Interview With An Expert

This is a brief but concise email interview I conducted with Dr. Adrienne Feasel, a highly renowned dermatologist from Austin who originally diagnosed me with Vitiligo several years ago. Her bio and information about where she practices is provided here: http://www.laderaparkdermatology.com/physicians_feasel_bio.htm. If you live in Austin or nearby and have any questions regarding Vitiligo, I highly suggest getting an appointment with her.

GM: What is Vitiligo and what causes it exactly?

AF: Vitiligo is a skin disorder characterized by depigmentation of the skin, manifest as white macules.  It affects 0.5- 2% of the population worldwide.  Although the cause is unknown, there is a loss of functional melanocytes (pigment-producing cells) in the affected area.  While up to 30% of cases may be familial,  most cases of vitiligo occur sporadically.  Patients may be affected at any age, but many cases develop at 10-30 years of age. The majority of cases demonstrate depigmentation in limited areas (segmental), but the disease may become widespread in some individuals.  The course often progresses slowly, but may stabilize or rapidly worsen for some individuals.  The cosmetic appearance is often concerning for  patients and may be socially stigmatizing for others.

GM: What are the telltale signs of Vitiligo?

AF: The diagnosis of vitiligo is clinical, with obervation of sharply demarcated white areas of skin.  The observation of depigmentation may be aided by the use of a Wood's Lamp.  This may be paticularly useful in fair-skinned patients, where the descrepancy between light and white skin is not as apparent.  Biopsy demonstrates an absence of melanocytes in the affected area. 

GM: Does it have a cure?

AF: There is no single cure for vitiligo.   Most treatments attempt to repigment the skin, but response is variable among patients.  Topical therapies which may be useful  include corticosteroids, and immune modulators (tacrolimus ointment), and vitamin D derivatives.  Ultraviolet therapy with narrowband UVB,  and photochemotherapy with psoralen and UVA, often provide good clinical response. Excimer laser therapy is also useful for limited disease.Cosmetics (ie, Dermablend) help camoflauge affected skin during or in lieu of treatment. In rare, widespread cases, chemical depigmentation of the normal skin  may be employed. It is important to use strict photoprotection as the affected areas are easily sunburned. The discoloration also becomes more apparent  if the normal, surrounding skin is tanned.