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Vitiligo, when the skin loses its color

June 25 marks World Vitiligo Day, a disease that causes depigmentation of the skin. What are the causes of the appearance of these white spots? What are the treatments for vitiligo? What is corrective makeup?

Vitiligo is a skin disease that causes depigmented areas to appear on the body . Kinds of “white spots” more or less important depending on the type of vitiligo and the stage of the disease. Vitiligo affects 0.5 to 1% of the population (source: INSERM). In France, it is estimated that 900,000 to 1.2 million people are affected. In half of the cases, it begins between 10 and 20 years old.

These spots correspond to the absence of melanin , a pigment which protects us from UV radiation and which is produced by our skin. The skin is made up of three layers: the epidermis, the dermis and the hypodermis. Melanin is produced in the deepest layer of the epidermis, in melanocytes (star shaped cells). The melanin pigments will then bind to keratinocytes on the surface of the skin. And the more pigment the keratinocytes are, the darker the skin. In vitiligo, melanocytes are destroyed. The production of melanin is therefore stopped and the skin remains white.

For a long time, vitiligo was considered a psychosomatic disease because stress plays an undeniable role in the aggravation of certain vitiligos. The vitiligo is certainly a complex disease, and today we know that it may be related to genetic factors, including genes related to the immune system . Autoimmune factors are also involved (the immune defenses are turned against the body). Moreover, in some cases, it is associated with autoimmune diseases: diabetes or thyroid problems  in 15 to 20% of patients, or an inflammatory disease such as polyarthritis or Chrohn’s disease.

There are several forms of vitiligo . Often the white areas appear on the face, feet, hands, joints or skin of the genitals, and roughly symmetrically: this is generalized vitiligo . In other cases, the spots affect only one part of the body: this is called segmental vitiligo .

The condition does not cause any physical pain and it is absolutely not contagious. However, it must be considered as a serious dermatosis because it quite often causes psychological discomfort in those affected.

How to treat vitiligo?

Vitiligo is a progressive disease . The spots can spread under the effect of repeated rubbing, pressure on the skin or even inflammation … This is called Koebner’s phenomenon .

The depigmented plates are sensitive to the sun: they blush faster than the rest of the body. They should therefore be protected with a high index sunscreen.

Treatment adapted to the stage of vitiligo

There is no treatment that cures the condition, but some treatments reduce the symptoms, they are chosen according to the stage of vitiligo:

  • Stage 1: incomplete depigmentation, the epidermis is not white and black hairs persist.
  • Stage 2: white skin with persistent black hairs
  • Stage 3: very white skin, white or absent hairs

The phototherapy based UVB , at 2 times a week, has a place in the management: it promotes repigmentation by stimulating production of melanocytes and their migration into the surface layer of the skin, the epidermis.

This light treatment helps to  restart the production of melanin  from reserves located in the skin or in the hair. Hairless areas like the hands or feet are therefore the most difficult to treat.

” On the contrary, the face is relatively easy to re-pigment and the treatments are effective. You have to be patient. You depigment much more easily than you re-pigment, but if you are patient, if you accept the constraint of treatment and time, we can repigment in vitiligo in any case on the most visible areas such as the face “, explains Pr Khaled Ezzedine, dermatologist.

The laser is also used in people whose skin is almost covered with lesions, to depigment areas that are still healthy and thus harmonize the color.

Different medicinal treatments at a skin doctor in west delhi can be considered. They aim to stimulate the precursors of melanocytes (cells which evolve into melanocytes). Unfortunately, there is no quick fix and some spots are difficult to treat.

Among the treatments that are the subject of consensus, drugs can be applied to depigmentation spots: corticosteroids can be prescribed as a cream in patients with few spots, small sizes and not located on the face.

Another cream, tacrolimus, which is also applied to small spots of reduced size, at the rate of 2 times a week, preferably in combination with laser or UVB-based phototherapy.

In more extensive or rapid extension or flare-up cases, the dermatologist prescribes medication in tablets, such as a low dose of corticosteroids, two days a week for a few months. When the autoimmune reaction is subdued, which happens in the majority,

When the  vitiligo spots  have stabilized for several years, dermatologists can also consider melanocyte transplants . In this case, the doctor will take an area of ​​pigmented skin (often in the scalp), then he will graft it onto the affected area … The results vary depending on the patient. But the graft meets very specific criteria, such as the absence of evolution for a year, the edges of the spot well drawn, etc. Repigmentation is optimal after 3 to 6 months.

Although vitiligo is not uncommon, it is best to be monitored by a dermatologist who is familiar with the condition. But in France, specialist consultations are still too few and the waiting lists are particularly long.

Other treatments are emerging thanks to research but they are not yet the subject of consensus: prostaglandins E2, afamelanotide which stimulates pigmentation, certain immunopressants, such as tofacitinib and ruxolitinib, etc.

 

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