Vitiligo

Vitiligo is a chronic autoimmune skin condition in which patches of skin lose their natural pigment and turn white, caused by the destruction of melanocytes, the cells responsible for producing melanin. It affects roughly 0.5-2% of the world's population and can occur at any age, though onset before age 30 is most common. Vitiligo is not contagious, not life-threatening, and does not affect the underlying health of the skin, but its visibility, particularly on darker skin tones where the contrast is most pronounced, can have a significant psychological and social impact. In Nigeria, misconceptions that vitiligo is contagious or a curse contribute to stigma that often affects patients more than the physical symptoms themselves.

• Patches of skin that lose colour and turn milky white, usually starting on the hands, face, or around body openings such as the eyes, nostrils, and genitals • Patches are often symmetrical, appearing on both sides of the body in a similar pattern • Premature whitening or greying of scalp hair, eyebrows, eyelashes, or beard • Loss of colour in the mucous membranes lining the inside of the mouth and nose • Patches may remain stable for long periods or slowly spread over months to years; the course is unpredictable and differs between individuals

Vitiligo is an autoimmune condition in which the immune system mistakenly identifies melanocytes as a threat and destroys them, though the exact trigger for this immune response is not fully understood. Genetic predisposition plays a significant role, and vitiligo often runs in families alongside other autoimmune conditions such as autoimmune thyroid disease, type 1 diabetes, and alopecia areata. Environmental factors, including significant stress, skin trauma (a phenomenon called the Koebner response, where new patches appear at sites of injury), and oxidative stress within skin cells, are thought to trigger or accelerate the condition in genetically susceptible individuals.

• Family history of vitiligo • Personal or family history of other autoimmune conditions, particularly autoimmune thyroid disease • Onset typically before age 30, though it can occur at any age • Significant physical or emotional stress, or skin trauma, which can precede new patches appearing

• Increased sunburn risk in depigmented patches, since they lack the natural UV protection that melanin provides • Significant psychological and social impact, including reduced self-esteem, anxiety, depression, and social stigma, particularly pronounced on visible areas of the body • Association with other autoimmune conditions, most commonly autoimmune thyroid disease, which should be screened for at diagnosis • Rarely, partial loss of hearing or eye pigmentation changes, since melanocytes are also present in the inner ear and eye

There is no known way to prevent vitiligo, given its autoimmune and genetic basis. However: • Consistent daily use of high-SPF sunscreen on depigmented patches reduces sunburn risk and can also reduce the visible contrast between affected and unaffected skin • Early treatment, started while patches are small, offers the best chance of halting spread or achieving partial repigmentation Treatment options include topical corticosteroids or calcineurin inhibitors, phototherapy (narrowband UVB), and, for widespread stable disease, surgical repigmentation techniques or camouflage cosmetics.