What foods should I avoid for vitiligo?

Vitiligo (white spot disease)

What does medicine understand by vitiligo?

In medicine, vitiligo is suspected to be an autoimmune disease in which the immune system attacks and destroys the pigment cells of the skin (melanocytes). White spots suddenly appear, especially on the face, hands and feet. That is why vitiligo is often called white spot disease. Those affected are not in pain, but suffer from the psychological consequences of the illness. To date, it has not been possible to clearly determine how this disease comes about.
Medicine is based on genetic factors, as family members are often also affected by the disease. Permanent reddening of the skin has not yet been possible, but suitable therapies can prevent the spots from spreading to the rest of the body. Those affected should strengthen their immune system, eat a healthy diet and avoid the sun.

What types of vitiligo are there?

On the basis of the extent and the location of the white spots, doctors differentiate between three different forms of Vitiligo:
Local vitiligo
White spots only appear on isolated parts of the body. They appear within a few months, but do not spread any further.
Generalized Vitiligo
The most common form of Vitiligo is usually symmetrical, with the spots appearing over a large area on several parts of the body and the number of spots increasing steadily. The course of the disease cannot be predicted. Often other autoimmune diseases such as thyroid disease are associated with this form. In generalized Vitiligo, a distinction can be made between Vitiligo vulgaris and Vitiligo acrofacialis. The former affects both halves of the body, the latter the face, hands and feet.
Universal vitiligo
In the case of universal Vitiligo, over 80 percent of the body surface is discolored. This makes this form the most difficult.
Another distinction is made in medicine based on the time at which the symptoms first appear:
Type 1 vitiligo
This form occurs in childhood, but is rather rare. Those affected often also suffer from neurodermatitis, have many birthmarks and gray hair in places.
Type 2 vitiligo
This form begins after puberty and occurs in about 85 percent of all cases of vitiligo.

What are the symptoms of Vitiligo?

Typical symptoms of Vitiligo are the suddenly appearing white spots on the skin, which occur primarily on sun-exposed areas such as the face or hands as well as in the genital area. They have a diameter of a few millimeters to centimeters and are round or oval, but can also merge into one another and form so-called herds. In most cases, those affected remain symptom-free, and very rarely itching can occur.

White spot disease often occurs in connection with other autoimmune diseases such as thyroid diseases (Hashimoto's thyroiditis, Graves' disease), type I diabetes mellitus or circular hair loss, which suggests a false reaction of the immune system that leads to the destruction of the body's own pigment cells. Hearing disorders can also occur.

What are the causes of Vitiligo?

So far, various hypotheses have prevailed in medicine about the cause of Vitiligo. Specialists assume that many factors interact:
Genetic predisposition
A familial cluster can often be observed, which suggests a genetic origin. Altered enzymes disrupt pigment production.
Autoimmunological processes
White spot disease often occurs together with other autoimmune diseases such as diabetes mellitus, diseases of the thyroid gland and lupus erythematosus, a rheumatic disease.
Changes in the nervous system / psychological factors
The assumption is that the body produces self-damaging substances due to stress and inner restlessness, which throw the pigment structure out of balance.

  • Sunburn and local skin irritation
  • Toxic radicals: Aggressive environmental pollutant molecules such as hydrogen peroxide trigger the disease.

Which parts of the body are particularly affected?

The white spots usually arise symmetrically, that is, on both halves of the body. But it can also lead to a non-symmetrical course on only one side of the body. Basically, the entire body can be affected by Vitiligo. Most commonly, however, it occurs on sun-exposed areas such as the face, hands, and feet. On the face, the spots mainly appear around the eyes, on the eyelids and around the mouth. Other popular areas are the elbows, knees, arms, the gluteal folds and the genital area or the mucous membranes. The hair that grows on the affected areas can also turn white. Rarely, white spots can also be observed on the inner ear.

How does the doctor diagnose vitiligo?

If white spots suddenly appear on your body, you should consult a dermatologist. The doctor will first conduct a detailed anamnesis discussion with you and then physically examine you to rule out other diseases. He takes a close look at the affected areas and photographs them if necessary so that he can document the process. Then he looks at the white patches of skin with a special UV lamp, the so-called Wood light, in which the affected areas glow white-yellow.
To confirm the diagnosis, the doctor irritates healthy areas of skin with a wooden stick. If you have vitiligo, white spots will also appear there. This method is also known as the "Koebner phenomenon". To complete the diagnosis, the specialist can also order a blood test, which tests the blood for specific antibodies, thyroid levels, and sugar levels.

Who is most affected by it?

The disease occurs predominantly before the age of 20, although it can break out at any age. Men and women are equally affected. In about 30 percent of the cases, other family members are also affected. In Austria around 40-80,000 people suffer from white spot disease.

What is the course of the disease in Vitiligo?

The course of Vitiligo can be very different. In essence, the disease continues to progress, the spots multiply and enlarge. Often they flow together into individual flocks. In very severe cases, entire body depigmentation can occur. Existing stains only recede in individual cases. Vitiligo can be slowed down or even brought to a standstill by starting therapy at an early stage. It is therefore important that you see a dermatologist at the first sign.

What are the consequences of vitiligo for those affected?

Normally there are no restrictions for those affected by the disease, unless there are additional health disorders such as thyroid malfunctions. Nevertheless, many patients suffer psychologically from the disease, as the stains pose an aesthetic problem for them. Many people still mistakenly believe that vitiligo is contagious. Affected people are often stared at and often avoided. You still face a lot of prejudice. A visit to a self-help group or psychological support can be helpful here.

What treatment options are there?

Vitiligo is not curable. Still, there are a few treatment options that can be used to stop the disease from progressing:

Non-drug treatment
You can either cover the white spots cosmetically with skin-coloring agents or self-tanners, or have them irradiated with ultraviolet light in the range of 311 nm. This application is called phototherapy and leads to repigmentation of about 75 percent in most patients. Another type of therapy is a combination of phototherapy and orally administered psoralen or phenylalanine, agents that make the skin more sensitive to light. Medicine also calls it Psoralen plus UV-A, or PUVA for short, and the therapy lasts two to three months with the 200 treatments required.
It can lead to a re-pigmentation of the spots, whereby a complete re-coloration can only be achieved with 15-20 percent. This treatment can also take place in the so-called PUVA water bath, in which patients spend 15 minutes in a bathtub filled with psoralen water. This promotes the absorption of the active ingredient, which in turn has a positive effect on the subsequent irradiation.
Since the disease is believed to be an autoimmune disease, the doctor will prescribe drugs that suppress the immune system. These so-called immunosuppressants are supposed to prevent the immune system from attacking the pigment cells. Above all, glucocorticoids (cortisone) and calcipotriol are used in the form of a cream. In addition, specialists often recommend taking vitamin D. Newer preparations from the group of calcineurin antagonists are still in the test phase but promise an improved immunosuppressive effect.
If the disease is very weak, the specialist can take the body's own color pigments - or melanocytes - from a healthy area in a small operation, grow them and replant them in the affected areas. The risk of relapse with this method is extremely low. Further treatment methods would be bleaching the unaffected areas of the skin and taking ginkgo extract. Many sufferers also need accompanying psychological treatment.

What are the risks and complications?

Basically, there is no pain or complication with the disease. Since the white spots are very sensitive to light and encourage sunburn, you should use the highest sun protection factor in sun cream and protect your skin from the sun. This will reduce the risk of developing skin cancer.

What else can I do?

As a Vitiligo patient, you should reduce stress, pay attention to a healthy diet and protect your immune system. Exercise a lot and largely avoid alcohol and other stimulants, as these can promote relapses. Always use sunscreen with a particularly high sun protection factor to reduce the risk of skin cancer. You can use highly opaque cosmetics such as camouflage make-up to hide the annoying spots on your face. It can also be helpful to visit self-help groups or psychotherapy.

Do the health insurance companies cover the costs?

The health insurance companies take care of all the necessary examinations. Your doctor will settle accounts directly with the responsible health insurance provider. Some carriers may still have a deductible. With a doctor of choice or a private doctor, you have to bear the costs yourself. You will get some of this back with an existing supplementary health insurance. You can get information about this from the respective insurance company.

About the author: Dr. Simone Hermanns

Female medical specialist for gynaecology and obstetric

Dr. med. Simone Hermanns works as a specialist at the University Hospital Zurich and has been supporting MOOCI as a medical expert in the field of gynecology and obstetrics since February 2020.

For 7 years she has been working full of energy and zest for life as a doctor in various clinical departments in Germany and Switzerland. She discovered her love for medicine especially in the operational area, as the diversity of this area is always fascinating.