Vitiligo
Classification and external resources
ICD-10	L80.
ICD-9	709.01
OMIM	193200
DiseasesDB	13965
MedlinePlus	000831
eMedicine	derm/453
MeSH	D014820

Vitiligo (pronounced /ˌvɪtəl.ˈaɪɡoʊ/ ( listen), UK: /ˌvɪtɨˈlaɪɡoʊ/) is a chronic disorder that causes depigmentation in patches of skin. It occurs when the melanocytes, the cells responsible for skin pigmentation which are derived from the neural crest, die or are unable to function. The precise pathogenesis, or cause, of vitiligo is complex and not yet fully understood. There is some evidence suggesting it is caused by a combination of autoimmune, genetic, and environmental factors. It is also common in people with thyroid disorders. The population incidence worldwide is considered to be less than 1 percent.^[1] Non-segmental vitiligo has a greater prevalence than the disorder's other form(s).

[edit] Signs and symptoms

The most notable symptom of vitiligo is depigmentation of patches of skin that occurs on the extremities. Although patches are initially small, they often enlarge and change shape. When skin lesions occur, they are most prominent on the face, hands and wrists. Depigmentation is particularly noticeable around body orifices, such as the mouth, eyes, nostrils, genitalia and umbilicus. Some lesions have hyperpigmentation around the edges.^[2] In regards to psychological damage, vitiligo can have a significant effect on the mental health of a patient.^[3] Psychological stress may even result in an individual becoming more susceptible to vitiligo. Patients who are stigmatised for their condition may experience depression and similar mood disorders.^[4].

[edit] Non-segmental vitiligo

In Non-segmental vitiligo (NSV), there is usually some form of symmetry in the location of the patches of depigmentation. New patches also appear over time, and can be generalised over large portions of the body, or localised to a particular area. Vitiligo where little pigmented skin remains is referred to as vitiligo universalis. NSV can come about at any age, unlike segmental vitiligo which is far more prevalent in teenage years.^[2]

[edit] Segmental vitiligo

Segmental vitiligo (SV) differs in appearance, aetiology and prevalence of associated illnesses. Its treatment is also different to that of NSV. It tends to affect areas of skin that are associated with dorsal roots from the spine. It spreads much more rapidly than NSV and, without treatment, patches of depigmented skin remain throughout life.^[2]

[edit] Pathogenesis

Vitiligo is associated with autoimmune and inflammatory diseases, commonly thyroid overexpression and underexpression. A study comparing 656 people with and without vitiligo in 114 families found several mutations (single-nucleotide polymorphisms) in the NALP1 gene.The NALP1 gene, which is on chromosome 17 located at 17p13, is on a cascade that regulates inflammation and cell death, including myeloid and lymphoid cells, which are white cells that are part of the immune response. NALP1 is expressed at high levels in T cells and Langerhan cells, white blood cells that are involved in skin autoimmunity.

Among the inflammatory products of NALP1 are caspase 1 and caspase 5, which activate the inflammatory cytokine interleukin-1β. Interleukin-1β is expressed at high levels in patients with vitiligo. There are compounds which inhibit caspase and interleukin-1β, and so might be useful drugs for vitiligo and associated autoimmune diseases. In one of the mutations, the amino acid leucine in the NALP1 protein was replaced by histidine (Leu155->His). The original protein and sequence is highly conserved in evolution, and found in humans, chimpanzee, rhesus monkey, and bush baby, which means that it is an important protein and an alteration is likely to be harmful. Addison's disease (typically an autoimmune destruction of the adrenal glands) may cause vitiligo. ^[5][6]

[edit] Treatment

There are a number of ways to alter the appearance of vitiligo without addressing its underlying cause. In mild cases, vitiligo patches can be hidden with makeup or other cosmetic camouflage solutions. If the affected person is pale-skinned, the patches can be made less visible by avoiding sunlight and the sun tanning of unaffected skin. However, exposure to sunlight may also cause the melanocytes to regenerate to allow the pigmentation to come back to its original color.

Home UVB narrowband phototherapy is a very common approach that treats vitiligo.^{[citation needed]} The exposure to a UVB light comes from a small UVB narrowband lamp that gives a specific wavelength of only 311-313 nanometer. The power of the lamp is very low and there is no heat. The success rate is very high in children and in adults when the spots are on the face and neck. Exposure times vary; treatment frequency ranges from two to three times per week with a gradual increase in exposure every subsequent session.

The source for the UVB narrowband UVB light can be kind of a fluorescent lamps that treat large areas in a few minutes or high power fiber-optic devices in a fraction of a second, in a clinic.

Long-wave ultraviolet (UVA) light from UVA lamps, with Psoralen, called "PUVA", is given in clinics. It helps in most of the cases. Psoralen can be taken in a pill 1–2 hours before the exposure or as a Psoralen soaking of the area ½ hour before the exposure.

Lately, UVB narrowband replaces PUVA since this treatment does not involve Psoralen since the effect of the UVB narrowband lamp is sufficient.^{[citation needed]}

The traditional treatment (if any) given by most dermatologists is corticosteroid cream.^[7]

Studies have also shown that immunomodulator creams such as Protopic and Elidel also cause repigmentation in some cases, when used with UVB narrowband treatments.^[8][9]

In late October 2004, doctors successfully transplanted melanocytes to vitiligo affected areas, effectively repigmenting the region. The procedure involved taking a thin layer of pigmented skin from the patient's gluteal region. Melanocytes were then separated out and used to make a cellular suspension. The area to be treated was then ablated with a medical laser, and the melanocyte graft applied. Three weeks later, the area was exposed to UV light repeatedly for two months. Between 73 and 84 percent of patients experienced nearly complete repigmentation of their skin. The longevity of the repigmentation differed from person to person.^[10] In the 1980s, dermatology professor Aaron B. Lerner had pioneered a skin transplantation therapy for vitiligo.^[11]

In early 2008 scientists at King's College London discovered that piperine, a chemical derived from black pepper, can shorten the repigmentation process in skin and reduce the UVB exposures, produces a longer lasting and more even pigmentation.^[12]

A limited 2003 study in India of 25 patients with limited and slow-spreading vitiligo given orally-taken Ginkgo biloba found it to be "fairly effective therapy for arresting the progression of the disease".^[13] A 2008 review of natural health products found studies to generally be of poor quality but concluded that L-phenylalanine used with phototherapy, and oral Ginkgo biloba as monotherapy showed promise.^[14]

[edit] Support organizations

Support groups and organizations are available to help people learn more about vitiligo, understand treatment options, and find support from other people with vitiligo.

Vitiligo Support International is the largest vitiligo organization in the world. The non-profit organization provides free access to online message boards, chat rooms, frequently asked questions, information and articles, as well as a patient-referred doctor search. The group advocates on behalf of patients, conducts patient conferences and has local support groups.

The National Vitiligo Foundation (NVF) is focused on supporting medical and basic science research directed towards finding a cure for vitiligo, building public awareness of this disease, and providing information and support. Recently, the NVF has partnered with Vitiligo Friends to begin creating a social network for patients, friends, and family.

The American Vitiligo Research Foundation Inc. (AVRF) is a non-profit, tax-exempt charity that aims to increase public awareness about vitiligo and to help those affected by vitiligo, focusing specifically on children and their families. It supports finding a cure through alternatives to animal research.

The Vitiligo Society The Vitiligo Society is a registered charity and a company limited by guarantee. It is the only organisation which offers support and understanding to people with vitiligo and their families in the UK and the Republic of Ireland. The Vitiligo Society strives to support people anywhere in the world who asks for help and provides reliable information to the general public and health professionals about vitiligo and available treatment for the condition.

The VitiligoTURK is the first and only vitiligo support organization in Turkish Republic

The Turning White Foundation was founded by broadcaster Lee Thomas, who suffers from the disease, as a support group for other sufferers.

[edit] Public figures with vitiligo

Michael Jackson two years after he was diagnosed with vitiligo universalis, pictured in the early stages of the disease. ^[15]

• Michael Jackson was diagnosed with vitiligo and lupus in 1986, but he claimed that the disease begun around the making of "Thriller". In a 90-minute interview with Oprah Winfrey in February 1993, Jackson dismissed the rumors that he bleached his skin, admitting for the first time that he had the illness. The admission went on to promote awareness of vitiligo, a relatively unknown condition before then, which is probably the reason for the speculations around Michael Jackson's changing skincolor.^{[16][17][18][19]} A friend claimed he started wearing his signature sequin glove to cover the vitiligo that had begun to appear in the early 80's.^[20]
• Graham Norton has white patches in his hair as a result of vitiligo.^[21]
• Lee Thomas, a news anchor and entertainment reporter for WJBK (Fox) Detroit.^[19][22][23]
• Krizz Kaliko, singer/rapper of the Strange Music record label. He has even named his debut album after the condition, Vitiligo.^[24]
• Thomas Lennon of Reno 911! fame.^[25]
• Eduardo Panlilio, Governor of the province of Pampanga in the Philippines.
• Yvette Fielding, British TV presenter, has had vitiligo from age 11; her mother developed it at age 24.^[26][27]
• Mikel Jollett, lead singer and creator of American alternative rock band The Airborne Toxic Event.
• Fez Marie Whatley - The Ron and Fez Show XM 202

[edit] See also

• Alphos
• Albinism
• Leucism
• Melanism
• Pityriasis alba
• Quadrichrome vitiligo
• Selective ultraviolet phototherapy
• List of cutaneous conditions

[edit] Notes

[edit] References

• Millington GW, Levell NJ (September 2007). "Vitiligo: the historical curse of depigmentation". International Journal of Dermatology 46 (9): 990–5. doi:10.1111/j.1365-4632.2007.03195.x. PMID 17822509. 

[edit] External links

Wikimedia Commons has media related to: Vitiligo

• Overview at Davidson College
• Interview about Piperine with Dr. Soumyanath
• DermAtlas 45