Vitiligo: when the color gradually disappears from the skin

Vitiligo is a skin condition with white to light pink patches. There is no skin pigment present in the spots. Pop star Michael Jackson attributed the lightening of his skin to this disease. Vitiligo is probably an autoimmune process. Vitiligo is not contagious. What are the symptoms of vitiligo and how can the disease be treated? Can vitiligo be cured?

Article content

  • The color of the skin
  • The lack of color: albinism, albino
  • Vitiligo
  • Causes of vitiligo
  • Symptoms of vitiligo
  • Vitiligo diagnosis
  • Vitiligo treatment
  • Vitiligo prognosis
  • Impact on the life of someone who is diagnosed
  • Camouflage
  • LVVP: patient association for people with vitiligo
  • Facebook and fellow sufferers
  • Book in which vitiligo plays a role: Het Lelietheater

The color of the skin

The color of the skin depends, among other things, on the amount of melanin (skin pigment) in the skin. There are special pigment cells called melanocytes that produce melanin. These pigment cells are located in the bottom layer of the epidermis. Melanin is passed on in small spheres, melanosomes, to epithelial cells of the epidermis. Another name for these epithelial cells is keratinocytes. The job of melanin is to protect skin cells against the harmful effects of ultraviolet radiation. They do this by absorbing the rays. Sunlight causes more melanin to be made. Everyone has approximately the same number of melanocytes, but in people with dark skin color the melanocytes are more active. This leads to more melanosomes being made and the keratinocytes having more pigment, which makes the skin color darker. The color of the skin is also determined by the thickness of the epidermis and the blood circulation . With good blood circulation, the skin will turn a pink to red color.

The lack of color: albinism, albino

People with albinism (albino) lack the pigment melanin in the entire body. The skin and hair are white and the irises have a red-pink color. It occurs very rarely, usually a small amount of pigment is present. The irises are then light blue in color. Albinism is a hereditary condition, an enzyme is missing. There is a great sensitivity to the light of the sun, so protection is necessary. For example, you can purchase special glasses.

Vitiligo

Vitiligo occurs in approximately two hundred and forty thousand people in the Netherlands. The condition is not contagious. Pigment is missing in parts of the skin, it can occur almost anywhere on the body. Preferred places are hands, feet, face and armpits. The spots are white to light pink in color. You can get Vitiligo at any age, but in approximately fifty percent of cases the disease starts before a person turns twenty. Vitiligo can have a major impact on someone’s mental well-being.

Causes of vitiligo

The cause is probably an autoimmune process. In vitiligo, the body produces antibodies against a person’s pigment cells. Approximately one in three people with the disease has one or more blood relatives with vitiligo. Whether you are male or female and how you live are not factors that play a role in the development of vitiligo.

Symptoms of vitiligo

  • The disappearance of color is very slow, it can take months or even years.
  • These are milky white spots. There is often a slightly dark edge around it, but that is not always the case.
  • Loss of pigment from parts of the skin, often around the openings of the body and in folds. Also in places where pressure is regularly exerted and on feet, hands and face.
  • The spots are spread ‘mirror-like’ over the body, the sizes and shapes differ.
  • Sometimes white hairs grow on the spots. This is due to the lack of pigment in the hair follicles.

Vitiligo diagnosis

It is usually clear that it is vitiligo. Sometimes a skin examination is necessary to rule out other causes. For example, pityriasis versicolor , a fungal infection, can also cause discoloration of the skin. Blood tests can be used to determine whether someone also has another autoimmune disease, such as diabetes mellitus or pernicious anemia.

Vitiligo treatment

  • If you have a mild form of vitiligo, you can use cosmetics to hide the spots.
  • Do not expose the areas to sunlight and use a sunscreen with a high protection factor.
  • Sometimes phototherapy is advised with ultraviolet light, possibly in combination with a product that makes the skin more sensitive to the effect of light.
  • Corticosteroid ointment can be prescribed for vitiligo. It suppresses inflammation and infections and can sometimes prevent the spread of spots in people with vitiligo. The disadvantage of the corticosteroid ointment is that it has side effects. For example, the skin can become increasingly thinner.
  • Tacroli ointment: this ointment does not contain corticosteroids and therefore has fewer harmful side effects. The ointment inhibits inflammation and stops the breakdown of pigment.
  • If large parts of the body are affected, skin bleaching may be an option.

Vitiligo prognosis

Vitiligo does not go away, the spots often gradually become larger. Occasionally, pigment formation restarts spontaneously. Sometimes, if the spots do not get bigger, transplantation with cells from your own epidermis that do produce pigment can be a solution.

Impact on the life of someone who is diagnosed

If you have fair skin, white spots may not be noticeable in winter. So it can be scary in the summer, the skin turns brown, but you suddenly see white spots. Go to your GP, who will refer you to a dermatologist. The dermatologist will make the diagnosis. It is wise to take someone with you, as the two of you will hear more than if you were alone. The shock will be great, especially in the beginning, there is no certainty (yet) about the cause and at the moment there is no treatment that ensures that the process will stop or that the white spots will disappear. However, it is important not to panic, stress does not have a good effect on vitiligo. It is not contagious, it is not life threatening. Yet no one wants stains on their body. There is light therapy, there are creams (with and without hormones) that may be able to inhibit the process. It remains to be seen what it does to someone. The hands are quite difficult to treat, spots on the face often respond well.

Camouflage

If you are not bothered by the white spots, then camouflage is not necessary. But if you feel very insecure, it is nice to know that there are good camouflage products. With very light skin you will hardly see the spots in the winter and you can camouflage them in the summer months. This can be done, for example, with self-tanners . Please note, you apply these products, but the tanning continues for a while. There are self-tanners from different brands, you have to test which product suits you best. Try it out first in a place that is not so visible. There are also body lotions with a little bit of self-tanner , with these products the tanning is a bit more subtle. It always remains to be seen whether the stains will also color properly. Dermacolor products are also an option . With these products you can immediately see what the result will be and if you don’t like it you can remove it and do it again (something that is not possible with self-tanners). It is best to make an appointment with a skin therapist, he/she can choose the right color.

LVVP: patient association for people with vitiligo

You can contact the LVVP with all your questions about vitiligo. The interests of people with vitiligo are represented and the LVVP funds research.

Facebook and fellow sufferers

You may not know people with vitiligo, but you would like to talk to fellow sufferers. To exchange experiences, to get tips, to receive support in difficult times. On Facebook you can visit: Vitiligo Netherlands and Vitiligo fellow sufferers . Vitiligo fellow sufferers was founded in July 2017 by Martine Daems, and now (August 2020) the (closed) group already has 1000 members.

Book in which vitiligo plays a role: Het Lelietheater

Lulu Wang wrote the story, it is largely autobiographical. She describes the friendship between Lian (Lulu gave herself this name in the book) and Kim. Lian and her family belong to a high caste, Kim to a lower caste and she is bullied at school. Mao Zedong decides that the high caste families should be re-educated in prison camps. When Lian goes to the prison camp with her mother, it is Kim who helps Lian, she arranges medication to prevent the spread of white spots (vitiligo). Lulu Wang has the skin condition vitiligo.