SKIN PROBLEMS: VITILIGO
About 1-2 percent of the population exhibits a failure of pigmentation in patches of the skin which, as a consequence, appear unnaturally white. While in a few cases, the lack of pigmentation is generalized, the white patches are usually only a few inches across and occur on the parts of the body that are most exposed. The face (especially around the mouth and eyes), neck, chest, armpits, elbows, and knees are most affected.
Treatment, which, the American Family Physician (33#5:137) reports, is often unsatisfactory, includes repeated exposure to ultraviolet light after the patient has been given psoralen, a drug that sensitizes skin and makes it more reactive to sunlight. Before this, however, the eyes must be examined by an expert since the retina may also be involved in this pigment disturbance and could be injured by the psoralen-light reaction. Some parts of the skin may pigment more deeply and permanently than others in response to treatment. Skin that does not darken can be hidden with cosmetics or, alternatively, the surrounding skin can be lightened with
Eldoquin or Artra creams to blur the edges of the patches and make them less noticeable.
It is essential that anyone with patches of de-pigmented skin be seen by a dermatologist, since there are other conditions, including some types of poisoning and serious infection, that resemble vitiligo but that urgently need very different treatment. Moreover, anyone with vitiligo should undergo very careful medical examination, because in some cases there is an associated major illness, such as an autoimmunity (in which the tissues attack themselves), diabetes, thyroid disease pernicious anemia, myasthenia gravis, or melanoma. The relationship with melanoma is intriguing since a melanoma is a cancer of pigment-producing skin cells. However, having vitiligo does not mean that one is likely to develop a melanoma; the reverse is true and about 20 percent of melanoma patients also have vitiligo. Furthermore, the occurrence of vitiligo in someone who has had a melanoma removed sometimes heralds the development of recurrent melanoma tumors elsewhere in the body (i.e: in the liver).
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