The cosmetic and psychological impact of vitiligo can be devastating in patients and could result in low esteem, poor body image (dysmorphea) and difficulties in personal and social relationships. It is not possible to predict the exact outcome of treatment in vitiligo; but some factors may help assess the prognosis and possible positive responses to medical and surgical therapies.
What is the Normal Course of Vitiligo or What Happens if Vitiligo is Left Untreated?
- In less than one third of patients the vitiligo patches may stop progressing and remain stationary throughout life. In about 30% of patients there is spontaneous pigmentation, especially in the sun exposed areas; though this usually does not extend to cover the full area of skin color loss.
- In most patients the vitiligo has a rapid onset followed by slow progression with the color loss localized to certain parts of the body.
- In others, left untreated, vitiligo progresses relentlessly to become generalized turning the skin fully white, with islands of black or brown skin at places.
- Segmental vitiligo, which is limited to an area supplied by a branch of cutaneous nerve (called a dermatome), after attaining certain size, remains stationary without any further whitening of the skin in other areas of the body.
What is the Prognosis in Treated Cases of Vitiligo?
- In some patients, regardless of treatment, the repigmentation is slow and never may be complete, especially of the finger tips, feet, bony prominences like elbows, wrist, lips, genitals etc.
- In others, as in Michael Jackson, irrespective of treatment, the vitiligo progresses to turn the skin white all over the body, leaving islands of pigmented skin at places. In such cases, the vitiligo patients opt for bleaching out the pigmented normal skin so that the skin becomes uniformly white to give satisfactory cosmetic appearance. This is how Michael Jackson turned white.
- In many patients, especially in those with involvement of limited area of skin with proper treatment, the patients recover with full repigmentation.
- The treatment of vitiligo associated diseases like thyroiditis does not have any effect on the course of the vitiligo.
What are the Indicators of Poor Prognosis or Unfavorable Response to Medical Treatment?
There are some indicators of poor prognosis to vitiligo treatment. Following are a few pointers to poor response to medical treatment:
- Early age of onset. Earlier the age of onset of vitiligo, worse the prognosis.
- Presence of associated autoimmune disorders like thyroid disease, lupus erythematosus, pernicious anemia, diabetes mellitus
- Presence of uncontrolled stress affects the vitiligo adversely.
- Acrofacial Vitiligo. Involvement of lips, finger tips, toe tips and genitals indicates poor prognosis.
- Segmental Vitiligo responds poorly to all types of treatment except the surgical.
- Generalized Vitiligo. Treatment outcome is unsatisfactory in generalized vitiligo.
- Leucotrichia, or hair turned white, within the vitiligo patch is a bad omen. This is because the skin affected by vitiligo gets back the pigment from the melanin pigment in the hair follicle and the adjacent normal skin.
Thus age of the patient, extent of involvement, the advantages and disadvantages of the medications all help the patient and the dermatologist to select the most effective treatment for vitiligo.
Reference
- Disorders of Skin Colour, in Rook’s Textbook of Dermatology, 7th Edition, 2004
- Fitzpatrick's Color Atlas & Synopsis of Clinical Dermatology, Fifth Ed, 2005
Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or suite101 will not be responsible for any consequences. The images provided are for illustration purpose only.
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