Vitiligo is one of the most common skin diseases, and yet the vast majority of people have never even heard the name. Probably because vitiligo is not life threatening, statistics on its prevalence are not routinely collected. On the basis of various clinical studies around the world, it is generally estimated to affect 1-4% of all races and populations. This implies that over half a million people in the UK alone have vitiligo.
Symptoms and Causes
Vitiligo can affect anyone of any age and either sex. In those who have the condition, patches of skin turn white, and in some cases their hair can also lose its colour in patches. Although it has no effect on the patient's general physical health, the white patches usually increase over time , producing further patches with patches joining together to form large areas of totally white skin and are highly vulnerable to sunburn, even when only briefly exposed to mild sunshine. On exposed areas such as the face and hands it can be very disfiguring, especially on dark or tanned skin. Many people who have vitiligo find it socially and psychologically devastating, and can lose their self esteem and self confidence.
The causes are not yet properly understood, but there is growing evidence which indicates that the disease is genetic in origin in most cases.
There are other skin conditions, particularly fungal infections, which can easily be mistaken for vitiligo. If there is any doubt about the diagnosis, a referral to a hospital dermatology (skin) clinic is advised.
An outright cure has not yet been found, but there are recognised National Health Service (NHS) treatments which can sometimes bring colour back into the white patches or at least control their spread, although there is no guarantee that they will work in any individual case.
One of these treatments is the use of steroid creams on the affected areas at the onset of the disease. This can sometimes stop the spread of the patches or, even restore some of the lost colour. This treatment is usually given only for a limited period under medical supervision.
Another NHS treatment involves the use of ultraviolet light. One of these treatments, known as PUVA (psoralen + UVA), can encourage the natural colour to come back within the white patches. This treatment involves the use of drugs called psoralens, which make the skin sensitive to light. The skin is then exposed to ultra-violet A light . In the UK, PUVA is normally available only as a hospital outpatient treatment, and it should always be supervised by a dermatologist (skin specialist).
A more recent development is the use of narrow-band ultraviolet B light This has the advantage that no drugs need to be taken, and the repigmentation is often more successful with this method than with PUVA. In the UK this treatment is usually only available in hospitals under the supervision of a dermatologist.
A further development in research, has shown that psychological counselling using cognitive behavioural therapy can both help the patient to recover his/her self-esteem and can, in some cases, help lost colour to return to the white patches.
Complementary treatments, including herbal and homoeopathic remedies, can be very expensive. They may sometimes work, but there is no proof of this and there could be unforeseen side effects. The patient should be cautious and should never take any medicine or pills without knowing what they contain. It is important to inform the General Practitioner about any treatments undertaken, and to make sure that the complementary practitioner consulted is properly qualified and registered with a recognised professional body. Anyone who claims to offer a ‘cure' should be avoided.
For those who are troubled by their appearance, concealing the white patches may improve self confidence. There are cover creams which are specially designed for this purpose and are suitable for use by men, women and children alike. Some of these, classified by the NHS as ‘borderline substances', can be prescribed by doctors. The Skin Camouflage Service of the British Red Cross has a nationwide network of clinics which advise on the use of cover creams. Some people prefer to use self-tanning creams (sometimes called fake tans), which are available over the counter at most chemists or beauty counters.
It is important to protect the white patches from burning in the sun. These patches are wholly or partly lacking in the pigment which is the skin's natural protection against sunburn. Allowing the skin to burn can encourage the vitiligo to spread. The patches should be protected from the sun by clothing, or by the use of a high factor sunblock. Some brands of sunblock, which have a sun protection factor of 25 or above are classified as borderline substances and can be obtained on prescription.
Children and young people
Children with vitiligo cope best if parents answer their questions about their condition truthfully and simply. They need to be reassured that it will not affect their family's feelings towards them. They can have problems with bullying and teasing at school, which may be overcome by explaining vitiligo to teachers and enlisting their help.
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