Diagnosis
A dermatologist can usually recognize the condition by its characteristic features. He or she will look for bilateral, symmetric, sharply defined areas of hypopigmentation with surrounding unaffected skin. Skin spots may be examined with an instrument, called a Wood’s light, which shines ultraviolet light onto the skin. Vitiligo will show up as yellow-green in color or with a bluish tint under the Wood’s light.
It is important to distinguish vitiligo from other dermatologic conditions that may cause various degrees of color loss (such as, postinflammatory hypopigmentation, morphea, leprosy, and chemical leukoderma). Laboratory testing and specific genetic screening is unnecessary unless clinical evaluation suggests a possible alternative diagnosis.
Treatment
Although a variety of cosmetic treatment options exist, there is no medical cure for vitiligo at this time. The amount of depigmentation is more visible on people with darkly colored skin. It is important to remember that vitiligo may last for years or go away rather quickly depending on the individual. Some possible management options are:
- Find a Dermatologist: It is important that your physician knows how to treat vitiligo and is able to provide emotional support and guidance.
- Support Groups: Talking with other people who have vitiligo and confiding in family members and close friends can help to lessen any concern associated with the appearance of skin spots.
- Sunlight Protection: It is very important to protect areas of depigmentation with sunscreen because they are very sensitive to sunlight and may easily burn. The American Academy of Dermatology recommends choosing a water-resistant sunscreen with broad protection of UVA & UVB rays and a Sun Protection Factor (SPF) of at least 30 for application on a year-round basis.
- Make-up coverage: Cosmetic cover-up lotions and creams help to even out skin tone and darken areas of hypopigmentation.
- Topical corticosteroids: This is often the first choice for medical treatment of depigmented areas. It is important to apply the topical steroid only to the area of depigmented skin to prevent thinning of unaffected skin. All topical steroids should be used exactly as directed by your dermatologist.
- Topical calcineurin inhibitors: These medications are helpful for the face, armpit, or groin areas where topical corticosteroids may be too potent.
- Phototherapy with narrowband UVB: Few adverse treatment effects are expected in specialized phototherapy centers. Patients should be able to commute to phototherapy centers 2 to 3 times a week for many consecutive months.
- PUVA therapy: This strategy involves exposure to a compound called psoralen (either through oral medication or a topical bath soak) followed by exposure to UVA radiation. PUVA is an effective therapy for vitiligo in many patients, but may take hundreds of treatment sessions.
- Lasers: An option for more localized areas that have not respond to topical or light treatments.
- Surgery: Possibly an option for stable, limited areas when all other medical therapies have failed. This includes techniques such as autologous micrografting, suction blister grafting, and tattooing.
- Depigmentation of unaffected skin: This may be an option when the condition covers most of the body and the individual has chosen to undergo permanent pigment loss. This is a lengthy, although painless, process that essentially removes all remaining pigment from the skin.
Associations and Support Groups:
Vitiligo Support International
http://www.vitiligosupport.org/
Vitiligo Support International
P.O. Box 4008
Valley Village, CA 91617
Tel: (818) 752-9002
National Vitiligo Foundation
http://nvfi.org/index.php
National Vitiligo Foundation
P.O. Box 23226
Cincinnati, OH 45223
Tel: (513) 541-3903
American Vitiligo Research Foundation, Inc
http://www.avrf.org/
The Vitiligo Society
http://www.vitiligosociety.org.uk/
The Vitiligo Society
125 Kennington Road
London SE11 6SF
Tel: (0800) 018-2631
The Turning White Foundation
http://www.turningwhite.com/
References:
Vitiligo: Pigmentation Disorders. The Merck Manual for Healthcare Professionals, Oct. 2008. Web.
Vitiligo. MDconsult, 2009. Web. www.mdconsult.com