Vitiligo

Vitiligo is a dermatosis whose underlying mechanisms have not yet been fully elucidated.

This skin condition is characterized by the destruction of melanocytes , the cells responsible for producing melanin, the pigment that gives skin its color. The loss of these melanocytes will result in achromia or progressive depigmentation of the skin, with the appearance of white skin spots.

The most commonly affected areas are the hands , feet, face , armpits, genitals, and skin folds.

Several factors are certainly involved and studies have shown that the genetic component has an important part.

Some of the patients who suffer from vitiligo are also followed for an autoimmune disease such as autoimmune hyperthyroidism, chronic inflammatory bowel disease, or type I diabetes.

Genetic mutations can affect the production of melanocytes or their survival, which can lead to the destruction of pigment cells. Environmental factors such as infections, injuries or stress can also trigger or worsen the disease in genetically predisposed people.

This dermatosis can take several forms:

• Non-segmental vitiligo or vitiligo vulgaris is the most frequently found form: it first and foremost affects the face, then the hands and feet with bilateral and symmetrical development . The onset of symptoms is generally marked by the appearance of a white spot which evolves in a variable manner over time (we speak of vitiligo flare-ups ). Some patients may report pruritus prior to the appearance of new spots.
• Segmental vitiligo is less common with unilateral involvement, meaning only one side of the body will show the characteristic depigmentation of vitiligo. Moreover, the white zone is well limited, circumscribed.
• We speak of vitiligo universalis when almost the entire body is affected by white spots.
• When only the mucous membranes are affected (genitals, lips, etc.), we speak of mucous vitiligo : this clinical form is rare.

While vitiligo can affect any part of the body and can affect people of all ages, genders, and races, it is more commonly seen in people with darker skin tones .

The lesions most often appear in adulthood, but children are also likely to be affected.

The diagnosis of vitiligo is based on a clinical examination performed by your dermatologist.

Dermatoscopy visualizes white areas without pigmentary structures or with reduced pigmentary structures.

The lamp of wood makes it possible to find with certainty the white zones characteristic of this dermatosis, to determine a possible capacity of repigmentation on the level of certain places and to evaluate the level of activity of the disease.

At the biopsy , we find a normal epidermis with a loss of melanocytes.

The clinical examination is also used to eliminate a panel of pathologies responsible for a lightening of the skin such as eczema or psoriasis .

Vitiligo is not a carcinogenic risk factor. Some studies even report a three times lower frequency of melanomas  in people suffering from vitiligo.

The evolution of vitiligo is difficult to predict: this dermatosis can remain stable, evolve in a variable way or even regress. Our team of dermatologists is available to provide you with the necessary advice on the precautions to take on a daily basis. For example, rubbing or micro-traumas as well as the repetition of certain gestures can promote the appearance of vitiligo patches: this is the Koebner phenomenon.

Lifestyle has an important role in the treatment of vitiligo .

The treatment of vitiligo is decided according to various factors such as the age of the patient, the extent of the plaques and the affected areas, the speed of progression of the disease as well as the importance of its psychological and emotional impact:

• Topical treatments :
• Creams containing corticosteroids, to be avoided however on the thin skin of the eyelids and folds .
• Calcineurin inhibitors (Pimecrolimus and Tacrolimus).

• UV phototherapy : UVB lamps and the UVB excimer laser have shown really encouraging results with high rates of skin repigmentation. On the other hand, this treatment is not suitable for very light phototypes I and II.
  • Broadband or narrowband (311 nm) whole body or localized UVB
  • Excimer laser UVB (308 nm) or targeted UVB for small areas.
  • Photochemotherapy (PUVA)
• Systemic therapy with corticosteroids, methotrexate, ciclosporin, mycophenolate mofetil or oral minocycline.
• Surgical treatment is only done on stable vitiligo.
• General measures and lifestyle : these measures are of paramount importance in the management of vitiligo. Traumatic skin lesions must be avoided and sun protection optimized (wearing sun protection clothing and application of a sunscreen with an appropriate index).

Drug treatments and UV treatments have shown variable results, and it’s common to go through several trials before finding the one that works best. It should be noted that the effectiveness of treatment aimed at restoring skin pigmentation does not guarantee the prevention of the appearance of new vitiligo lesions.

Combined treatments can be considered when vitiligo affects areas that are difficult to treat: combination of ointment and UVB phototherapy for example.

Several studies are underway and it has been shown that the effectiveness of vitiligo treatments depends on the affected area: the face and the trunk give better repigmentation results than the hands and feet for example. The age of the spots is important because new spots respond better to treatment.