Vitiligo Types, Causes & Treatments
Vitiligo is a skin condition characterised by the loss of melanocytes, the cells responsible for producing melanin, which gives colour to our skin, hair, and eyes. The exact cause of vitiligo is unknown, but it is believed to be an autoimmune disorder, where the immune system mistakenly attacks and destroys melanocytes.
There are several types of vitiligo, each with different appearances and treatment responses:
- Generalised (non-segmental) vitiligo: The most common type, characterised by symmetrically distributed white patches on the skin, affecting multiple body areas.
- Segmental vitiligo: A less common form, affecting only one side of the body or a single body segment. This type tends to progress more rapidly but stabilises sooner than generalised vitiligo.
- Focal vitiligo: Characterised by one or a few isolated white patches, typically affecting a small area of the body.
Vitiligo can present in the following manner:
- White patches on the skin, varying in size and distribution
- Premature whitening of hair, including eyelashes and eyebrows
- Loss of colour in the mucous membranes, such as the mouth or nose
Different Morphologies of Vitiligo
Vitiligo can present itself in various morphologies, with each type displaying unique characteristics and patterns on the skin.
Trichrome vitiligo is a particular type of vitiligo characterised by a gradual transition of colour in the affected areas. This morphology is distinguished by three distinct colour zones: a central area of complete depigmentation (white), a middle zone with partial pigment loss (tan or light brown), and a peripheral zone with normal skin colour. The gradual change in colour can create a more noticeable contrast between the affected and unaffected skin, which can be challenging to camouflage or treat. Management of trichrome vitiligo typically involves the same treatment options as other forms of vitiligo, such as topical corticosteroids, calcineurin inhibitors, and phototherapy. However, trichrome vitiligo may require additional attention and tailored treatment plans due to its unique presentation.
Inflammatory vitiligo is characterised by the presence of a reddish or inflamed border surrounding the depigmented patches. This type of vitiligo may be associated with increased immune activity in the skin, leading to the inflammation and redness observed. Inflammatory vitiligo can cause additional discomfort due to the inflammation, and treatment may need to address both the depigmentation and inflammation.
The primary focus of treating inflammatory vitiligo is to control the inflammation and redness, which can be achieved using topical corticosteroids or calcineurin inhibitors. Additionally, treatments such as phototherapy and oral or topical antioxidants may be beneficial in managing both the inflammation and pigment loss. In some cases, the inflammatory component may subside over time, leaving only the classic depigmented patches, which can then be managed using standard vitiligo treatment approaches.
Confetti vitiligo is another distinct morphology characterised by numerous small, round or oval-shaped depigmented patches scattered across the skin, resembling confetti. These patches are generally smaller than 5mm in diameter and can appear suddenly on any part of the body. The abundance and scattered pattern of these small lesions can make confetti vitiligo particularly challenging to treat and camouflage.
Treatment options for confetti vitiligo may include conventional approaches like topical corticosteroids, calcineurin inhibitors, and phototherapy. In addition, cosmetic camouflage techniques using specialised makeup products can help conceal the appearance of confetti vitiligo, providing temporary relief and improving self-esteem.
General Lifestyle Measures for Vitiligo Management
While there is no cure for vitiligo, adopting certain lifestyle measures can help manage the condition and prevent further depigmentation:
- Protect your skin from the sun: Apply broad-spectrum sunscreen with at least SPF 30 on exposed skin and wear protective clothing to minimise sunburn and skin damage.
- Avoid skin trauma: Injuries to the skin, such as cuts and scrapes, can trigger the development of new vitiligo patches.
- Maintain a healthy diet: Eating a well-balanced diet rich in fruits, vegetables, and whole grains can help support your immune system and overall health.
- Seek emotional support: Living with vitiligo can be emotionally challenging, so it’s essential to find a support network of friends, family, or support groups to help cope with the condition.
Vitiligo Treatments: Phototherapy, Cosmetic Camouflage, MBEH, and Other Options
Various treatment options are available for managing vitiligo, although results may vary depending on the individual, the type of vitiligo, and the extent of the condition. Your dermatologist may recommend one or more of the following treatments:
- Oral and Topical corticosteroids
- Topical calcineurin inhibitors
Phototherapy for Vitiligo Treatment
Phototherapy, or light therapy, has been shown to be effective in repigmenting the skin in some cases of vitiligo, particularly for generalised vitiligo. The most common type of phototherapy used for vitiligo is narrowband UVB (NB-UVB) therapy. NB-UVB therapy emits a specific wavelength of ultraviolet light that stimulates melanocytes, promoting repigmentation of the affected skin areas.
Phototherapy treatment plans typically consist of multiple sessions per week over several months. The frequency and duration of treatment are determined by your dermatologist based on your specific condition and treatment response. Although phototherapy is generally considered safe, potential side effects may include skin redness, burning sensations, and an increased risk of skin aging and skin cancer with long-term use. It is essential to discuss the risks and benefits with your dermatologist before initiating phototherapy treatment.
Cosmetic Camouflage for Vitiligo
For individuals who wish to cover vitiligo patches for cosmetic reasons, cosmetic camouflage is an option. Specialised makeup products are available that can be matched to your natural skin tone, effectively concealing vitiligo patches and providing a more even appearance. These products are usually water-resistant and can be applied to various parts of the body, including the face, hands, and legs. While cosmetic camouflage does not treat the underlying condition, it can help improve self-confidence and quality of life for those with vitiligo.
MBEH (Monobenzone ether of Hydroquinone) for Vitiligo Treatment
In some cases, when vitiligo is extensive and repigmentation is unlikely, your dermatologist may discuss the option of depigmentation therapy using monobenzone (MBEH). MBEH is a cream that works by removing the remaining pigment from the unaffected skin, resulting in a more uniform appearance. This treatment is typically reserved for those with more than 50% body surface area involvement and should be used with caution, as the depigmentation is permanent, and the treatment can be associated with side effects, including redness and irritation. It’s crucial to discuss the risks and benefits of MBEH with your dermatologist before starting treatment.
JAK Inhibitors: Emerging Potential for Vitiligo Treatment
Janus kinase (JAK) inhibitors are an emerging class of medications that show promising potential for the treatment of vitiligo. These drugs work by inhibiting the JAK enzymes, which are involved in the signaling pathways of the immune system. By blocking these enzymes, JAK inhibitors can modulate the immune response and help restore pigment in vitiligo-affected skin.
Both oral and topical JAK inhibitors are currently under investigation for their efficacy in vitiligo treatment. Early clinical trials have demonstrated that these medications can lead to significant repigmentation in some patients, particularly when used in combination with existing treatments such as phototherapy. While oral JAK inhibitors have shown encouraging results, topical formulations may offer the advantage of fewer systemic side effects and a more targeted approach to treatment.
It’s important to note that JAK inhibitors are not currently TGA approved for the treatment vitiligo, and no commercially available JAK inhibitors are available for vitiligo in Australia.
When to See a Dermatologist
If you suspect you have vitiligo or are struggling to manage the condition, it’s essential to consult a dermatologist. They can accurately diagnose the type of vitiligo you have, recommend appropriate treatments, and help you explore additional coping strategies, including cosmetic camouflage and emotional support resources. Remember that the response to treatment can vary between individuals, and finding the right approach may require patience and persistence.