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When skin simply won’t tan

July 2018

Back of skin with white patches
Vitiligo causes white patches to develop on the skin

In the recent sunny weather, many of us will have developed a light tan.

But some areas of the skin may have remained obstinately white. One reason for this is the condition of vitiligo.

Vitiligo can be spotted when white patches develop on the skin. You may not fully realise you have this condition until you have been out in the sun and the rest of your skin changes colour. Then these pale white patches, which can be quite small, suddenly become apparent. They most commonly occur on the face, neck and hands and also around body openings including the eyes, nostrils and mouth.

It is a long term condition and the full background is not yet understood although there is some early evident that repeated trauma such as rubbing or scratching the skin can trigger vitiligo. What is known is that it is a lack of melanin in these sections of skin that causes the lack of colour. Melanin is made by cells known as melanocytes, and at the moment there is thought that vitiligo causes the body to make antibodies to its own melanocyte and because of this it destroys them.

After that, the colour pigment cannot develop and the skin turns white. It is equally common in both men and women of all races, and it is not contagious in any way.

There are two types of vitiligo, non-segmental and segmental. With non-segmental vitiligo, the symptoms often appear on both sides of the body as symmetrical white patches. Oddly, this is the most common type of the disease and accounts for 90% of people with the condition. In segmental vitiligo the white patches only affect one part of your body.

While there is no irritation or pain from the affected areas, the paler areas of skin are more prone to sunburn and therefore taking precautions when out in the sun is especially important for these areas.

Before jumping to conclusions, it is a good idea to get your doctor or dermatologist to verify the condition as there are other problems which can also cause pigment loss. Pityriasis versicolor for instance results in similar loss of pigment but is due to a fungal infection. The doctor may need to use a special ultraviolet lamp to ensure a correct diagnosis.

Bad news is that the white patches caused by vitiligo are usually permanent and there is no treatment to stop the condition spreading. In fact the treatment options are limited.

Phototherapy can sometimes be helpful, involving exposing the affected area to special ultraviolet light. But this treatment often needs to be repeated over a long period and full repigmentation is unusual. A newer treatment involves transplanting small areas of normal skin into the areas of vitiligo, but this is still being developed and not yet generally available. Some sufferers have tried laser treatment, and a special Excimer laser has been reported to have had some success.

Some topical creams are said to help restore some pigment; potent corticosteroid anti-inflammatory cream and calcineurin inhibitors have been used. Occasionally a short course of oral steroids may be recommended although this can produce unwelcome side effects.

But for most people with the condition, rather than trying to treat the problem the best solution is to try and hide the affected skin with camouflage products. Artificial sun tanning products can work, and a GP and dermatologist can advise of other specific products that can assist.

One thing to be careful about is sun burn. Areas of skin affected by vitiligo will burn easily as they have no natural pigment protection. This means it is important to cover up or use a high sun protection, factor 30 or higher, when going out in the sun.

The British Association of Dermatologists has a patients’ leaflet on vitiligo.

The British Skin Association also have good information.

The NHS have a short information section.

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