TL;DR:
- Albinism & Vitiligo: Albinism is a genetic lack of melanin; vitiligo is acquired or congenital and causes hypopigmented patches due to melanin loss.
- Symptoms: Chalky, well-demarcated patches, often on sun-exposed areas (face, hands, extremities); size varies from millimeters to centimeters.
- Causes: Immune disorders (e.g., Hashimoto's), congenital factors, or viruses (e.g., HIV, HCV); exact cause is unclear.
- Types: Congenital (linked to defective melanin-producing enzyme) vs. acquired (often environmental); focal (localized spots) vs. generalized (widespread).
- Diagnosis: Medical history, physical exam, Wood’s lamp, and sometimes biopsy; differentiated from other disorders like Addison’s disease.
- Treatments:
- Medications: Glucocorticosteroids, calcineurin inhibitors, and vitamin D3 derivatives.
- Aesthetic options: Dermabrasion, phototherapy (stimulates melanocytes), and laser therapy (308 nm wavelength).
- Surgery: Skin grafts for resistant cases.
Albinism is a relatively common disease that affects up to 2% of the general population. It affects men and women just as often. It occurs in people of all skin colors, but is much more prominent in those with darker skin. It is associated with a lack of a naturally occurring pigment in the skin called melanin. Learn about the course of vitiligo and how it can be treated.
Symptoms of vitiligo
Vitiligo is characterized by discolored patches of light, chalky color on various parts of the body. This is caused by the destruction of melanin in certain areas on the body. The spots that appear in the course of the disease are well demarcated from healthy skin and are noticeable during the patient's daily activities. They usually range in size from a few millimeters to a few centimeters and are oval or round in shape. The spots usually appear in areas that are fairly well exposed to sunlight, namely the face, hands and extremities. Sometimes they also appear as a result of skin damage – a break in continuity, abrasion, irritation or burns.
Causes of the condition
To date, the mechanism of the disease has not been fully explained. However, at least several theories can be found in the literature to explain the causes of vitiligo. One of them considers autoimmune processes as the determining factor in the formation of the disease. This is because antibodies to melanocyte proteins and autoimmune diseases such as Hashimoto's or Addison's disease are often detected in patients suffering from vitiligo. There is also talk of the possibility that congenital factors are involved in the development of the disease. In that case, the patient has congenital damage to melanocytes, which, as the person grows, become damaged and break down too quickly. It can also happen that vitiligo occurs in connection with a viral background. It is more often detected in people who have HIV, HCV and CMV than in healthy people. Ultimately, no single theory has emerged to fully explain the etiopathogenesis of the disease. It is assumed that the disease is associated with a number of overlapping environmental and individual factors.
Types of vitiligo
The most basic classifications distinguish between congenital and acquired vitiligo. Congenital vitiligo is already visible in newborns and persists throughout life. It is often referred to as albinism. The mechanism of albinism is known – as a result of the presence of a defective gene, the child lacks the enzyme responsible for converting melanin – tyrosinase. Acquired vitiligo usually appears in adolescence or adulthood, usually before the age of 20. Whether the disease becomes active is mainly influenced by environmental factors, although the role of genetic factors is not excluded either.
Classifications of vitiligo according to the frequency of spots
Vitiligo can be classified not only by the cause of the condition, but also by the frequency and location of the spots on the body. A distinction is therefore made between:
- Focal – in which well-demarcated spots appear in specific locations on the body. Most often in clusters. They cover both sides of the body.
- Generalized form – when the spots occupy a much larger area of the body than in the focal form. They can cover the face and limbs or up to 80-90% of the body surface.
Course of the condition
The course of the disease varies from case to case. Occasionally, vitiligo goes away on its own. Mostly, however, the spots appear and never disappear, but at the same time there are not many more, or there is a severe course in which the disease progresses and spreads very quickly. It is known that traumatic life experiences and stress have a negative impact on the course of the disease. People suffering from dermatoses are much more prone to the occurrence of depression, other diseases and mental disorders. Stable forms of the disease are somewhat easier to treat.
Diagnosis of vitiligo
In the diagnosis of vitiligo, a thorough patient history and physical examination play a key role. Sometimes a Wood's lamp is additionally used in the evaluation of disease foci. Occasionally, histopathological examination is also performed. When diagnosing vitiligo, it is important to consider the similarity of the symptoms to certain conditions, and to exclude them. In differentiating vitiligo from other diseases, one must take into account dandruff, drug-induced and post-traumatic lesions, Waardenburg syndrome or Addison's disease, among others.
Treatment methods for vitiligo
In the treatment of acquired vitiligo, glucocorticosteroids are mainly used. Due to the side effects, treatment in this way should not be long-term. It mostly works well for small and not excessively diffuse patches. An alternative to glucocorticosteroids may be calcineurin inhibitors, which, similarly, are used only in cases where the lesions are not too extensive. Pharmacological treatment also often includes vitamin D3 derivatives, which have the potential to stimulate melanocytes and calm inflammation. Vitiligo is relatively difficult to treat, but in addition to this there are a number of options from aesthetic medicine, cosmetology and surgery. If, before starting a particular therapy, it has been possible to find the factors that, in a given patient, influence the spread and formation of new hyperpigmented spots, they must be eliminated for the best possible results. In the event that most of the available therapies fail, the Patient is referred to surgical treatment, which involves skin grafts performed by various methods.
Dermabrasion and microdermabrasion.
Dermabrasion and microdermabrasion are non-invasive methods that can be used alone for minor lesions on the face and body, or adjunctively for combination therapies. They can even be used for sensitive and vascular skin, regardless of the season. This type of peel can remove a layer of dead skin, even out skin tone, brighten and reduce the appearance of lesions. For vitiligo patients, regular dermabrasion can stimulate skin renewal and secondary pigmentation. The procedure is completely painless, takes tens of minutes, and the first effects are visible immediately.
Phototherapy
Phototherapy for the treatment of vitiligo is one of the most popular methods, with quite satisfactory results. This type of therapy inhibits the breakdown of melanocytes, stimulating them to renew and regenerate. The irradiation method can be used alone or in combination with agents that increase the skin's susceptibility to light. Depending on the selected method of phototherapy, it can be used for children and adults. Thanks to it, it is possible to repigment already formed spots and inhibit the formation of new ones. If treatment with any method for more than 2-3 months, does not bring the desired results, it is considered ineffective and an alternative method is sought. This also applies to phototherapy. Lesions on the face turn out to be the most susceptible to treatment with this method.
Laser therapy
The use of laser therapy gives very good results in the treatment of not only vitiligo, but also other skin diseases. It involves emitting a beam of light toward the lesions, which has a stimulating effect on them and allows repigmentation. After several irradiations, one can count on very satisfactory results. The therapy is safe, and the light beam is selected individually to the patient's skin condition. However, for the treatment of vitiligo, a beam with a wavelength of 308 nm is recommended.
Because it is applied only topically, the risk of side effects is reduced. Lesions that develop on the face respond fastest to laser therapy. Among the advantages of using laser therapy are the short treatment time, the speed of noticeable effects and the effectiveness. Thanks to the fact that in most devices used in laser therapy there is the possibility of using interchangeable heads, the therapy can be subjected even to quite large areas on the body. The treatment is comfortable and is unlikely to cause painful sensations.
Conclusion
Vitiligo, while not fully understood, impacts patients both physically and emotionally. It manifests as discolored patches, progresses differently for everyone, and has multiple potential causes, from genetics to autoimmune factors. Treatments like phototherapy, laser therapy, and medication can help manage symptoms, though not always permanently. Understanding its triggers and early diagnosis can improve outcomes. Though challenging, effective options exist to improve quality of life and restore confidence for those affected.
