What is vitiligo and how is it treated?
7 minVitiligo is a relatively common skin disorder that manifests as flat, well-defined, white patches on the face, extremities, joints or genital area. According to the Inserm website, between 0.5 and 1% of the world's population suffers from this condition, which affects men, women and children, with all skin phototypes. This article summarises everything you need to know about vitiligo, including the causes, treatments and how to conceal it with corrective make-up.
What are the causes of vitiligo?
Vitiligo is a complex disease that can be caused by multiple factors, including genetic and non-genetic factors. It results from the gradual loss of melanocytes, the cells responsible for skin pigmentation, and the cause of this loss is still unknown, although various theories have been put forward: the autoimmune system, psycho-affective factors or the accumulation of free radicals.
Vitiligo and heredity
While a predisposition in the family can play a role (according to the French Vitiligo Association, between 30% and 35% of patients have at least one first- or second-degree relative who has been affected by the condition), vitiligo is not a hereditary disease. Parents can pass on predisposing risk factors of the disease to their children, but not the disease itself.
Vitiligo and the immune system
The loss of melanocytes is the result of an exaggerated immune system response. Vitiligo is one of many autoimmune disorders which affect the skin (lupus erythematosus, dermatomyositis etc.), and it is not uncommon for it to be associated with other disorders linked to immune system dysfunction (thyroid disease, rheumatoid arthritis, type-1 diabetes, alopecia areata, etc.).
Vitiligo and stress
While stress is not the main cause of vitiligo, it can promote its onset and/or make the condition worse. This can be due to psychological stress (emotional trauma, accident, etc.), physical stress (friction on the skin, sunburn, etc.) or physiological stress (illness, surgery, etc.).
Vitiligo and oxidative stress
Oxidative stress plays an important role in the destruction of melanocytes (the cells responsible for skin pigmentation), and an alteration in the free radical/antioxidant balance may be a potential mechanism of vitiligo. According to several recent scientific studies (1, 2 and 3), people with this disorder tend to have an abnormally high quantity of free radicals in the skin, leading to self-destruction of the cells.
What are the two types of vitiligo?
There are two types of vitiligo: segmental, which affects a single area of the skin, and generalised, which is the most common and can develop all over the body in a more or less symmetrical pattern.
Segmental vitiligo
Segmental vitiligo is highly localised, affecting a single area of skin on one side of the body. It most commonly affects the face, but the white patches can develop anywhere on the body. According to the French Society of Dermatology’s public website, this form of the condition is particularly common in children, with the lesions expanding rapidly and then the disease’s progression coming to an abrupt halt.
Le vitiligo généralisé
Also known as “vitiligo vulgaris”, generalised vitiligo can affect several areas of the body to a varied extent. The patches develop on both sides in a symmetrical pattern, and their development can vary widely over time. Patients are generally affected on the face, hands and feet in the first instance, with the patches potentially spreading across the entire body (a condition known as “universal vitiligo”).
Generalised vitiligo develops in three progressive stages:
- Stage 1: the patches are lightly pigmented, with a few melanocytes remaining in the epidermis.
- Stage 2: the patches become completely discoloured with black hair.
- Stage 3: the patches lose all pigmentation and the hair turns white.
How do you treat vitiligo?
Depending on the type of vitiligo, its level of activity and the patient’s requirements, the dermatologist may suggest various therapeutic options, to be taken on their own or in combination with other treatments, with the aim of stopping the patches from spreading, inducing repigmentation and preventing recurrence. At present, there is no definitive cure for vitiligo.
Local treatments for vitiligo
Topical corticosteroids and immunosuppressants (tacrolimus and pimercrolimus) for local application are generally prescribed in cases where vitiligo is less extensive. These treatments reduce the activity of the immune system, which has the effect of halting melanocyte loss, while promoting repigmentation.
To avoid the common side effects associated with topical corticosteroids, such as skin atrophy and abnormal dilation of small blood vessels (telangiectasias), they are prescribed for a fairly short period, and only for the treatment of small lesions.
Narrow-spectrum UVB phototherapy
Narrow-spectrum UVB phototherapy is now the preferred treatment for generalised vitiligo. Administered in a doctor’s surgery, this therapy induces local immunosuppression and stimulates melanin production, with patients undergoing two to three sessions a week for several months.
PUVA therapy
PUVA therapy combines the oral intake of psoralen medication, which stimulates melanin production under the action of light, with exposure to Ultraviolet Light A (UVA). It is prescribed less and less because of its many side effects (burns, pruritus, skin dryness, nausea, etc.) but it may be recommended by a dermatologist for patients who have an unsatisfactory response to narrow-spectrum UVB phototherapy.
Antioxidants
In addition to phototherapy, oral and topical antioxidants, which combat oxidative stress, can prevent the spread of vitiligo, slow its development and help achieve satisfactory repigmentation.
Surgical treatments for vitiligo
For localised vitiligo that has been stable for several years but has not responded to other treatments, surgical treatment in the form of a tissue or cell graft may be used. There are various techniques available (blister roof graft, melanocyte graft, ultra-thin skin grafts, etc.) and results can differ from one individual to another, with varying degrees of satisfaction.
Laser depigmentation
For universal vitiligo affecting almost the entire body, and in cases where repigmentation therapies have not worked, the doctor may suggest laser depigmentation of healthy areas to make skin appear more uniform. Use of this treatment requires careful consideration because of its definitive nature (melanocytes are completely destroyed). Since depigmented skin is much more sensitive to the sun, a protective skincare routine (clothing, sunscreen, management of time and duration of sun exposure, etc.) must be put in place to prevent sunburn and the risk of skin cancer.
How do you conceal vitiligo?
In addition to medical treatment to halt the progression of vitiligo and induce repigmentation, various short- and longer-term techniques can be used to conceal the condition and thus improve patients’ quality of life.
Make-up to conceal vitiligo
High-coverage foundations can be used to correct vitiligo temporarily. When applied to the face, neck and neckline, their pigment-rich formulas, which are largely resistant to water and sweat, can make the complexion appear more even. For small lesions, the local application of concealer may suffice to make the skin tone appear more even, but for more extensive forms of vitiligo, a corrective product should be applied all over the face.
Self-tan to mask vitiligo
Self-tanning creams and lotions can help add colour to areas of depigmented skin to achieve a temporary, water-resistant result that can last for several days. The molecules most often found in self-tanners are dihydroxyacetone (DHA) and erythrulose, which react with the amino acids in epidermal cells causing colour to develop in different shades and levels of intensity. This is a popular technique for patients with lighter skin phototypes, although its application requires a certain amount of dexterity as only the lesions should be targeted.
- (1) Xuan Y, Yang Y, Xiang L, Zhang C. The Role of Oxidative Stress in the Pathogenesis of Vitiligo: A Culprit for Melanocyte Death. Oxid Med Cell Longev. 2022 Jan 22;2022:8498472. doi: 10.1155/2022/8498472. PMID: 35103096; PMCID: PMC8800607.
- (2) Chang WL, Ko CH. The Role of Oxidative Stress in Vitiligo: An Update on Its Pathogenesis and Therapeutic Implications. Cells. 2023 Mar 19;12(6):936. doi: 10.3390/cells12060936. PMID: 36980277; PMCID: PMC10047323.
- (3) Chen J, Li S, Li C. Mechanisms of melanocyte death in vitiligo. Med Res Rev. 2021 Mar;41(2):1138-1166. doi: 10.1002/med.21754. Epub 2020 Nov 17. PMID: 33200838; PMCID: PMC7983894.
