What is Vitiligo
Vitiligo is an autoimmune disease in which the skin loses melanin,the pigment that determines the colour of the skin,hair and eyes.
Vitiligo occurs when the cells that produce melanin die or no longer form
melanin,causing white patches of irregular shapes to apper on your skin.
Vitiligo affects all races but may be more noticeable in people with darker skin
A patch of Vitiligo begins as a localized area of hypopigmentation that becomes chalky white after a variable period.

Vitiligo occurs when melanin-forming cells fail to produce melanin pigment.
Doctors and scientists have different theories :
It may be due to immune system disorder in which person’s immune system reacts against the body’s own organs or tissues.
Heredity may be a factor.
Some people have reported a single event,such as sunburn or emotional distress,that triggered the condition.
Sometimes pigment loss can occur in someone who has had a melanoma.
Vitiligo is more common in people with certain autoimmune conditions such as Hyperthyroidism, Alopecia areata, Pernicious anemia.

•Pigment loss produces milky white patches on skin.
•Premature whitening of the hair on scalp,eyelashes eyebrows,beard.
•Loss of the colour of the tissue that lines the inside of the mouth.
•Loss of colour of the inner layer of the eyes.
•Depigmentation firstly appear on the sun exposed areas of skin such as hands,feet,arms ,face and lips.Genitalia may also affected.
•A few people say that the skin affected by vitiligo itches or feels painful.

•To easier explain this condition, scientists have separated vitiligo in basically two types which are called: non segmental, and segmental vitiligo.
•Non-Segmental Vitiligo It is the most common type of vitiligo and occurs in up to 90% of the people who have this disorder. In non-segmental vitiligo,
•the patches often become visible equally on both sides of the body, with some kind of symmetry. These unusual symmetrical patches most commonly appear on skin that is exposed daily to the sun, such as the face, neck, and hands, but it also appears on these other areas:
backs of the hands
•Non-segmental vitiligo has sub-categories:
Generalized Vitiligo: the most familiar pattern, it has no specific area or size when the white patches start occurring.
Acrofacial Vitiligo: This type of vitiligo is considered only when the appearance is mostly on the fingers or toes
Mucosal Vitiligo: The appearance of the depigmentation generally around the mucous membranes and lips
Universal Vitiligo: It is very rare since depigmentation has to cover most of the body.

•Medical history:-
A family history of vitiligo or an autoimmune disease A personal history of sun sensitivity of other skin conditions.
A rash,sunburn or other skin traumawithin 2-3 months of start of pigment loss
A history of melanoma
Premature graying of hair(before 35)
Stress or physical illness
•Woods lamp test-:
In which UV light shines onto the skin to determine whether you have vitiligo or other skin conditions.
•Skin biopsy and blood draw-:
A small sample of your skin is taken for biopsy
Draw blood to check your blood cell count, thyroid function and to look for the presence of anti-nuclear
antibodies (a type of autoantibody) that would indicate an autoimmune disease.
Stress or physical illness

•Four options are currently available for the treatment of vitiligo: sunscreens; cover-up; restoration of normal skin color; and bleaching of normal skin with topical creams to remove normal skin pigment to make an even color.
The two goals of sunscreen treatments are: to protect unpigmented involved skin from sunburn reaction and to limit the tanning of normal pigmented
skin. The sun protection factor (SPF) of sunscreens should be no less than SPF 30, as this grade blocks not only erythema, but also the affects of sunlight on
the DNA of the skin cells. Sunscreen treatment skin phototypes 1, 2, and sometimes 3 (those who burn, then tan to some degree).
The goal of cover-up with dyes or make-up is to hide the white macules so that the vitiligo is less visible. Self-tanning lotions and camouflage are quite helpful for some patients.
Restoring Normal Skin Color:
Restoration of normal skin color can take the form of spot treatments or whole body treatment.
Spot Treatment: Topical Corticosteroid Creams Initial treatment with certain topical corticosteroid creams is practical, simple, and safe.
If there is no response in 2 months, it is unlikely to be effective. Physician monitoring every 2 months for signs of early steroid atrophy (thinning of the skin) is Required.
•Spot Treatment: Topical Oxsoralen:
Much more complicated is the use of topical Oxsoralen (8-MOP). Oxsoralen is highly phototoxic
(likely to cause a sunburn), and the phototoxicity lasts for 3 days or more. This should be performed only as an office procedure, only for small spots, and only by
experienced physicians on well-informed patients. As with oral psoralens, 15 or more treatments may be required to initiate a response, and 100 or more to finish.
• Spot Treatment: Mini Grafting
Mini grafting, which involves transplanting the patient& normal skin to vitiligo affected areas, may be a useful technique for refractory segmental vitiligo macules.
PUVA may be required following the procedure to unify the color between the graft sites. The demonstrated occurrence of Koebnerization in donor sites in generalized vitiligo restricts this procedure to patients who have limited skin areas at risk for vitiligo. “Pebbling” of grafted site may occur.