Vitiligo, a disease that causes skin depigmentation, is neither infectious, contagious nor (physically) painful. Nevertheless, it has important psychological repercussions because people who suffer from it often suffer from the gaze of others. Good news: there are adapted treatments.
1. Depigmentation of hair, face, lip, hand, eyes, arms: definition of vitiligo
Vitiligo is a skin disease that is not contagious. It is linked to a progressive depigmentation of the skin, which affects 0.5 to 1% of the world's population, according to the French National Institute for Health and Medical Research (Inserm). Men are as well affected as women by this dermatosis. It is, however, quite rare in children. The depigmentation spots can evolve and become generalized. Vitiligo is a benign skin condition. Nevertheless, it has a significant impact on the psychological health of the patient and can alter his or her quality of life. This is one of the main reasons why scientists have conducted numerous research projects on this skin disease. This development of medical research has made it possible to identify the causes of vitiligo and to better manage this disease with more effective treatments. However, morals and physical standards tend to evolve and this aesthetic and atypical difference can now be considered a real asset.
2. When does vitiligo appear: symptoms and first signs
The signs of vitiligo are very characteristic. They are plaques, also called achromia or leucoderma, because they are white in color. This depigmentation is not painful, it does not cause itching or burning. In other words, vitiligo is asymptomatic. The patches are smooth, without relief, and perfectly delimited thanks to their geometric contours.
There are several types of vitiligo:
- Generalized "vulgar" vitiligo, which is the most common form. The plaques are numerous and roughly symmetrical;
- Localized vitiligo, corresponds to the appearance of only a few patches visible only on an area of skin. They have the appearance of a band and are present only on one side of the body;
- Universal vitiligo or Universalis can affect almost all areas of the skin and hair, leaving very little of the original skin/hair color visible.
Vitiligo can take three forms:
- Segmental, which includes localized or unilateral vitiligo;
- Non-segmental, which is generalized or universal vitiligo. Generally, in the case of non-segmental vitiligo, a simple white patch appears on the face, hands, or feet. It then evolves in a very variable way from one individual to another. When vitiligo spreads, it can end up covering almost the entire body (universal vitiligo). It also happens that the patient's hair is affected, this is called leukonychia;
- Mucous vitiligo is an extremely rare form of vitiligo. It is characterized by the appearance of depigmented areas on the mucous membranes (genitals, lips, etc.).
3. What causes the disease vitiligo, which causes white spots to appear on the skin?
The skin is composed of several types of skin cells, such as keratinocytes or melanocytes. When vitiligo occurs, white spots appear on the skin. They are linked to the disappearance of melanocytes, whose role is to produce melanin, the pigment responsible for the color of the skin, hair or eyes.
There are genetic predispositions in the occurrence of vitiligo. According to Inserm, children who have a parent with this skin disease have a 5 to 8% risk of developing it themselves. Exceptionally, a child can be affected by vitiligo in a congenital form. Numerous scientific studies on this disease have ruled out certain causes and highlighted others. Vitiligo is complex and results from a combination of genetic and non-genetic factors.
Indeed, several genes could be likely to trigger vitiligo, such as HLA or CTLA4. There are also locus, i.e. precise locations on a chromosome gene, which favour the appearance of depigmented patches. These are chromosomes 1, 7, and 8. A certain gene would be involved in the appearance of vitiligo within the same family. This genetic lead also shows that almost all the genes involved play a role in the immune system, whether it is in skin pigmentation, in the regulation of immune functions, in the general functioning of the body's defences, or in the occurrence of autoimmune diseases.
It, therefore, appears that autoimmunity is one of the causes of vitiligo. In fact, according to the French Society of Dermatology, 15 to 20% of patients affected by this depigmenting skin disease also suffer from an autoimmune disease, in particular a hypo/hyperthyroidism disorder. Less frequently, other autoimmune diseases develop, such as rheumatoid arthritis, type 1 diabetes, or chronic bowel diseases. In addition, people with vitiligo produce abnormal antibodies, which are directed against melanocytes and destroy them.
It is important to remember that vitiligo does not favor the occurrence of skin cancer and that it is not a psychosomatic disease (bodily expression of psychological tensions). Indeed, stress, as in any pathology, can have a deleterious effect on the symptoms of an already existing disease. Nevertheless, stress is not the cause of vitiligo, even if it can be an aggravating factor of dermatosis.
- Examinations and diagnosis
Generally, a person consults his or her general practitioner as soon as the first white spots appear. The doctor will then recommend that the person make an appointment with a skin specialist, the dermatologist. The diagnosis of vitiligo is first made by a clinical examination including careful observation of the skin. If the diagnosis is difficult, especially when depigmentation begins, the dermatologist uses a Wood lamp. This ultraviolet (UV) lamp allows for the precise identification of all lesions, especially in people with fair or very fair skin. The Wood's lamp is also used to determine the melanocyte reserve, to list the white spots according to their characteristics (contours, shapes, etc.). The emitting lamp is also used to evaluate the effectiveness of a pigment treatment. In addition, Wood's lamp is used to rule out other skin pathologies that may be the cause of hypopigmentation. The use of biopsy is exceptional.
4.A difficult disease to live with
Although this disease does not affect life expectancy, it has a very strong impact on the quality of life of those who suffer from it. In some countries, they are sometimes even ostracized from society. Apart from the prejudices that stigmatize patients, the location and extent of white spots can cause significant discomfort. "Depigmentation of the genitals can be very difficult for young boys to live with, especially during adolescence," says Professor Passeron, who continues: "It is unbearable to be told that it is due to a state of psychological stress. It makes patients feel unnecessarily guilty and takes away any hope of a cure."
5."Less risk of melanoma"
Another misconception: vitiligo does not promote skin cancer, it is even the opposite. "We know for sure, since 2013, that people who have it have less risk of making a melanoma," confirms the dermatologist. Exposure to the sun is, in fact, an essential component of the therapy: "If you want to repigment discolored areas of skin," he adds, "you have to expose them to UVB, either with sunlight, from April to October, or with phototherapy sessions in a dermatology booth." Not to be confused with sessions in a tanning booth at a beautician's, as the latter dispenses UVA, which is extremely harmful to the skin.
6. Treatment: can vitiligo disappear?
Even if the disease is not medically serious, people with vitiligo suffer psychologically. The impact of depigmentation is considerable on the psycho-social level. This is why the demand for treatment is growing rapidly and why researchers are innovating to find scientific solutions.
Even if vitiligo is not completely curable, there are now treatments that have three complementary objectives:
- Blocking depigmentation;
- To induce repigmentation;
- Prevent recurrence.
One of the reference treatments for vitiligo is based on the combination of phototherapy (exposure to natural UV rays or in a cabin) and topical care, generally, creams or ointments are applied locally on the white areas: these are dermocorticoids or calcineurin inhibitors.
Surgical treatment may be indicated for localized, stable vitiligo or for segmental forms. This is a melanocyte transplant, which is one of the best treatments for segmental vitiligo. This type of transplant is autologous, as the grafts are taken directly from the patient.
Certain techniques are also in full expansion. This is the case with medical makeup, which can be a solution, particularly while waiting for the skin to repigment. Indeed, the repigmentation of vitiligo is a long process. Pigments start to reappear after 6 to 24 months of treatment. It is also possible to apply specific foundations or self-tanners to even out the skin tone of the face or body. Even if make-up does not treat the disease, it can be of great help.
Depigmentation is recommended for vitiligo universalis, when the vitiligo covers almost the entire body. It is done with bleaching solutions or laser.
Finally, other therapeutic approaches are being developed by researchers, some of which are in very advanced stages.
7. How does vitiligo evolve?
Vitiligo generally evolves in an unpredictable way. The skin disease can stabilize, regress or spread to other parts of the body and face. UV light from the sun can be beneficial to the patient. When the patient begins treatment, the dermatologist may advise him or her to expose himself or herself for a limited time. A person with vitiligo has no increased risk of skin cancer. Furthermore, they have the same life expectancy as a healthy person.
Preventing vitiligo
Vitiligo is a disease that is very difficult to prevent since its causes are still not well known. On the other hand, a person with a genetic predisposition should be aware of Koebner's phenomenon: recent scars, skin lesions, or areas subject to regular rubbing may encourage the appearance of new white patches.
Finally, apart from treatment for vitiligo, it is advisable to apply a cream with a high protection factor to be applied on areas without melanocytes.
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