Vitiligo is another presumed autoimmune condition. In this disease the targets of attack are the skin's melanocytes, the pigment-producing skin cells. As in the case of alopecia areata, the psychological and social consequences of this disorder, especially in blacks exhibiting widespread involvement, cannot be minimized.
Affecting 1 percent of the American population, vitiligo is not rare. The disorder appears to run in some families, and many cases begin in childhood. Not long ago, vitiligo received quite a bit of media attention when black rock singer Michael Jackson announced that he was suffering with the condition.
Vitiligo may affect any area of the skin. The face, neck, nostrils, nipples, genitals, and other body-fold regions are favored locations. As a rule, pigment loss tends to be symmetrical: If the right side of the mouth loses color, the left usually does, too. In extensive cases, sufferers can be left with disfiguring zebra stripe-like patterns. Naturally, the darker the sufferer's normal skin tone, the more obvious the contrast between the affected and nonaffected areas.
The course of vitiligo is variable. Typically, periods of marked disease progression alternate with intervals of quiescence. Although repigmentation does occur occasionally on its own, complete spontaneous improvement is unfortunately rare.
For the experienced dermatologist, the diagnosis of vitiligo is obvious. In contrast to other depigmenting conditions, patches of vitiligo, when exposed to a Wood's ultraviolet light, demonstrate a stark white absence of all pigment. In uncertain cases a biopsy may be performed. The finding of a complete absence of melanocytes confirms the diagnosis.
Unfortunately, there is still no cure for vitiligo. Skin dyes (Vitadye and Dyoderm) and waterproof masking cosmetics (Covermark and Dermablend) can be satisfactory for hiding small areas of involvement. For selected cases of more extensive involvement, oral or topical use of psoralens combined with periodic exposure to ultraviolet A radiation, a process known as PUVA (psoralens plus L/VA), may be helpful. In extreme cases the few remaining normal-pigmented islands of skin can be completely and permanently depigmented by the repeated application of monobenzyl ether of hydroquinone (Benoquin). For more information about vitiligo, you may contact the National Vitiligo Foundation, Inc., Texas American Bank Building, RO. Box 6337, Tyler, Texas 75711.