Vitiligo is an acquired pigmentation disorder that results in white spots appearing on the surface of the skin or of the mucosae at any time during a person's lifetime.
It is caused by the progressive destruction or inactivation of the melanocytes which are located at the bottom layer of the epidermis and are responsible for the pigmentation of its surface cells.
Thus, due to the presence of special autoantibodies in the serum of the people suffering from vitiligo, the immune system does not recognise some cells (melanocytes) as its own and destroys them. The result, due to the deficiency of functioning melanocytes, is the depigmentation of the skin caused by the interruption of the melanin transfer to the keratinocytes that cover it.
The condition is characterised as autoimmune with a genetic predisposition, i.e. it belongs to a category of diseases where, as we said, the immune system turns against the organism itself, and it is not completely clear if it is a disease or a syndrome.
So, in an autoimmune disease our body attacks and destroys its own cells and organs. Recent studies have shown that the alteration of the biochemical composition of the cell interior is accompanied by an alteration of the membrane and the external cell image.
Vitiligo often coexists with other autoimmune diseases such as thyroid dysfunction, psoriasis, rheumatoid arthritis, type 1 diabetes, pernicious anemia, Addison's disease, systemic lupus erythematosus and polyglandular autoimmune syndrome.
The autoimmune theory, the autocytotoxic theory, the neurochemical theory, the biochemical theory, the genetic theory, the nutrition theory and the oxidative stress theory have tried from time to time to clarify the pathogenesis and pathophysiology of vitiligo.
A more recent theory suggests that the destruction of the melanocytes is caused by anomalies in the biochemical or metabolic pathways. The neural theory, based on dermal segmentation studies rather than on the segmental vitiligo distribution proposed by Blaschko, suggests that the destruction of the melanocytes is due to a dysfunction of the sympathetic nerves.
Epidemiologically, 1-2% of the Europeans, 1-2% of the Americans and 8.8% of the Mexicans, Indians and Japanese suffer from vitiligo. Among them, 50% of the patients manifest vitiligo under the age of 20 and 25% under the age of 8. Vitiligo most commonly appears in the twenty year period between 10 and 30 years of age. Nevertheless, there have been cases of vitiligo in ages under 12 months and over 80 years.
Statistically, it appears more frequently in women, although this is notional, as men do not easily visit a doctor.
The disease is generally asymptomatic, yet in some cases there is mild sense of itching in the areas where there is a possibility of a later spread of the skin lesions - white spots. Nevertheless, vitiligo does not belong in the category of infectious diseases and is not caused by bad medical treatment or poor personal hygiene.
The course of the disease is unpredictable and the patient's response to the treatment varies. Sometimes the spreading of the spots stops without any treatment. Yet, in most of the cases, the pigment loss spreads and covers even bigger parts of the body surface. There is considerable evidence which proves that the disease may be hereditary. It has been estimated that 30% of the patients suffering from vitiligo have a family member which also suffers from the disease. The patients inherit three genes that render them more susceptible to skin depigmentation.
Many times, even the everyday life of the patient that is not aware of the aggravating factors of the disease may contribute to the course and development of vitiligo. It seems that dietary factors do not affect the disease but food that destroys the free radicals can help the course of vitiligo.
The etiology of the disease still remains elusive to the scientific community. Some researchers claim that oxidative stress and various neurogenic disorders are the primary causes of the disease (especially in the case of segmental vitiligo). On the other hand, environmental factors such as temperature, the sun, humidity, infectious agents, such as contact with or exposure to various chemical substances, are reported as basic causes of vitiligo. Some patients, though, report that the appearance of the disease followed a particularly stressful event or exposure to chemical substances or a serious sunburn.
But the psychological impact of vitiligo is important, especially to the younger people, and much greater when the depigmentation is located on the face.
The deformity that these people undergo provokes increased stress, feelings of shame and difference, low self esteem, mainly in patients with a weak ego.
This way the quality of life is lowered and important aesthetic issues come up, often with an impact on the mental and physical health of the patients, affecting deeply their life and often leading them to social exclusion.
Moreover, the bad psychological condition of patients suffering from vitiligo distorts their character and, as a result, they become aggressive and bad-tempered or affects their personality, making them unhappy and unable to adapt to their new body condition, especially when the changes are taking place quickly.
Unfortunately even the extent of the psychological effect resulting from this feeling of difference that patients experience is not proportionate to the damage, but depends mostly on the age, the low self esteem and the negative impact of the social stigma, mainly in Greece.
Thus we can understand the sociopsychological and professional aspect of a psycho-dermatological disorder like vitiligo.