14 December 2020 Author : Iolanda Fernandes Vitiligo is a chronic inflammatory dermatosis that affects the skin and mucous membranes. It is characterized by the presence of depigmented and well-defined spots . Depigmentation is due to the selective destruction of functional melanocytes. Melanocytes are the cells that produce melanin, which is the pigment responsible for skin color. Vitiligo affects approximately 0.5% to 1% of the population. Its prevalence is similar in both genders and in all races. It can appear at any age, but it often starts before the age of 20. The disease does not affect life expectancy. However, it can have a significant impact on quality of life, especially psychologically and be responsible for disorders such as depression and anxiety. What causes vitiligo? The causes of vitilig o are not completely known. It is a multifactorial disease , that is, for which development several factors may contribute. These include genetic, autoimmune, and environmental factors. It includes intrinsic defects of melanocytes and complex immunological reactions. Some patients relate the onset of the disease to specific events, such as emotional stress, illness, pregnancy, trauma, but there is still no scientific consensus on this subject. How does the disease manifest? The most common clinical presentation of vitiligo is macules or amelanotic (white) spots , surrounded by normal skin. These white spots can reach any region of the body: They are located more frequently on the face, back of the hands, armpits and genital region; They can also appear on the mucous membranes of the mouth (oral), nose (nasal) and genital; Hair, eyebrows, eyelashes, and beards can also be white. In some people Koebner phenomenon is observed, which is the appearance of new vitiligo lesions in areas where there is a trauma, for example a wound. Vitiligo spots usually do not cause any symptoms, although some patients report itching or burning. There are 2 main clinical forms: Vitiligo vulgaris : it is the most frequent and is characterized by the presence of multiple spots scattered throughout the body; Segmental vitiligo : affects only one half or region of the body. This type is more frequent at younger ages, tends to progress for 1 or 2 years, and then stabilizes. Association with other diseases Vitiligo can be associated with autoimmune diseases . Autoimmune thyroid disease is the most frequently associated pathology, occurring in about 15% of patients. Other less commonly associated pathologies include alopecia areata, pernicious anemia, diabetes mellitus, lupus erythematosus, among others. Diagnosis and treatment of vitiligo Vitiligo diagnosis is based on the presence of the typical spots of the disease. The need of a skin biopsy to confirm the diagnosis is rare. In patients with clear skin the lesions may be subtle and observation with a Wood lamp may be necessary. It is difficult to predict the evolution of vitiligo . Sometimes the lesions stop progressing and recover pigmentation without any treatment; However, in most cases there is a progressive worsening. There is currently no curative treatment for vitiligo . The most used therapies are: Topical application of corticosteroids and calcineurin inhibitors; Phototherapy with UVBb and PUVA; Surgery with micrografts for stable disease. Response to treatment is slow and lesion repigmentation may not occur, despite intensive treatments. It is also important to note that the probability of recurrence of depigmentation after treatment is high. Refe rences Alikhan A, Felsten LM, Daly M, Petronic-Rosic V. Vitiligo: A comprehensive overview Part I. Introduction, epidemiology, quality of life, diagnosis, differential diagnosis, associations, histopathology, etiology, and work-up . J Am Acad Dermatol 2011;65:473-91. Bolognia JL, Schaffer JV, Cerroni L. Dermatology, 4th ed. Elsevier, 2018. Migayron L, Boniface K, Seneschal J. Vitiligo, From physiopathology to emerging treatments: A review . Dermatol Ther 2020;10:1185-98. Rodrigues M, Ezzedine K, Hamzavi I, Pandya AG, Harris JE. New discoveries in the pathogenesis and classification of vitiligo . J Am Acad Dermatol 2017;77:1-13. Meet the dermatology team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
