In this interview with MOTUNRAYO JOEL, Consultant Physician/Dermatologist, Department of Dermatology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Dr. Onyekonwu Chinwe, speaks about vitiligo
What is vitiligo?
Vitiligo is a disorder characterised by the development of white patches on the skin or mucous membranes of affected individuals as a result of the destruction of or damage to the pigment cells (melanocytes) responsible for skin colour. This condition may lead to severe psychological distress and reduced quality of life, especially in dark-skinned people because such patches become more noticeable.It is impossible to predict how much of the skin can be affected. In the majority of cases, the affected areas remain affected for the rest of the person�s life.
What causes it?
Melanin is the pigment that gives the skin its characteristic colour. Vitiligo is caused by a loss of pigment in the skin, due to destruction of pigment-forming cells known as melanocytes. The exact cause of the destruction of these cells is not known. One possible explanation might be that the body�s immune system destroys the cells, as in other autoimmune conditions. Several theories have been suggested but the current thought is that each of these mechanisms cumulatively contributes to the disease process.
What are the symptoms of vitiligo?
Vitiligo signs and symptoms vary considerably from person-to-person. It is by far more perceptible in people with dark or tanned skinned. Some people may only acquire a handful of white dots which develops no further, while others develop larger white patches that join together affecting larger areas of the skin. However, people with vitiligo are usually well. Vitiligo is not sore or itchy. However, the appearance of the skin can be distressing, particularly if the face or the hands are affected. There is no natural protection from the sun in affected areas of skin. This means that skin affected by vitiligo burns much more easily than normal skin if exposed to sunlight.
How is vitiligo diagnosed?
The diagnosis can be made in the clinic but in some situations, there may be need to carry out some investigations including taking a surgical specimen of the skin and sending it to a pathology lab. Some other skin conditions may sometimes mimic vitiligo and so, when the attending clinician is unsure, it will be best to refer such an individual to a dermatologist.
Who gets vitiligo?
Millions of people worldwide have vitiligo. Nearly half get it before they reach 21 years of age. Most will have vitiligo for the rest of their lives. It is very rare for vitiligo to disappear. Vitiligo occurs about equally in people of all skin colours and races. About half the people who get vitiligo are male and half are female.
What treatment options are available?
Several treatment options exist. Some of these treatments date back to several decades ago and with improvement in the understanding of the disease, newer treatments are evolving. The type of treatment will depend on the extent of the patches, whether it affects a small area or the whole skin. There are a wide range of helpful drugs (including creams that can be applied to the skin) and non-drug therapies also exist, but it is important that people who develop this condition should visit their health care provider early for prompt initiation of treatment.
Is vitiligo infectious? What is the relation between leucoderma and leprosy?
Vitiligo is neither infectious nor contagious. Leucoderma actually means �white skin� and there are several conditions that could lead to white skin. It is not synonymous with leprosy. Although some cases of leprosy may present with white patches, there are other forms of leprosy that will not show any pigment loss at all.
Can one marry a person with leucoderma?
Leucoderma is a wide term that could mean a lot of things and yes, why not? People marry for so many reasons and I do not think there is any law prohibiting marriage to someone just because they have white patches.
Will the vitiligo patches spread over time? Will they get larger?
Spread of vitiligo depends on several factors including what type of vitiligo the person has. Some cases may spread and get larger and a few may stay within the confines of the initial patch or even reduce in size, over time.
What is segmental vitiligo?
Segmental vitiligo is the type that usually affects one side of the body; it is commoner in childhood, involves hair changes with whitening of the hair and does not spread rapidly. It affects only about 10 per cent of people with this condition. But unpredictably, segmental vitiligo is more noticeable in the early ages affecting about 30 per cent of the children that have been diagnosed with vitiligo.
What is generalised vitiligo?
In generalised vitiligo, the individuals are usually older, the patches affect both sides of the body, the hair may not be involved at the initial onset and it spreads rapidly to involve wider areas. This type of vitiligo may occur in patients who have other diseases called Autoimmune Diseases.
Do people with vitiligo transmit it to their children?
Although vitiligo may run in families, the inheritance is multifactorial. That means there is a mix of several factors which all add up to cause vitiligo in affected individuals. There is no gene that is isolated alone that one can say this is the main cause and therefore transmitted to the children.
What happens once a person develops vitiligo? How long does it last?
The duration for vitiligo is not uniform across all individuals. It depends on what triggers it and other associated conditions or diseases. Some may progress very fast once it is noticed while some others may linger for years before involvement of other sites. It may occur in childhood or in adults and age of onset can vary from as early as in infants of a few weeks old to the elderly population.
Can vitiligo be cured?
There is no known way to prevent or cure vitiligo. However, several methods, including cosmetics, re-pigmentation using UV light therapy, corticosteroid creams, depigmentation of unaffected skin areas, and skin grafting, can be used to improve the appearance of skin severely affected by vitiligo.
Are there things that a person with vitiligo should avoid?
Essentially, especially in our environment, it may be better to avoid unnecessary sun exposure to avoid the risk of skin cancers, although this does not occur commonly.
If a woman is pregnant and has vitiligo, will her child develop vitiligo?
There is no documented scientific evidence that a pregnant woman will transmit vitiligo to her unborn child as may happen in certain diseases like HIV infection.
Is one at greater risk of skin cancer because of my vitiligo?
There may be an increased risk of skin cancer but the evidence in support of this is moderate at this time.
Are cosmetics which have been manufactured to cover vitiligo spots safe to use?
Yes, they are. There are several camouflage cosmetics that are available.
What is the relationship between vitilago and leprosy?
There is no relationship between vitiligo and leprosy.Vitiligo is a disease of as yet, undetermined cause. Several factors have been postulated as to the cause of vitiligo. It is neither infectious nor contagious. Leprosy is an infectious condition caused by a bacteria. It is contagious and can lead to severe disfiguring sores on the body and damage to the nerves. Some complications include loss of fingers and toes and other deformities.
Acid victim, Naomi Oni, who was attacked in December 2012, by her friend, Mary Konye, has disclosed that she has gotten hope from her new found friend.
