Vitiligo is quite a common skin disease which affects at least 2 person in every 100 in countries throughout the world. Anyone, male or female, irrespective of skin color or ethnic origin can develop the condition.
Vitiligo causes the skin, and sometimes the hair, to turn white in patches. This is because melanocytes, the cells which give the skin its color, have either been damaged or destroyed. The disease can spread, rapidly or slowly, to cover the entire body surface (universal vitiligo) but this is not inevitable. The most common form of vitiligo appears in symmetrical form (generalized vitiligo) affecting both sides of the body. In some cases only one half of the body is affected (segmental vitiligo) and this type has limited progression and is more difficult to treat. Vitiligo can begin at any age, though about fifty percent of people develop it before the age of twenty.
You cannot catch vitiligo. It is not infectious. Although there are no physical symptoms apart from sunburn in the white patches if they are not protected from the sun, it can cause severe psychological distress, especially when the face, neck, hands and genitals are affected. Although the disease is more noticeable on dark or tanned skin the degree of distress is not necessarily linked to skin color or to the extent of the disease. However, people with dark skin from certain ethnic groups who develop vitiligo may feel particularly stigmatized and fear a loss of identity should the disease become widespread.
The course of vitiligo is unpredictable. Some people may not notice a change in their condition for many years, while for others it can spread quite rapidly. In some cases the white patches can spontaneously repigment, particularly in children, though it is rare for the disease to resolve completely without treatment.
The incidence of vitiligo in the population is thought to range from 0.5% – 2%, affecting as many as 65 million people. It has been found to affect both genders and all races equally, however it is more noticeable in individuals with a darker complexion due to the greater contrast between natural skin colour and depigmented areas. A slight female predominance of vitiligo has been reported but remains statistically insignificant; these discrepancies may be attributed to female patients having a higher reporting rate due to cosmetic concerns. Disease onset can occur at any age but is more common in youth, with over half of cases commencing before 20 years of age
Types of vitiligo
Vitiligo is classified into three main types, based on the distribution of the lesions. These categories are further subdivided depending on specific features of the disease.
Localised Vitiligo: Presents in distinct sections.
- Focal – lesions are limited to one or two areas; commonly in a pattern parallel to the trigeminal nerve, which lies beneath the face.
- Segmental – lesions develop in patches on one side of the body only. Occurs most frequently in children.
- Mucosal – affects mucous membranes only (i.e. inside the mouth and eyes).
Generalised/Nonsegmental (NSV) Vitiligo: Widespread across the body; the most common form of vitiligo.
- Acrofacial – affects the face and other extremities.
- Vulgaris – Lesions are scattered all over the body with a symmetrical distribution.
- Mixed – some combination of acrofacial, vulgaris and segmental vitiligo.
Universal Vitiligo: Near complete loss of pigment (over 80% of the body); this type of vitiligo is rare.
In addition to the different classes of vitiligo there are a number of clinical variants based on the appearance of the lesion.
Trichrome Vitiligo – between the unaffected skin and the unpigmented area appears an intermediate zone of moderate pigmentation. This results in 3 shades of color; brown, tan, and white; in the same patient.
Quadrachrome Vitiligo – this reflects the presence of a fourth band around the lesion. It is usually a hyperpigmented band which develops during spontaneous repigmentation.
Inflammatory Vitiligo – the depigmented lesion is surrounded by a raised, inflamed border. It can be present from the onset or develop over time
Blue Vitiligo – this occurs when the patches develop a blue colouration. It has been observed in patients who have developed vitiligo on areas of skin where there was previously post-inflammatory hyperpigmentation (dark spots which occur following inflammation or injury).