By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

“WHITE PATCHES” OF VITILIGO DO MORE EMOTIONAL THAN PHYSICAL HARM

Question: My son, who is 20, has started having these large areas where the skin is turning white. He also has a place where his beard is turning white. His doctor says this is vitiligo and there is nothing to be done for it. Can you tell me more about this problem?

Answer: Vitiligo is a disorder that affects special cells in our bodies that produce a dark pigment called melanin. About one percent of the U.S. population has this disorder. It affects men and women equally and usually starts before age 40.

The special pigment-producing cells – doctors call them melanocytes -- are responsible for the color of the skin, the mucous membranes and the retina in the back of the eye. When vitiligo develops, some melanocytes are destroyed. This curtails melanin production in the involved area or areas, and they turn white.

The resulting “white patches” are usually most noticeable on the sun-exposed areas, such as the hands, arms and face, but they can appear anywhere on the body. People with darker skin may notice a loss of color inside their mouth. In cases like your son’s, where the affected skin has hair on it, the hair turns white as well. This can also affect scalp and body hair.

Vitiligo can spread to new areas of the body or can remain unchanged for years. It can spread slowly or quickly. Some scientists believe there is a correlation between the spread of vitiligo and emotional or physical stress.

The cause of vitiligo is not known, but the theory is that sufferers develop antibodies that destroy melanocytes. If true, this would make it an autoimmune disease. It is known that vitiligo is more common in people who have other autoimmune diseases such as overactive thyroid or pernicious anemia.

Vitiligo appears to “run in families,” and thus may have a heredity component. There also seems to be increased risk for vitiligo if there is a family history of autoimmune diseases.

While vitiligo is not contagious and does not make the person ill, it can have a devastating emotional effect. Many people use cosmetics to cover their hypopigmented areas, but this can be difficult and expensive if the areas are extensive.

Treatment is aimed at restoring the function of the melanocytes in the skin, but it can take a long time, and there is no treatment that works for everyone. There are both medical and surgical therapies. But the surgical treatments should be considered experimental at best.

Probably the most effective treatment is psoralen and ultraviolet A, or PUVA, therapy. It can re-pigment the white patches but can take a long time to work. First, a special drug that reacts with ultraviolet light to cause darkening of the skin is taken either orally or applied to the skin. Then, the patient is exposed to a measured amount of ultraviolet A light.

In milder cases, sometimes just applying a prescription corticosteroid cream will return pigment to the skin. But this also takes time -- usually at least three months before any change will be noticed. Another treatment is to fade the rest of the skin to match the whitened areas.

Currently there is ongoing research to find the exact cause and to develop better treatments. One interesting experimental approach is to try to transplant melanocytes from healthy skin to the affected areas.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.