type (e: segmental vitiligo, often children, rapidly increasing, often Hair affected). Mixed forms exist. Not fully known. Probably an autoimmune disease. Risk factors: genetic predisposition, stress, sunburn, skin irritation.
- Treatment: medication (cortisone, calcipotriol, etc.), light therapy (phototherapy), PUVA (psoralen plus light therapy), bleaching, transplantation of pigment cells (melanocytes). Relief prevention through stress avoidance and intensive sun protection.
- Possible complications: Greatly increased risk of skin cancer in depigmented areas.
- Prognosis: incurable, but easily treatable. Without treatment, Vitiligo progresses. Once stains have occurred, they usually remain permanent. They rarely resolve on their own.
Vitiligo: description and causes
Vitiligo ( white spot disease ) is a harmless, non-contagious skin disease. It is based on a pigment disorder. The disease is characterized by white patches of skin either all over the body or limited to the face, hands, and feet. They usually arise in batches.
In Germany, around one percent of the population suffers from white spot disease. There are no differences between women and men. It is noticeable that the disease occurs predominantly before the age of 20. Also, a familial accumulation can be determined: In 30 percent of the patients, another family member suffers from Vitiligo. Besides, vitiligo sufferers develop other autoimmune diseases more often, such as autoimmune thyroid inflammation (Hashimoto’s thyroiditis), neurodermatitis, or type 1 diabetes mellitus.
As long as the spots grow, more and more skin cells perish on their edge.
You may know that the black pop star Michael Jackson suffered from vitiligo, as he repeatedly claimed. Many did not believe him and thought he had been artificially bleached. The diagnosis was not confirmed until his autopsy; and he probably passed the disease on to his eldest son, Prince Michael. Not every light spot on the skin is Vitiligo: the dermatologist should not confuse Vitiligo with other skin changes that look similar (e.g. white spots on the lower leg in women going through menopause). It is not uncommon to find so-called halo nevi, which are round white spots around birthmarks. They are considered a sign of cellular autoimmunity against birthmark cells. Sometimes there is a mild hearing impairment (14%) as an expression of a disorder of melanocytes in the inner ear (cochlea).
Vitiligo: Different types
Vitiligo mainly affects young people. Depending on when the white spot disease first appears, a distinction is made between two different types:
- The rarer type 1 vitiligo begins before puberty. Many of those affected also suffer from neurodermatitis. Also, the young patients usually have many birthmarks (halo nevi) and gray hair in places.
- Type 2 vitiligo begins after puberty. It accounts for about 85 percent of all white spot disease cases. In contrast to Vitiligo type 1, type 2 is not accompanied by increased birthmarks, neurodermatitis, or gray hair.
The white spot disease can also be classified according to the extent of the white spots:
- With local vitiligo, only a few white spots appear.
- In generalized Vitiligo, several parts of the body are most affected over a large area. Vitiligo Vulgaris, the most common form of white spot disease, is one of the sub-forms of generalized vitiligo. In doing so, large white spots are formed in various places. Usually, the respective sides of the body are affected in parallel ( non-segmental vitiligo ). If, on the other hand, the white spots are limited to one side, one speaks of segmental vitiligo. The segmental vitiligo is limited to the face, hands, and feet. When vitiligo spreads eventually the body’s skin without pigment more than 80 percent.
The white spot disease rarely spreads to mucous membranes and scalp hair.
How exactly and why Vitiligo develops has not yet been conclusively clarified. However, doctors suspect that it is an autoimmune disease: the immune system acts against the body’s structures due to a malfunction. In the case of white spot disease, these are the pigment cells (melanocytes) in the skin. The melanocytes produce the pigment melanin and release it to the surrounding skin cells. The more melanin there is in the skin, the darker it is.
Melanin formation does not occur due to the destruction of melanocytes in vitiligo patients. This is how the typical pigment-free white skin spots are created.
Vitiligo: Risk Factors and Triggers
The risk of white spot disease appears to be genetic. Familial clusters suggest this connection. The most important trigger for acute relapses is stress: physical (such as an infection) and psychological stress can promote the development of further white spots. Also, sunburns and local skin irritation, such as those occurring in the context of psoriasis can trigger vitiligo.
As a Vitiligo patient, there are several things you can do yourself. In particular, you should reduce stress, as it can trigger new flare-ups. Due to the increased risk of skin cancer, you should also protect the affected skin areas from direct sunlight and use sunscreens with a, particularly high sun protection factor.
You can effectively conceal the annoying light spots with highly opaque cosmetics such as camouflage make-up.
Many of those affected suffer mentally from their illness. Then it can help to exchange ideas with other Vitiligo patients, for example in a self-help group. Psychological support also offers psychologists, for example, during speech therapy.
Besides, you can have your Vitiligo medically treated with special medication and phototherapy.
Vitiligo: drug therapy
Since Vitiligo is believed to be an autoimmune disease, drugs that suppress the immune system are used to treat it. These so-called immunosuppressants are intended to prevent or at least weaken the immune system’s attack on the pigment cells. Glucocorticoids (cortisone) and calcipotriol are used, for example. Both active ingredients can be applied to the skin as a cream. In certain cases, the doctor may also prescribe the immunosuppressant tacrolimus (as an ointment).
Vitiligo: phototherapy and PUVA
Alternatively or additionally, you can undergo phototherapy. This enables good results to be achieved in Vitiligo therapy: The white patches of skin are specifically irradiated with UV-B light of a certain wavelength. This is supposed to stimulate the growth of the pigment cells.
A combination of phototherapy and the active ingredient psoralen (PUVA = psoralen plus UV-A light) is even more effective: the patient first receives psoralen (as a tablet, cream, or bath additive), which makes the skin more sensitive to light. Then the skin areas affected by Vitiligo are irradiated with UV-A light.
Other methods of vitiligo treatment
In the case of very pronounced, generalized vitiligo, bleaching the skin can be the last treatment option: The unaffected areas of the skin are chemically bleached to match their color to that of the white spots. But be careful: the result is not always uniform. It is also permanent and cannot be reversed.
A melanocyte transplant is another option for Vitiligo treatment. The doctor removes healthy pigment cells from the patient, multiplies them in the test tube, and transplants them into the skin’s affected areas. Discuss with your doctor whether this treatment method would be possible for you.
From a naturopathic point of view, experts recommend ginkgo extract for the treatment of white spot disease. Studies have shown that it promotes skin repigmentation in some patients.
The white coloration (depigmentation) of the skin is typical of the white spot disease: spots appear in more or less numerous places that are only slightly or not at all pigmented (white). They are a few millimeters to centimeters in size, round or oval. Their edges are irregular, but stand out sharply from the surrounding skin. The white spots can also merge and form so-called foci.
The white patches of skin can in principle appear on all parts of the body, from the face to fingers and wrists, elbows, forearms, and knees to the genitals. The mucous membranes can also be affected, as can the eyes and inner ear.
In some patients, the hair that grows on the pigment spots also loses its color. The appearance of a new stain is accompanied by itching in some patients.
Vitiligo: examinations and diagnosis
If you think you have white spot disease, it is best to consult a dermatologist. This you initially asked in detail about your medical history. Possible questions are, for example:
- When did you first notice the skin changes?
- Where are the spots and how big are they?
- Are other family members sick?
- Do you have any other illnesses (diabetes mellitus, neurodermatitis, etc.)?
- Do you regularly take medication?
- Did you suffer from severe sunburn or other skin conditions or irritations before the onset of the disease?
Vitiligo: Physical Exam
After the anamnesis discussion, the doctor will examine you: he will examine the skin all over your body. Ideally, he photographs the affected areas of the skin to be able to understand the course of the disease later.
The doctor also looks at the white patches of the skin using a special UV lamp, the so-called Wood light (wavelength: 364 nm). In this light, the Vitiligo spots glow white-yellow.
To confirm the diagnosis, healthy areas of skin can be mechanically irritated with a wooden stick. If it is the white spot disease, new pigment spots appear in the irritated area. This effect is known as the “Koebner phenomenon”.
Vitiligo: further investigation
If vitiligo is suspected, the blood is usually also examined for special antibodies (such as total IgE, antinuclear antibodies = ANA). The thyroid values are also determined because the white spot disease is often associated with an inflammation of the thyroid gland (Hashimoto’s thyroiditis). The doctor also takes a closer look at the sugar levels – diabetes is another possible concomitant disease with vitiligo.
If the laboratory values show abnormalities, further investigations are carried out for clarification.
The various examinations are not only used to diagnose Vitiligo. They also help rule out other conditions that can cause similar skin changes. These so-called differential diagnoses in white spot disease include other pigment disorders and skin diseases such as certain types of birthmarks, piebaldism, hypomelanosis.
Vitiligo: disease course and prognosis
White spot disease is a chronic disease that continues to progress if left untreated. Once stains have occurred, they usually remain permanent. They rarely regress on their own. Further relapses can be prevented through consistent treatment of Vitiligo. A cure is currently not possible.
Is Vitiligo Dangerous?
Vitiligo is almost always completely harmless and has nothing to do with cancer. However, in rare cases, the disease can accompany skin cancer, which is why a dermatological examination is always necessary. On the other hand, it is a disease and not a “cosmetic disorder” – as some health insurance companies argue in order not to have to cover any treatment costs. The mental stress caused by conspicuous white spots is often very high for those affected; the disease should therefore be taken seriously and in no way trivialized. If the Vitiligo treatment is treated with UV treatments or lasers, a skin cancer check should be carried out regularly by the dermatologist because of this increased exposure.
Vitiligo in children
There are no known factors that affect the child’s risk of vitiligo during pregnancy. A healthy diet and less stress should be a matter of course for pregnant women. Since the susceptibility to disease for vitiligo is inherited through many genes, it is not possible to give a precise probability of how high the risk is for newborns with vitiligo in their families. Only 30% of Vitiligo sufferers have close family members who also suffer from it. Children in whom one of the parents has vitiligo have a risk of about 5-6% of developing white spots as well. Vitiligo can rarely occur in babies. Light spots in children can have many other reasons (leukoderma, nevus pityriasis alba, nevus anemic, albinism, etc.). Particular caution should be exercised when using steroids in children; only cortisone creams with a favorable side effect profile should be used, e.g.
Home remedies for vitiligo
Due to the lack of brown skin pigment, the white areas of the skin are very sensitive to light. They are prone to sunburn and must therefore be covered very well with sunscreen in everyday life (paradoxically, one form of treatment is very careful tanning or UV radiation). If the stains are cosmetic, they can be covered with special cosmetics (e.g. Covermark) for women and men. Sometimes an open spa treatment is successful as a Vitiligo treatment in Israel at the Dead Sea.
Investigation of Vitiligo Disease
Unfortunately, it still happens that patients are simply sent home after the diagnosis. Even doctors are sometimes of the opinion: “There is nothing you can do about it”. There are treatment methods to which over 80% of patients respond successfully. We proceed like this: First, a possible internal, triggering cause must be excluded. Extensive blood tests are carried out for this purpose. Autoimmune thyroiditis is found in 10-50% of all cases, autoimmune gastritis in about 10%; Pernicious anemia, Addison’s disease, alopecia areata, lupus erythematosus, diabetes, multiple sclerosis, rheumatoid arthritis, and others have been described less frequently. A Wood-light examination may be useful to determine the disease activity. The stage of the disease is documented using video incident light microscopy. A skin cancer check should also be carried out before UV treatment. Then, depending on the result, it will be decided which treatment is possible. In our opinion, a treatment attempt is always useful. There is no guarantee of success, but many patients can still be helped.