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DocSpot: Vitiligo

Dear Dr Margaret
I have some white patches on my skin. I am dark skinned, so they show up. My doctor says it is vitiligo. What is the cause of this? Will they go away?

I don’t know the cause of vitiligo. All I can tell you is that skin coloration is made by melanocyte cells within the skin. These make pigment, and distribute it to all the nearby skin cells. In vitiligo, melanocytes disappear from the affected areas of skin. The skin becomes chalky white, but otherwise feels and looks completely normal. The reason the melanocytes disappear is a mystery. It is not caused by an infection. Genes may be involved, because a third of people with vitiligo have a relative with the same problem. Although vitiligo is more noticeable in dark skin, it occurs in all ethnic groups.
Most people with vitiligo first noticed it when they were in their teens or twenties. The white patches are often on the backs of the hands, the wrists, the fronts of the knees and the neck. It also affects the genital area.
It is difficult to predict what will happen to your white patches. They may remain just as they are for many years, or they may enlarge very slowly. Melanocytes can migrate into the white area from the surrounding skin, so the colour may return, but this is fairly unusual.
If the condition is troubling you, ask your family doctor to refer you to a dermatologist for specialist advice. Unfortunately, no treatment is reliably effective. Some people respond to a short course of a steroid cream. The usual treatment is ultraviolet light, combined with a drug that makes the light more effective.
There are now very good camouflage creams to disguise the patches. In the UK, you can get advice about camouflage from the hospital dermatology department or the Red Cross. The British Association of Skin Camouflage can also point you towards experts in camouflage for skin problems. Vitiligo on the face is particularly distressing, in which case you might wish to make contact with ‘Changing Faces’, a UK not-for-profit organization that helps people with disfigurements, especially facial disfigurements.
Just a couple more things you should be aware of. Firstly, vitiligo skin burns easily (because it has no pigment to protect it), so use sunscreen. Secondly, people with vitiligo are slightly more likely to have diabetes, thyroid problems and a type of anaemia called ‘pernicious anaemia’. Your doctor is probably aware of this and has checked you for these conditions, but it might be an idea to ask at your next visit to the surgery.

Last updated; Monday, March 29th 2010 at 7:18 am

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