Evident throughout history, the white spots caused by vitiligo have been a cause of anxiety for people who contracted the disease. Millenniums ago, Egyptian and Indian texts induced a social stigma for this disease. As one of the most common pigment disorders globally, there are still some social misunderstandings about the nature of the disease. However, this would not happen if people understood vitiligo. This article will provide you with established truths about the disease and the current state of vitiligo in medicine. We will be exploring recent advancements in the cause, symptoms, and treatment of vitiligo.
What Caused These White Patches on Your Skin?
Although much of what scientists believe about vitiligo is still debatable in the medical community, they have ample evidence to suspect that vitiligo is likely an acquired autoimmune disease that targets our pigment-producing cells called melanocytes. Once our own immune system attacks these melanocytes, these white spots appear as a lack of pigmentation in the skin. These spots may appear on the face, back of the hands, below the shoulders, navel, and groin area.
As an acquired disease, scientists believe vitiligo came about because of genetic factors. However, there is sufficient evidence to say that the disease is an interplay of several factors in the body. These factors can involve:
- Uncontrolled environmental stress and triggers
- Abnormal metabolic response of the body
- Impaired renewal and healing of damaged cells
- Altered inflammatory and immune response
Out of all these factors, the leading theory is that vitiligo is an autoimmune disease because:
A number of cases involved both vitiligo and autoimmune diseases.
- Most vitiligo-susceptible patients have genes that encode immunomodulatory proteins.
- Doctors often find immune cells infiltrating depigmenting melanocytes.
However, other plausible theories include the primary role of intrinsic abnormalities in melanocytes that prevent them from adapting properly to environmental stressors. This abnormality can lead to the release of danger signals such as autoantigens that our immune system responds to.
Some scientists believe that the cause of vitiligo is dependent on the interplay of both immunological and non-immunological factors. A 2020 review study believes that aside from studying much on melanocytes, researchers should also focus on the participation of keratinocytes, fibroblasts, natural killer cells, and innate lymphoid cells.
Who Are Vulnerable To Vitiligo?
As previously discussed, much of the risk factors for vitiligo are hereditary since scientists think of it as an acquired autoimmune disease. In detail, these are the risk factors involved in vitiligo.
- Heritability: Those whose family has had a history of vitiligo.
- Immunodeficiency: Those who have a history of immune system-related diseases.
- Cancer: A study reports that vitiligo and cancer are positively correlated, although the relative causation is still unclear.
- External Factors: a 2021 review study notes that several environmental factors can be a risk for vitiligo. These include:
- Physical Trauma
- Agricultural Pollution
- Industrial Pollution
- Emotional Stress
These internal and external risk factors can all affect the ability of melanocytes and keratinocytes to function properly and resist harmful effects that lead to vitiligo.
In addition to these risk factors, the same 2021 review study notes other diseases or comorbidities which can arise along with vitiligo. This is due to the same root cause of autoimmune disorders. These comorbidities include:
- Hashimoto’s thyroiditis
- Diabetes mellitus
- Addison’s disease
- Alopecia areata
- Ophthalmic anomalies
Which Type of Vitiligo Do You Have?
Scientists classify vitiligo into different types according to its morphology, progression, and extent of involvement in the body:
- Non-segmental: More common vitiligo cases which involve patches in an area or in a widespread distribution that occur without segment.
- Segmental: Common vitiligo cases in children which involve segmented patches in the body showing a block-like or linear spot that does not cross the body’s midline.
- Progressing: Signs of an increase in the size or number of patches.
- Stable: No signs of increase in the size or number of patches.
- Extent of Involvement:
- Limited: Vitiligo localizes within one area of the body.
- Extensive: Vitiligo has affected other parts of the body.
The treatment recommended for the vitiligo in case a person has is dependent on the type. For example, if a case shows no sign of progression, then reproduction of the melanocytes will be the priority. Extensive cases of vitiligo involve drastic measures because other parts of the body are already at risk of related diseases.
Is It Possible To Cure Vitiligo?
Although the disease is not entirely curable, current treatment for vitiligo can fully reverse the symptoms. The main goal of these treatments is to reverse the disease through suppression of the attacking immune cells and stimulation of melanocyte stem cells to reproduce again. These are the current treatments used today, according to a 2020 review study:
- Psoralen Ultraviolet A (PUVA) Light: A combination of an herb-based substance called psoralen with UVA light to suppress immune cells and stimulate melanocytes.
- Topical Corticosteroids + Calcineurin Inhibitors: Use of systemic corticosteroid treatment to stabilize active vitiligo cases.
- Combination of PUVA and Systemic Corticosteroid Treatment: More recent treatments combine the two in order to achieve a better result. Scientists now believe that the use of narrow-band Ultraviolet B phototherapy in place of PUVA proves to be more effective.
These phototherapy treatments require weekly visits with the dermatologists, while patients take the topical treatments twice a day in the affected area of the skin.
As of now, this is the current state of vitiligo treatment. Not only are we still limited in options, effectiveness is also not observed in all patients. In these cases, repigmentation does not occur in the treated areas. Moreover, even if one is apparently without symptoms, the relapse rate using these treatments occurs at 40% within the first year after discontinuing.
More than the state of the disease in the medical field, people should understand the societal implications of vitiligo. Vitiligo is not contagious. It is also usually not life-threatening. Our doctors also worry about individuals with vitiligo in terms of the emotional distress the disease causes them. While researchers continue to develop ways to cure vitiligo, we should understand the disease so that we do not burden patients with vitiligo with the stigma of an acquired disease.