Around sixty-five million people worldwide live with vitiligo, a pigmentation disorder of the skin. The cells giving the skin its color are destroyed, and as a result, starkly white patches appear randomly on the body. They can even affect the mucous membranes in the mouth and nose, and have been found in the inner layer of the eye. If there is hair growing over the area lacking pigment, it often turns snowy white, and vitiligo treatment is designed to reverse or stop the process.
The initial cause is unknown. Some researchers suspect genetic predisposition, while others call it an autoimmune disorder, which causes the body's immune system to attack itself rather than stopping external threats. Cases have been reported where the disease has suddenly been activated by a traumatic sunburn, but these have not been scientifically verified.
The disease is more noticeable in people with darker skin, but it attacks all races and sexes equally. The disease itself is not fatal, but the impact psychologically and emotionally can be devastating. Those who suffer often feel depressed or embarrassed, and there are even some places in the world where it is grounds for divorce. Young people are particularly sensitive to the unsightly patches and are sometimes socially stigmatized by their peers.
There is no cure. Treatments help, but can only improve the appearance, not eliminate the cause. One which may restore a resemblance of normal pigment is topical steroid therapy. The results often do not become visible for at least three months, and side effects may include skin shrinkage or streaking. The cream contains corticosteroids, similar in makeup to the hormonal content in cortisone. Special care must be taken when giving it to patients under age ten.
Another method is called psoralen photochemotherapy, or more commonly PUVA therapy. Used in conjunction with ultraviolet light, psoralen reacts with that light to darken skin. The drug is either taken orally or applied directly to the skin, followed by exposure to a special lamp. Sessions must be very carefully timed, because there is a very real danger of severe sunburn-like injury.
While oral psoralen can produce good results, it does increase the possibility of the eyes forming cataracts. Users generally are advised to wear special protective UVA sunglasses for a period up to a full day after being treated. Some patients have suffered side effects such as extreme itching, abnormal hair growth, nausea or vomiting, and sometime, hyperpigmentation. For those not tolerant of this treatment, a drug called monobenzone is used to cause depigmentation of surrounding areas, so there will be less visual contrast. This chemical sometimes causes a super-sensitivity to sunlight, which usually does not disappear.
Autologus skin grafts are another choice for patients. Doctors remove a patch of normal skin and graft it to a part of the body lacking pigment. This method can be expensive, and like any surgery, the results are not guaranteed, and there are the usual surgical risks. A similar grafting method actually creates and uses specially induced skin blisters, but this method is also not foolproof. Scarring may result, and re-pigmentation does not always happen.
Tattooing has been used to color affected areas, and there is continuing vitiligo treatment research that involves actually growing new skin cells in a laboratory for future transplantation. For many patients, use of special cosmetics can be quite effective. Some companies today produce specific personal products designed to effectively cover up the pigment-free patches. In addition, many sufferers also find counseling and support groups to be very useful when dealing with this lifelong problem.
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