Understanding Vitiligo

Human skin colour is mainly determined by the presence of a brown-black pigment called melanin present in the superficial part of the skin (epidermis). Melanin pigment is produced by pigment producing cells that are located in the deep parts of the epidermis. These pigment producing cells are called melanocytes. Melanocytes also exist around the hair follicles and give melanin pigments to the hair, giving hairs their colour.

Vitiligo is characterized by white patches on the skin. Vitiligo develops  when the white blood cells, that are responsible for protecing our body against the bacteria and viruses, attack the melanocytes of the skin “by mistake” and kill them. This causes the skin to become white in the areas where melanocytes are destroyed and killed; because no melanin pigment is produced in these areas anymore. Vitiligo is thus an auto-immune disease. Being an auto-immune disease means that it is produced by ones own white blood cells.

How to treat vitiligo

Taking into notice the cause of vitiligo, one may think that it is enough to make the white blood cells go away from the skin to cure vitiligo. Although it is necessary to make the white blood cells go away from the skin, this is not enough in order to cure vitiligo. Why?

Imagine that a city is attacked by the enemy and is destroyed. Simply making the enemy go away will not spontaneously cause the city to be re-built; the city should be built again. The same is true for vitiligo; when the white blood cells are made to go away from the vitiligo patches, the melanocytes should also be actively brought to the area to re-pigment the vitiligo patches. Making the white blood cells to go away is possible by topical treatments (corticosteroid creams as well as some non-corticoid creams). Bringing new melanocytes to the area is possible through different methods:

1- Phototherapy: UVB phototherapy causes the melanocytes around the hair follicles to proliferate and migrate into the vitiligo patches to repigment them. One should take notice that such proliferation and migration remains the characteristics of “hair follicle melanocytes” only and thus the presence of “pigmented hair” in the vitiligo patches is necessary for this type of treatment to be effective.

2- Melanocyte (pigment cell) transplantation: In case the vitiligo patches are on the hairless areas of the skin, or if the hairs of vitiligo patches are white, conventional phototherapy will not work. In these cases, melanocytes should be brought to the vitiligo patches from other parts of the body. It is done by melanocyte transplantation methods. In such methods melanocytes are taken from the normally pigmented skin areas (for example from the buttock area) and are transferred to the vitiligo patches. There are different methods available for melanocyte transplantation. According to where the vitiligo patch is located, its surface area and some other criteria, we will determine the most suitable method for melanocyte transplantation.

Please go to vitiligo treatment page to learn more about other treatment options.

To learn about the most effective surgical treatment options for vitiligo, please go to melanocyte transplantation page.