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Vitiligo

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VOL: 101, ISSUE: 22, PAGE NO: 28

- Vitiligo is acquired depigmentation of the skin. It is a condition characterised by variable-sized white patches…

 

What is it?
- Vitiligo is acquired depigmentation of the skin. It is a condition characterised by variable-sized white patches.

 

 

- On pale skin it may be almost invisible but on black or tanned skin it is more noticeable.

 

 

- Patches can stay static, spread or repigment spontaneously.

 

 

Causes
- In vitiligo, areas of skin have no or very few melanocytes, which means melanin cannot be made and the colour of the skin is lost.

 

 

- Trauma or sunburn are causative factors.

 

 

- There may be a link with autoimmune disease although there is no evidence that this is an autoimmune condition.

 

 

- There may be a genetic factor with a positive family history in about 40 per cent of cases.

 

 

Incidence
- Prevalence is between 0.5 and 1 per cent.

 

 

- Men and women are equally affected by the condition.

 

 

- It can develop at any age.

 

 

Affected areas
- Any skin area can be affected.

 

 

- Most common areas are:

 

 

- Backs of hands;

 

 

- Front of knees;

 

 

- Neck;

 

 

- Elbows;

 

 

- Face.

 

 

- Hair may also be affected and lose its colour to become grey.

 

 

- The condition can be generalised or segmental, with localised distribution on one side of the body.

 

 

Prognosis
The best prognosis is in those with dark skin, minor lesions or isolated facial involvement. The worst prognosis is in those with pale skin, where involvement is extensive and where oral, lip or fingers are involved. The course and severity of vitiligo varies from person to person and there is no way of predicting how much of the skin will eventually be affected when the first patch develops. It is common for the patches to gradually become bigger and for more patches to appear on other parts of the body. Large areas of the skin may eventually be affected.

 

 

Nursing considerations
- Vitiligo is not sore, itchy or painful and people with the condition are normally well. However, the altered appearance of skin can make this a distressing condition, particularly if the face or hands are affected.

 

 

- In the affected areas there is no natural protection from the sun therefore vitiligo skin burns much more easily than normal skin and sun protection is essential. Some sun protection used for medical reasons such as for vitiligo can be available on NHS prescription.

 

 

- In fair-skinned people, avoiding tanning of normal skin can make patches of vitiligo much less noticeable.

 

 

- Other autoimmune disorders are more common in people with vitiligo and appropriate testing should be undertaken.

 

 

Treatment
- Treatment is normally unsuccessful and skin camouflage is the usual method of dealing with vitiligo.

 

 

- Steroid cream prescribed when a patch of vitiligo first develops, may prevent it becoming bigger. However, the response to steroid cream is usually not very good.

 

 

- Psoralen and ultraviolet A light treatment (PUVA) twice a week for 6-12 months may be helpful.

 

 

- Grafting of normal skin to small patches of vitiligo has been tried. It is a time-consuming procedure and not always available or successful.

 

 

- In extensive vitiligo depigmentation treatment may be considered.

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