50 shades of vitiligo! how the condition is different for everyone

Among the many vitiligans I’ve come across online, everyone seems to have their own unique story. Giuseppe has had a vitiligo patch on his forehead for over 20 years, and it has never spread. On the other hand, 80% of Vicky’s skin was affected in less than three years.

Hearing all of these very different stories makes me wonder…  why do some people have one or two small patches forever, while others turn fully white in a few years?  Unfortunately, not even the most famous vitiligo researchers in the world have the answer to this question, not yet anyway. Even if the nature of vitiligo is somewhat unpredictable, we can identify some different types of vitiligo, let’s begin here with the two main ones.


Non-Segmental vs Segmental Vitiligo

This is the biggest distinction between all forms of vitiligo, as these two types are very different from one another.  First of all, only one in ten cases are classified as segmental, making it the rarest form. The onset of segmental vitiligo occurs most frequently during childhood.  Its main features consist of it appearing on only one side of the body, and that it develops quickly, in 6 months to a year, but then stops spreading forever. Even if it is relatively widespread on the side of the body where it developed, it will never spread again. Therefore, researchers consider it to be the best form of vitiligo. Also, since it stops spreading permanently, it can be treated through melanocyte transplants. Interestingly, segmental vitiligo is not believed to be an autoimmune condition.

The most common form of vitiligo is, however, the non-segmental type.  In many cases, this kind of vitiligo is symmetrical on the body. For example, if you have a patch on your left elbow, you may develop a similar one on your right elbow, or on the left and right wrist and so on… Segmental vitiligo is now proven to be an autoimmune condition.  In some cases it doesn’t spread, in other cases it keeps spreading either extremely slowly or fast.

The remaining forms of vitiligo that we will discuss, are all subcategories of segmental vitiligo.


Focal Vitiligo

This type of vitiligo is when someone has only one or two lesions which have never spread. Focal vitiligo may be a lot more common than we think, because it often remains undiagnosed. It is believed that people affected by vitiligo are about 1% of the population, but a famous vitiligo specialist once said that it could be a lot more, because many people might have only one small patch and they never go have it checked, so they remain undiagnosed. However, focal vitiligo could also be the beginning of another type. 


Vitiligo Vulgaris

This is a fairly common form, it seems to spread randomly, patches can appear anywhere. Yet, in some people, it mostly affects the joints, like the elbows and knees 


Acrofacial

This form of vitiligo affects the areas that are far from the center of the body, like the face, hands and feet. 


Mucosal Vitiligo

This form is pretty self-explanatory, it affects the mucous membranes, for example, the genitals and lips 


Vitiligo Universalis

This is perhaps the rarest form of vitiligo, it is diagnosed when more than 80% of a person’s skin becomes affected by the condition. 


Follicular Vitiligo

This is now officially a new category of vitiligo, since more and more cases of this type are being reported.  Normally vitiligo does not attack the melanocytes present in the hair follicles, this is why in most cases (unless it’s aggressive) the hair does not turn white, even where there is a white patch on the skin in the same area. However, there is a form of vitiligo where only the hair follicles are affected, or where they are affected before the skin is; this is now officially called follicular vitiligo.

The types we have talked about so far, are the main distinctive forms in the appearance of vitiligo, let’s now analyze other types:


Confetti-like Vitiligo

During the last international vitiligo day conference, a vitiligo researcher addressed the onset of confetti-like vitiligo as an emergency. Most forms of vitiligo are characterized by the sudden appearance of one, or a few big patches, followed by long periods of stability, it can then be active again for a short time and then stable again for a long time or even forever. Unfortunately, there is a more rare form where vitiligo appears in a confetti-like manifestation, this is a bad prognosis because it normally means it will keep spreading, and it will do so quickly. If you notice the appearance of confetti-like vitiligo you might want to consult your doctor about taking corticosteroids to temporarily stop the spreading until it stabilizes again.  Read more here


Chemical Vitiligo

Vitiligo can be triggered by many environmental factors (although it is only triggered if you are already genetically predisposed to it), this would certainly include some chemicals. The worst ones being, hair dyes which include phenols, as well as chemicals used in creams to whiten the skin, or in some cases rubber and sometimes latex as well. Normally chemical vitiligo would start at the area of the skin in contact with the chemical, but it can then trigger an autoimmune response and spread to other areas.  In Dr Harris’s blog, it is said that there is some evidence that discontinuing the offending chemical significantly improves how people respond to treatment.

Some cases have been reported where vitiligo was triggered by a specific oral drug, which went away when the person stopped taking the drug. 


Age Onset

It looks like even age onset can play a role in how vitiligo develops differently for different people, it appears that the younger you are when it first appears, the more it will tend to spread. You can read an interesting article about age onset in vitiligo here


What works for some doesn’t work for others.

This is a very common sentence among vitiligans. It is indeed true: for example there are some people who fully repigment with dietary changes, while others have tried all sorts of food restrictions with little effect. Statistically, it seems like 4% of people (only if gluten intolerant), can benefit from a gluten free diet. This is however a very small percentage which means the vast majority of vitiligo patients would not see any benefit going gluten free (from a scientific perspective), however a small amount of people do. Some people who decided to go vegetarian saw their vitiligo worsen, however I have read of at least two cases reporting a nearly full repigmentation by adopting a vegan diet. So why do people react so differently? The easy answer could be that when you have some food sensitivity or intolerance it could trigger an inflammation which could make vitiligo worse, so eliminating that specific source of inflammation could potentially in some cases improve vitiligo. But unfortunately there is still no scientific evidence of that. It is however important to note that Dr La Poole, another very famous vitiligo researcher who is leading the work on HSP70i, reported that even science is starting to recognize a link between vitiligo and gut health. 


Koebner Phenomenon

A number of people, especially when vitiligo appears in childhood, experience the koebner phenomenon. This happens when you have a scratch, burn or a bruise and the damaged skin heals white, meaning once the skin heals, there is a vitiligo patch where the injury happened.


Itching

Some people have reported itching before the appearance of a new patch, according to research this only happens in 20% of people.


Vitiligo which comes and goes

For some people, vitiligo comes and stays (unless treated), but for others it’s a constant coming and going, some patches appear and others disappear just as they appeared. Cases of spontaneous repigmentation have been reported in people who did absolutely nothing to treat the condition, yet it happened. Why? Another mystery of our bizarre skin condition! 


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