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Autoimmune disease in which pigment is missing
You have probably encountered someone with milky white spots on, for example, the hands. Those spots are the result of a chronic skin disease in which pigment is missing: vitiligo. Strangely enough, you are not born with it. This skin condition can suddenly pop up all of a sudden.
The color of our skin is formed by a substance called melanin. Melanin is again made by pigment cells. Just like all cells in our body, pigment cells are also busy dividing and growing. If that no longer happens and pigment cells in certain parts of the body are destroyed, the skin disease is often called vitiligo. Because no more melanin is made, milky white spots appear on the skin. Vitiligo occurs in about 240,000 Dutch people and 0.5 percent of the world population.
Size and shape
The spots vary in size and shape and can change. Often the border is clearly visible because a dark border separates the vitiligo spot from the pigmented skin. Usually the spots are visible on the hands and feet or on the face, but vitiligo also occurs in the armpits, around genitals and anus, and on elbows and knees.
Familiarly determined
Vitiligo is a non-contagious disease that occurs at all ages, but strangely enough, a person is not born with it. The disease usually appears between a person’s tenth and thirtieth birthday. There are also exceptions: toddlers or the elderly who get vitiligo. The skin disease is familial. About 30 percent of patients have a family member with the same disease. There is also a link with autoimmune diseases such as diabetes mellitus, rheumatism and asthma in the family.
Autoimmune disease
Because vitiligo seems to involve the body’s immune system targeting the body’s own cells, many scientists consider this skin disease to be an autoimmune disease. This has a practical reason: it is not known what the exact cause of the disease is. It is believed that there are factors that can trigger vitiligo in people who are predisposed to it:
- Serious Emotional Efforts
- Unprotected exposure to sun rays
- Serious illnesses
- Operations
- Pregnancy
- Wounds on the skin
In addition, five forms of vitiligo can be distinguished:
1. Vitiligo Vulgaris
The most common form of vitiligo: the spots appear symmetrically on both sides of the body.
2. Segmental Vitiligo
There are spots on one part of the body, for example on one half of the face or on one of the two shoulders. The spots may enlarge but will not spread to other parts of the body.
3. Vitiligo universalis
In this form of the skin disease, patients have hardly any pigmented skin and they are ninety percent white.
4. Acral Vitiligo
The vitiligo is only on the ends of the body: arms and legs, especially the fingers and toes.
5. Acrofacial Vitiligo
In this form, there are spots on arms and legs, but also around the eyes and mouth.
Therapy
Because it is not known what causes vitiligo, the disease cannot be cured for the time being. There are treatments available to counteract the loss of pigment or to stimulate the production of pigment. Treatment does not always have results and the effect of the treatments differs per person.
UVB light therapy is usually the most effective treatment. Patients are then exposed to ultraviolet light twice a week for a year. The goal is to stimulate the production of pigment, but unfortunately it can also make vitiligo worse.
Other treatments include:
- Ointment with corticosteroids. However, nothing is done about the lack of pigment cells. In addition, there are harmful long-term side effects: it can make the skin thinner.
- Tacrolimus ointment is then usually a better choice. This ointment works especially well for vitiligo on the face and also prevents the breakdown of pigment, but does not make the skin thinner.
- Pigment grafting where pigmented skin is removed from less visible areas on the body and placed on unpigmented skin.
- Depigmentation therapy is available for patients with vitiligo universalis. The remaining pigmented skin is then removed using bleaching creams or a laser treatment.
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