Vitiligo is a disease responsible for depigmentation of the skin. It leads to stains on the face, neck, hands… and hair whitening. Among the celebrities who suffer from it, the former Prime Minister Edouard Philippe.
Vitiligo is a disease which causes a depigmentation of the skin resulting in the formation of white patches on the affected areas. THE fur are also affected. She can thus whiten the beard in man as with the former French Prime Minister, Edouard Philippe (also affected by alopecia). It’s a “disease without gravity, neither painful nor contagious” he recalled in Paris Match in June 2020. One year later, on RTL Eveninghe explained that the bleaching of his beard “was due to stress and work”. What is Vitiligo? What are the causes of these white spots? What to do ? Can they disappear ? Development with our dermatologist.
Definition: what is vitiligo?
THE vitiligo is a skin disease that is characterized by depigmentation resulting in the appearance of white spots on the integument (living tissue that covers the body). In general, the disease begins to appear before the age of 20. This depigmentation is due to the disappearance of melanocytes, cells responsible for skin pigmentation. All areas of the skin (neck, face, hands) and appendages (hair, nails and body hair) can be achieved. There are different forms of vitiligo:
Localized vitiligo : localized vitiligo affects only a small area of skin.
Segmental vitiligo : segmental vitiligo is localized on a single side of the body, on an area of the face, limbs or trunk corresponding more or less to a zone 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 in a lasting way to melanocyte transplantation.
mucosal vitiligo : mucosal vitiligo concerns the mucous membranes: lips, genitals.
generalized vitiligo : generalized vitiligo is characterized by more or less symmetrical spots reaching both sides of the body (bilateral). The evolution is capricious: the spots can remain localized or extend. 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
Why does the disease lead to white spots on the skin?
The white patches associated with vitiligo are related to loss of melanin (pigment that colors the skin) because of the destruction of melanocytes, cells that provide pigmentation. In the case of vitiligo, these spots are permanent. This disease should not be confused with the transient depigmentations observed for example in the case of pityriasis verticolor.
What are the causes of vitiligo?
“The origin of vitiligo still remains mysterious, confides Doctor Yvon Gauthier, specialist in pigmentary disorders. Despite everything within the framework of “converging theories” it is admitted that a deficit of melanocyte adhesion (melanocytorrhagia), a oxidative stress favor the development of autoimmunity in subjects genetically predisposed and often subject to psychological stresses“.
What are the symptoms of vitiligo?
→ localized depigmentation of the skin, limited to a small area or diffuse,
→ premature depigmentation of hair, eyebrows, beard and other body hair.
Photo of vitiligo on the beard
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 light and also to detect spots still invisible to the naked eye. In the case of vitiligo the spot appears chalky white in color“, details the researcher.
A person with an affected first degree relative has a 5 to 8% risk of also developing the disease.
What are the risk factors for vitiligo?
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 the appearance of autoimmune diseases. This would explain why 15 to 20% of people with generalized vitiligo also suffer fromautoimmune hypo or hyperthyroidism (Hashimoto’s thyroiditis, Graves’ disease). Moreover, family predispositions exist: a person with an affected first degree relative has a 5 to 8% risk of also developing the disease.
Can stress cause vitiligo?
THE stress can promote the onset or aggravation of vitiligo: psychological stress, but also physiological stress linked to pregnancy, surgery, acute illness, etc. In April 2021, at the microphone of RTL EveningEdouard Philippe explained that bleaching his beard “was due to stress and work”.
What are the treatments for vitiligo?
“Treatments for vitiligo aim tostop the inflammatory process responsible for the autoimmune destruction of melanocytes and on the other hand for stimulate repigmentation of dark spots from residual melanocytes that persist in the hair follicles“, explains Dr. Gauthier.”We can first get peripilary confetti repigmentation then later a total repigmentation of certain spots which unfortunately is not not final“.
► Creams to hide stains : it is possible to use cosmetics such as foundation or self-tanning cream on depigmented areas, which camouflages the discoloration but does not act on the disease. We use cosmetics for the eye contour, where the skin is sensitive and does not necessarily support heavy treatments.
► Phototherapy: Phototherapy has an anti-inflammatory virtue and stimulates the migration of melanocytes by action UVB : 2 to 3 sessions are scheduled per week, up to a total of 300 treatment sessions. Repigmentation may be partial and transient. There is also the phototherapy by “PUVA therapy”. This technique combines the exposure of the skin to rays UVA and taking (orally, topically, or as a bath) psoralen, a substance that increases the skin’s sensitivity to radiation. In case of localized vitiligo, the treatment can be done by EXCIMER lamp. It allows very localized phototherapy.
► Corticosteroids, vitamin D. A combination of topical corticosteroid therapy and vitamin D or topical tacrolimus may be prescribed for repigment small spots vitiligo: apply once a day for several months. Their effectiveness is not systematic. There systemic corticosteroid therapy can be discussed but the side effects are significant and explain that it is not often prescribed in this pathology. On the other hand, the sequential treatment by minipulse 2 days per week does not present these disadvantages.
► Zinc given in an anti-inflammatory dose may have an effect.
► Depigmentation. “Depigmentation is intended for voluntary patients who have lost all hope of repigmentation and who present on the face or the back of the hands with very unsightly small pigmented islands.“, emphasizes the specialist. “Depigmentation uses either the 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“.
► Transplants. The surgical procedure consists of grafting melanocytes from a donor area onto the depigmented areas. She is widely used in segmental vitiligo affecting the face in patients over 15 years of age. It is rarely used and only in the case of generalized, stable and not very extensive vitiligo.
Thanks to Dr. Yvon Gauthier, researcher, former head of the consultation for pigmentary disorders, Department of Dermatology Hôpital Saint André Bordeaux and to the French Vitiligo Association.