Vitiligo is a skin disease characterized by depigmentation resulting in the appearance of white spots on the skin. It can also whiten the beard as in the former French Prime Minister, Edouard Philippe. Causes, types of vitiligo, symptoms, effective treatments … Here’s what you need to know.
Vitiligo is a skin illness which is characterized by a depigmentation resulting in the appearance of white spots on the skin. It can also bleach the beard as with the former French Prime Minister, Edouard Philippe. In an interview with the magazine Paris Match in June 2020, he clarified that it was a “disease without seriousness, neither painful nor contagious “. In April 2021, at the microphone of RTL Evening, he explained that the bleaching of his beard “was due to stress and work”. “Many people around me have to live with this disease, he continued. Sometimes we don’t care about them. It’s okay, and I take full responsibility for that. “ What to do ? Explanations.
the vitiligo is a skin disease characterized by depigmentation resulting in the appearance of white spots on the seed coat (living tissue that covers the body). Usually the disease begins to appear before the age of 20. This depigmentation is due to the disappearance of melanocytes, cells responsible for the pigmentation of the skin. There are different forms of vitiligo:
- Localized vitiligo : localized vitiligo affects only a small area of the skin.
- segmental vitiligo : Segmental vitiligo is localized on only one side of the body, on an area of the face, limbs or trunk corresponding more or less to an area of innervation or to a metamer. It appears more often in children and adolescents. This form is generally not very progressive and is very rarely associated with generalized vitiligo. Segmental vitiligo responds very well and sustainably to melanocyte transplantation.
- Mucous vitiligo : mucous vitiligo concerns the mucous membranes: lips, genitals.
- Generalized vitiligo : generalized vitiligo is characterized by more or less symmetrical spots affecting both sides of the body (bilateral). The evolution is capricious: the spots can remain localized or spread. In some cases the depigmentation can ultimately be total, it is then a vitiligo universalis.
- Vitiligo universalis : it is characterized by depigmentation affecting almost all of the integument and appendages
All areas of the skin and integuments (hair, nails and body hair) can be affected.
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“The origin of vitiligo is still a mystery, confides Doctor Yvon Gauthier, specialist in pigmentary disorders. Despite everything within the framework of “convergent theories” it is admitted that a deficit of melanocytic adhesion (melanocytorrhagia), an oxidative stress favor the development of an autoimmunity in subjects genetically predisposed and often subjected to psychological stress.“.
Vitiligo is characterized by depigmentation of the skin.
The symptoms of vitiligo are as follows:
→ localized depigmentation of the skin, limited to a small area or diffuse,
→ premature depigmentation of hair, eyebrows, beard and other body hair.
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The diagnosis of vitiligo is a clinical diagnosis in the presence of skin depigmentation. “A Wood’s lamp used in a dark room allows a more precise study of the skin in cases where the skin is fair and also to detect spots still invisible to the naked eye. In the case of vitiligo the spot appears a chalky white color“, explains the researcher.
A person with an affected first degree relative has a 5 to 8% risk of developing the disease as well.
About fifteen susceptibility genes have already been associated with vitiligo: HLA, CTLA4, NLRP1, TYR … some are involved in skin pigmentation, others are linked to the functioning of the immune system or to the appearance autoimmune diseases. This would explain why 15 to 20% of people with generalized vitiligo also suffer froman autoimmune hypo or hyperthyroidism (Hashimoto’s thyroiditis, Graves’ disease). We also know that the stress, in the medical sense of the term, can promote the onset or worsening of vitiligo: psychological stress, but also physiological stress linked to pregnancy, surgery, acute illness … In addition, family predispositions exist: a person with a first degree relative with the disease has a 5 to 8% risk of also developing the disease.
“Vitiligo treatments aim to stop the inflammatory process responsible for the autoimmune destruction of melanocytes and on the other hand to stimulate the repigmentation of spots from residual melanocytes which persist in the hair follicles.“, explains Dr Gauthier.”We can get at first peripilar confetti repigmentation then subsequently a total repigmentation of certain spots which is unfortunately not definitive“. To attenuate the aesthetic damage one can have recourse to:
- the use of phototherapy (UVA, NbUVB, Laser or Excimer lamp),
- melanocyte transplantation mainly in the case of segmental vitiligo,
- as a last resort to camouflage or depigmentation of very unsightly pigmented residual islets.
Camouflage by cosmetics
It is possible to use cosmetics such as foundations or self-tanning cream on depigmented areas, which camouflages the discoloration but does not act on the disease. Cosmetics are used for the eye area, where the skin is sensitive and cannot necessarily endure heavy treatments.
UVB phototherapy
Phototherapy has an anti-inflammatory effect and stimulates the migration of melanocytes by the action of UVB rays: 2 to 3 sessions are scheduled per week, up to a total of 300 treatment sessions. Repigmentation can be partial and transient.
Phototherapy by PUVA therapy
This technique combines exposure of the skin to UVA rays and taking (orally, topically or as a bath) psoralen, a substance that increases the sensitivity of the skin to the rays.
EXCIMER Lamp Treatment
It allows a very localized phototherapy this technique is indicated in the localized vitiligo.
Local treatments (corticosteroids, vitamin D …)
The combination of local corticosteroid therapy and vitamin D or topical tacrolimus can be prescribed to re-pigment small spots of vitiligo: apply once a day for several months. Their effectiveness is not systematic.
Systemic treatment
Zinc given in anti-inflammatory dose may have an effect. Systemic corticosteroid therapy can be discussed but the side effects are important and explain why it is not often prescribed in this pathology. On the other hand, the sequential treatment with minipulse 2 days per week does not present these disadvantages.
Depigmentation treatments
“Depigmentation is intended for voluntary patients who have lost all hope of repigmentation and who have very unsightly small pigmented islands on the face or back of the hands.“, underlines the specialist.”Depigmentation uses either cryotherapy, laser, hydroquinone monobenzyl ether (less and less used). The chemical derivatives of hydroquinone are contraindicated on large surfaces because they are toxic to the kidneys“.
Surgery
The surgery consists of grafting melanocytes from a donor area on the depigmented areas. It is widely used in segmental vitiligos involving the face in patients over 15 years of age. It is rarely used and only in the case of generalized, stable and not very widespread vitiligo.
Thank you to Dr Yvon Gauthier, researcher, former head of consultation for pigment disorders, Dermatology Department Hôpital Saint André Bordeaux and to the French Vitiligo Association.
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