Dear HEALTHbeat subscriber,

Whether you want to drop a few pounds or keep your heart and health in tip-top shape, there are a range of diet plans to choose from. Low-fat, low-carb/high fat, specific ratios of fat, protein, carbohydrate — it’s confusing! Which one really works? In a recent study comparing several popular diets, participants who followed the Atkins plan lost more weight, without ruining their cholesterol levels. This issue of HEALTHbeat reveals the take-home message for you. Also in this issue, Dr. Celeste Robb-Nicholson discusses what can be done to treat the skin condition vitiligo.

Wishing you good health,


Nancy Ferrari
Managing Editor
Harvard Health Publications
HEALTHbeat@hms.harvard.edu

Q: I have white skin patches on both hands. My doctor says it’s vitiligo. What causes this, and how can I treat it?

A: Vitiligo is a common condition in which the skin loses melanin, the substance that determines the color of the skin, hair, and eyes. When the cells that produce melanin die in a given patch of skin or can no longer make the pigment, that area becomes white. Vitiligo most often appears on sun-exposed areas, such as the face, arms, backs of the hands, knees, and feet. It can also develop around orifices, including the mouth, eyes, nose, and anus. Some people lose color in the mucous membranes of the mouth or the retina of the eye.

Vitiligo usually begins as small white irregular patches that grow very slowly — over months to years. Pigment may occasionally return, but usually the white patches continue to spread, and if left untreated, may involve extensive areas of the skin. Vitiligo doesn’t itch or hurt, and most people with the condition are generally healthy, but they may be upset about the appearance of their skin.

We don’t know what causes vitiligo. One theory holds that it’s an autoimmune process (in some people, it’s associated with known autoimmune conditions). Heredity probably plays a role, because the incidence of vitiligo is high in some families. Stress and exposure to industrial chemicals have also been implicated, but this connection is unproven.

There is no cure for vitiligo, but treatment can prevent it from progressing and sometimes even restore pigment to the white areas. Topical corticosteroids are usually recommended if less than 10% of the body is involved and the face is not affected. It may be four to six months before you see any change, and you’ll need to be monitored for a common side effect of steroids — thinning of the epidermis and dermis, the top two layers of skin. For more extensive vitiligo, oral steroids are occasionally prescribed.

In another treatment, topical psoralen (a light-sensitive substance derived from plants) is applied and the skin is then exposed to ultraviolet A light — a technique called PUVA — usually once or twice a week. The skin turns pink after each exposure and eventually begins to take on a more normal color. If vitiligo affects more than 20% of the body, the treatment may be given two to three times a week and the psoralen taken orally instead of topically. Side effects include sunburn, itching, nausea, and hyperpigmentation of the surrounding skin. A newer therapy, narrow-band UVB, doesn’t require pre-treatment with psoralen and may be safer than PUVA. At this point, however, it needs further study.

Another approach is autologous skin grafting. Small patches of skin are surgically removed from normally pigmented areas of the body and transferred to areas of vitiligo. Pigment can also be implanted through tattooing. When vitiligo has spread to more than 50% of the body, some specialists recommend fading the rest of the skin on the body to match the white (depigmented) areas. In the short run, this can cause redness and swelling, and in the long run, the skin will be highly sensitive to sunlight.

Before undergoing any of these treatments, it’s important to be under the care of a skin specialist. Always use sunscreen to protect your skin and avoid tanning; this can help minimize the contrast between normal and depigmented skin. Certain cosmetics (for example, Dermablend, Chromelin, and Covermark) can be used to cover the white patches. You can also use self-tanning sprays and other sunless tanning products to camouflage the affected areas. If vitiligo is emotionally distressing to you, you may want to join a support group or visit a psychotherapist.

— Celeste Robb-Nicholson, M.D.
Editor in Chief, Harvard Women’s Health Watch

This Question and Answer first appeared in the May 2007 Harvard Women’s Health Watch, available at www.health.harvard.edu/women.

Harvard Medical School publishes authoritative Special Health Reports on a wide range of topics. Each report delivers practical information on diagnosis, treatment, and prevention of major health concerns in clear, easy-to-understand language. For more information on a specific topic, click the appropriate link below:

Alzheimer’s, Arthritis, Bladder, Cholesterol, Depression, Diabetes, Digestion, Energy, Exercise, Eye Disease, Headache, Heart Disease, High Blood Pressure, Memory, Menopause, Prostate, Sexuality, Sleep, Stroke, Vitamins