Understanding Vitiligo: Causes, Types, Diagnosis and Treatment Options

Vitiligo is a condition in which some of the skin loses its pigmentation (color), causing patches of lighter skin to appear. The loss of pigmentation occurs when cells that produce pigment, called melanocytes, are destroyed.

Primarily viewed as a skin condition, vitiligo can also affect hair, eyes, inner ear, and mucous membranes inside the mouth and nose. It is often seen on the face, dorsal hands, or feet.

What Causes Vitiligo?

Researcher don’t know exactly what causes vitiligo. The most common type of vitiligo, known as generalized or nonsegmental vitiligo, may be an autoimmune disorder in which the body’s immune system attacks melanocytes and kills them.

Alternatively, evidence suggests that segmental vitiligo, a type of the disease that differs from generalized vitiligo, may have a different cause and could be related to the nervous system.

Vitiligo Risk Factors

These factors can increase the risk of developing vitiligo:

．Family history of vitiligo

．Family history of autoimmune conditions

．Melanoma or non-Hodgkin lymphoma

．Another autoimmune disorder

．Certain gene changes

Types of Vitiligo

The two types of vitiligo are segmental and nonsegmental.

Nonsegmental or Generalized Vitiligo

Typically referred to as either generalized and nonsegmental vitiligo, this type of vitiligo is the most common. It causes white patches on both sides of the body — people with nonsegmental vitiligo may notice that patches appear on both hands, for example.

The loss of color typically occurs rapidly and covers a large area of the body. Color loss is typically progressive, meaning it occurs more over a person’s lifetime. New patches may form and existing patches may expand over time.

Segmental Vitiligo

This less common type of vitiligo causes patches on one part of the body, such as the face or an arm or leg. It tends to appear at a younger age and continues for about one or two years before it stops.

Some people with this condition also lose some hair color.

Vitiligo Diagnosis

People usually receive a vitiligo diagnosis through a physical exam. Your doctor will ask about your family history and personal medical history. They may also want to perform a blood test to check your thyroid.

Vitiligo Treatment

Not all treatments restore original skin color for all people. Treatments are meant to return pigment to some extent, slow the condition’s progression, and make the skin look more even.

Some people with vitiligo choose not to change the condition’s appearance.

Topical Treatments for Vitiligo — Topical Steroid

Before any new treatment is launched, some doctors may prescribe other off-label medications, such as corticosteroids or calcineurin inhibitors to treat vitiligo.

However, there are no established clinical studies proving the efficacy for re-pigmenting vitiligo.

Topical Treatments for Vitiligo — JAK Inhibitor

FDA has approved a topical JAK inhibitor in the form of medicated skin cream for the treatment of nonsegmental vitiligo in adult and pediatric patients 12 years of age and older.

It is the first FDA-approved pharmacologic treatment to address re-pigmentation in vitiligo patients. The medicated skin cream is applied twice a day to affected areas of up to 10% of the body’s surface area.

Safety and effectiveness of the JAK inhibitor medicated skin cream were demonstrated in clinical trials. In both trials, subjects with nonsegmental vitiligo were randomized to treatment with the JAK inhibitor medicated skin cream or placebo cream twice daily for 24 weeks, followed by an additional 28 weeks of treatment with JAK inhibitor for all subjects.

At the end of the 24-week treatment period, 30% of the JAK inhibitor patients had at least 75% improvement in the facial Vitiligo Area Scoring Index, compared with 10% of placebo patients.

Reference

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