Ever wondered why some people have white spots on their skin? Clearly it is not a cause from a failed bleaching experiment! It is a pigmentation disorder in the human skin, Vitiligo.

Vitiligo is a common skin disorder in which white spots appear on the skin usually occurring on both sides of the body in the same location. The disease has been around for thousands of years. Vitiligo occurs in 1-2% of the population. It affects both sexes, all races and all ages. Vitiligo occurs when melanin — the dark pigment in the epidermis that gives your skin its normal color — is destroyed or not produced. The involved patch of skin then becomes white.

Symptoms
When a person first develops vitiligo, the disease usually starts as flat white spots on the hands or around the eyes. The white spots usually do not itch or hurt. These white spots or patches are commonly circular and occur in the same areas on both sides of the body, thus producing a mirror-image effect. The spots are more common over bony areas. Most people experience a slow progression of the disease with more and larger white patches, while in others, the patches disappear by themselves.

There are two main types of vitiligo: the generalized form and the segmental form. In generalized vitiligo, the patchy white areas are often symmetrical, flat, have definite borders, and may affect or spread to any part of the body. In segmental vitiligo, the white patches usually stay on one side of the body, and they do not spread after the first six months or so. In some people the white patches spread over the entire body. This can make an African-American look like a Northern European-American.

Summary of diagnostic features:

• Patches with loss of pigment in the skin
• Family history
• Association with autoimmune disease.
• Woods lamp examination
• Skin biopsy

Causes
There are several theories regarding the cause of vitiligo but the actual cause is not fully known. Below are some that I compiled from the readings done through research via the internet.

• The skin is made up of two main types of cells or building blocks: keratinocytes and melanocytes. The keratinocytes make up the bulk of the skin. The melanocytes are the cells that make the skin color. In people with vitiligo, the immune cells (cells which fight infection) attack the melanocytes and kill them. When the melanocytes in a certain area die the skin turns white. No one knows why the immune cells attack the melanocytes in people with vitiligo.
• Patients with vitiligo are sensitive to free radicals and need aggressive vitamin therapy, see below.
• Vitiligo sometimes runs in families, meaning that a genetic factor may be involved.
• Vitiligo sometimes occurs at the site of an old injury.

Treatment
Vitiligo is very difficult to treat. Treatment often depends on the severity of the condition and the patient’s feelings of disfigurement. Cover-up cosmetics work well for some people. The traditional treatment given by most dermatologists is corticosteroid cream.

Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex. Corticosteroids are involved in a wide range of physiologic systems such as stress response, immune response and regulation of inflammation, carbohydrate metabolism, protein catabolism, blood electrolyte levels, and behavior.

Glucocorticoids such as cortisol control carbohydrate, fat and protein metabolism and are anti-inflammatory by preventing phospholipid release, decreasing eosinophil action and a number of other mechanisms.
Mineralocorticoids such as aldosterone control electrolyte and water levels, mainly by promoting sodium retention in the kidney.

Some common natural hormones are corticosterone (C21H30O4), cortisone (C21H28O5, 17-hydroxy-11-dehydrocorticosterone) and aldosterone.

Taken from Wikipedia – Corticosteroid

Other more sophisticated forms of treatment include gradually developing color back in these patchy areas (repigmentation) by PUVA ultraviolet light treatments or by surgically transplanting melanocytes into the white areas. These treatments are most successful in patients with vitiligo over less than 50% of their body surface area. With PUVA therapy, the patient takes a pill (psoralen) one hour prior to coming to the doctor’s office. The patient then stands in a box and the skin is exposed to ultraviolet type A light. This must be done two to four times per week for fifteen to thirty minutes each treatment. Patients with vitiligo usually require 100-300 treatments over a year or more. There is a 50-70% success rate with this treatment.

The newest treatment for vitiligo involves transplanting melanocytes from areas of normal skin color into the areas without skin color. This treatment is still experimental and is only done at university medical centers. Although there is very little that can be done to prevent the loss of skin color, patients with vitiligo should use sunscreen of SPF 15 or higher on the white patchy areas to prevent sunburn and skin cancer. The melanocytes, which are missing in these white patchy areas, are the skin’s natural protection against sun damage. So without these melanocytes, people with vitiligo are prone to sunburn in their white areas. People with vitiligo seem to be less likely to get skin cancer for reasons that are being studied.

Public figures with vitiligo

• Michael Jackson was diagnosed in 1986 with vitiligo and lupus; the latter is potentially lethal but is in remission in Jackson’s case.[12] In a 90-minute interview with Oprah Winfrey in February 1993, Jackson dismissed suggestions that he bleached his skin, admitting for the first time that he had the illness. The admission went on to promote a public debate on the topic of vitiligo, a relatively unknown condition before then.
• Graham Norton has white patches in his hair as a result of vitiligo.
• Lee Thomas, a news anchor and entertainment reporter for WJBK (Fox) Detroit.
• Krizz Kaliko, singer/rapper of the Strange Music record label. He has even named his debut album after the condition, Vitiligo.
• Doc Hammer, co-creator of the cartoon The Venture Bros. has vitiligo of the scalp, which causes his hair to grow in two different colors.

Taken from Wikipedia – Vitiligo: Public figures with vitiligo