Diseases

White spot disease (vitiligo) - causes and treatment

White spot disease (vitiligo) - causes and treatment


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White spots on the skin

Eye-catching white patches of skin caused by pigmentation disorders are the hallmark of White spot disease (Vitiligo). This chronic skin disease does not otherwise cause any further physical complaints, but the cosmetic impairments can become a considerable psychological burden.

Pigment disorder

Vitiligo describes the formation of white spots on the skin due to a loss or deficiency of the skin pigment melanin. Depending on the extent of the pigment disorder, hypopigmentation (reduced pigmentation) or depigmentation (complete absence of the skin pigment melanin) is mentioned. The disease must be differentiated from other symptoms, which can also lead to spots on the skin, but are not due to a pigment disorder (e.g. skin fungal infections).

Symptoms

The symptoms of white spot disease - as the name suggests - are essentially characterized by the appearance of light skin spots. The irregularly shaped spots are increasingly to be found on the hands, forearms, feet and in the area of ​​the genitals, but theoretically they can occur anywhere on the body. Most of the time, the spots are local, but it is possible to spread them over a large area, in which the spots can also be found, for example, in the area of ​​the mucous membranes and the hairy skin areas. The hair also appears white in the affected area due to the lack of melanin.

For many patients, the disease is limited to the area of ​​the face, hands and feet, which is also known as vitiligo acrofacialis in the professional world. In addition to the lack of pigmentation, the skin shows no further impairments, but it becomes significantly more susceptible to sunlight or UV rays in the affected areas, which in turn can increase the likelihood of sunburn and ultimately also the risk of skin cancer. Patients of all ages are affected by the disease.

Although the disease rarely leads to further physical impairments, the white spots are often perceived as a considerable cosmetic flaw, which leads to psychological problems in the course of the disease for many patients. Affected people feel inferior, vulnerable and, due to their obvious illness and fear of the reactions of others, increasingly shy away from the public, which can result in growing social isolation in the long run.

Complications

Some people may experience other complaints in the course of a white spot disease, for example:

  • Increased sensitivity to the sun: Due to the lack of melanin, the skin is more susceptible to the effects of the sun. Affected people should pay attention to a suitable sun protection to avoid sunburn.
  • Eye problems: Vitiligo may be associated with more common eye problems, such as inflammation of the iris (iritis).
  • Hearing difficulties: Likewise, hearing problems such as partial hearing loss (hypoacusis) often occur.
  • Mental problems: Affected people are more likely to suffer from mental health problems such as lack of self-confidence and reduced self-esteem.

White spot disease: cause

Little is known about the exact causes of the reduced or missing production of the skin pigment melanin in white spot disease. Both a misguided reaction of the immune system (autoimmune disease), disorders of cell metabolism and neurological causes are discussed here. In addition, an inherited component of the disease is considered certain. Vitiligo is increasingly associated with other autoimmune diseases, which supports the thesis of an excessive immune response as the cause of the pigment disorder. Here, for example, an underactive thyroid, an overactive thyroid but also diseases of type 1 diabetes can be mentioned.

What is also striking is the often documented connection between vitiligo and psychological stress or stress, which, according to current knowledge, tends to promote the onset of the disease indirectly through its effect on the immune system. Furthermore, skin injuries and severe sunburn are possible triggers for vitiligo, as well as repeated mechanical irritations from pressure or friction.

Diagnosis

Since other diseases can also be behind the skin spots, those affected should always consult a specialist or dermatologist in order to have security here. This can usually make a relatively reliable diagnosis based on the striking appearance of the white spot disease. Viewing the skin spots under special UV light using a so-called Wood lamp reveals a typical whitish-yellow color, which can also contribute to the diagnosis.

In case of doubt, a laboratory examination of a skin smear is recommended, with which fungal infections but also bacterial infections can be reliably diagnosed or excluded. It is also possible to take a tissue sample (biopsy) and then examine it for melanin in the cells of the epidermis. The laboratory examination of a blood sample is primarily used to determine possible comorbidities, such as diabetes, hyperthyroidism or hyperthyroidism. In order to find out the possible causes of the pigment disorder, the patients are also asked about the conditions under which the spots first appeared, as well as other cases of vitiligo in the family, as part of the diagnosis.

Vitiligo: treatment

The white spot disease is still not curable, even if the pigmentation of the skin can be increased to a normal level with various therapeutic methods. Since there are no physical impairments associated with the disease, the need for treatment is generally considered to be rather minor. In view of the psychological stresses that can be associated with vitiligo, therapy is often desirable for those affected. However, the costs for this are not covered by all health insurance companies.

UV therapy

According to the different forms of white spot disease, the spectrum of possible therapeutic measures is relatively broad. For example, patients who develop severe sunburns quickly on the affected skin areas are advised to thoroughly sunscreen using body-covering clothing and sunscreen (at least sun protection factor 30). In addition, a so-called phototherapy or UV therapy, in which the affected skin areas are specifically irradiated with light of a certain wavelength (spectrum from 310 to 315 nanometers), can stimulate the formation of melanin. This applies in a similar way to treatment by means of a so-called narrow-band excimer laser, in which precise irradiations of individual skin areas are possible.

Accompanying the treatment with UVA and UVB light, photosensitizing drugs can be used to increase the skin's response to the low-dose treatment. As a rule, phototherapy or UV therapy must be used over a period of at least six months in order to achieve extensive success. After a few weeks, however, the first signs of repigmentation often appear. UV therapy is contraindicated in patients with previous skin cancer or excessive photosensitivity. The therapy is also unsuitable for patients before the age of puberty. It should also be mentioned that in the worst case, the treatment can increase the visible contrast between the skin spots and the rest of the skin. Because if there is no repigmentation, the spots remain white and the rest of the skin becomes more tanned due to the treatment. Overall, the results of the treatment unfortunately often fail to meet the expectations of those affected.

Ointments and creams

To date, creams and ointments with cortisone and / or the psoriasis medication calcipotriol are occasionally used to treat vitiligo. However, the achievable treatment success remains extremely vague and, in view of the impending side effects, long-term use is not advisable. The use of immunosuppressive agents in vitiligo is fundamentally questionable because it has not yet been finally clarified what role the immune response plays in the disease and because there is no clear scientific evidence of its effectiveness, but significant side effects are expected.

Skin graft

The most radical treatment approaches are the transplantation of healthy skin or the body's own melanocytes as well as the opposite measure - a color balance by destroying the remaining melanocytes in healthy skin. The skin graft is only considered for patients with enormous psychological suffering and for localized treatment. This also applies to the transplantation of laboratory-grown, self-grown melanocytes, as is offered in some specialized treatment centers.

When the color is balanced, the healthy skin loses its color due to the destruction of the melanocytes by means of laser radiation, special medicines or surgical interventions and the spots are no longer visible. In principle, the physical symptoms of the disease are expanded in order to reduce the psychological strain on those affected. This is only an option for patients with extreme psychological suffering or psychological complications who are psychiatrically attested.

Naturopathy at Vitiligo

The naturopathic treatment of the white spot disease starts with the suspected causes of the skin changes. If, for example, based on traditional Chinese medicine, an impaired circulation of Qi is assumed to trigger vitiligo, medicinal plants and tinctures are used to stimulate the flow of Qi. If there is a suspicion that there is a connection with disorders of the immune system, measures can be taken that generally strengthen the immune system. Exercise and nutrition therapy also often play a role here.

In addition, those affected are sometimes advised to undergo colon cleansing. Homeopathic remedies (especially silica; silica) are also often part of the naturopathic vitiligo treatment, although the effectiveness is considered controversial. Last but not least, light therapy - but without the use of photosensitizing ointments - is also one of the naturopathic treatment approaches.

Decisive for the choice of the therapeutic procedure should be the individual symptoms of the patient, which requires a detailed medical history, which among other things interrogates possible connections with psychological stress, the nutrition or other health impairments. Naturopathy cannot point out a sure way to a cure, but there are good chances to have a positive influence on the overall clinical picture.

Further measures

Vitiligo patients who perceive their light skin spots as a significant aesthetic impairment can cover them up with so-called camouflage. Special make-up ensures that the light spots on the skin are colored so that they are no longer visible. Self-tanners or so-called tanning creams can also soften the contrast to such an extent that the stains can hardly be recognized. The intake of beta-carotene leads to an orange coloring of the light skin spots, which makes them less noticeable in general. The options for color matching are quite effective, especially in the case of rather limited forms of vitiligo. Large areas of skin can hardly be hidden with their help.

If the treatment attempts are unsuccessful and the stains cannot be covered cosmetically, psychotherapy may help patients who are under considerable psychological suffering. As part of the therapy, patients also learn to deal better with emotional stress, which can sometimes have an additional positive effect on the course of the disease. By learning stress management techniques (autogenic training, progressive muscle relaxation), stress can at least be significantly reduced as a factor influencing the development of vitiligo. Nevertheless, people's reactions to white spot disease often remain stressful for those affected. A more intensive education about the symptoms could possibly arouse more public understanding, especially since nobody has to be afraid of being infected because the disease is not communicable. (fp)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dipl. Geogr. Fabian Peters

Swell:

  • Rachela Bleuel, Bernadette Eberlein: Therapeutisches Management bei Vitiligo, Journal of the German Society of Dermatology (JDDG), Nov. 2018, onlinelibrary.wiley.com
  • M. Schild, M. Meurer: Vitiligo, Klinik und Pathogenese, Der Hautarzt, Volume 67, Issue 2, pp 173-189, Springer, Feb. 2016, link.springer.com
  • Marina Bährle-Rapp: White spot disease, encyclopedia cosmetics and body care, Springer Medizin Verlag Heidelberg 2007
  • Constantin E. Orfanos, Claus Garbe: Leukoderm and Vitiligo, therapy of skin diseases, Springer-Verlag Berlin Heidelberg 2002, link.springer.com
  • Austria's public health portal: Vitiligo (accessed: 04.09.2019), gesundheit.gv.at
  • Mayo Clinic: Vitiligo (access: 04.09.2019), mayoclinic.org
  • National Health Service UK (NHS): Vitiligo (access: 04.09.2019), nhs.uk

ICD codes for this disease: L80ICD codes are internationally valid encodings for medical diagnoses. You can find yourself e.g. in doctor's letters or on disability certificates.


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