Aetiology (etiology) – discussing the underlying cause/origin and pathways of disease and what they mean. For vitiligo, the aetiology is thought to be a combination of genetic, immunologic (autoimmunity), biochemical and neurogenic factors.
Antibody – a protein used by the immune system to identify and neutralize foreign substances like bacteria, viruses, and parasites. In autoimmunity, antibodies mistakenly identify parts of the body as foreign, leading the immune system to attack it – for vitiligo, antibodies target melanocytes.
Antioxidant – chemical compounds that can bind to free radicals to keep them from destroying healthy cells, reducing oxidative stress. Antioxidants are widely found in fruits and vegetables, as well as dark chocolate and red wine. Common vitamins and substances known as antioxidants are vitamins C, A, E, coQ10, selenium, glutathione, lipoic acid, and flavonoids.
Autoimmune – where the body’s immune system mistakes a part of the body as a threat and attacks it. In the case of vitiligo, the immune system attacks the melanocytes, or pigment-producing cells, resulting in a loss of pigment.
Autologous skin graft – Grafts done with a segment of the person’s own skin. In vitiligo, autologus grafts are usually taken from an area of normal skin and transplanted to an area with vitiligo.
Autosomal dominant – an abnormal gene on one of the non-sex-determining chromosomes (autosomes) that can cause disease even if it is only inherited from one parent (dominant). Vitiligo is considered autosomal dominant.
Ayurvedic – holistic therapy from India using herbs and diet to balance the body and cleanse it of disease. Ayurvedic therapy for vitiligo is similar to PUVA, using sun and herbs that make the skin more sensitive to light, but adds a diet component where certain foods can’t be eaten either at all, or sometimes, in combination with other foods.
Biochemical – relating chemistry to living systems. In vitiligo, biochemical differences are shown in an incorrect oxidant/antioxidant balance, resulting in oxidative stress, and by the appearance of antibodies to melanocytes.
Blister grafting/Suction blister grafting – Suction is applied to an area of skin until a layer of the epidermis (outer layer of the skin) raises in a blister. This blister is removed and grafted onto an area of vitiligo that has been dermabraded (roughed up).
Compounding Pharmacy – a specialized pharmacy where they make their own custom formulations of medicines. Pseudocatalase and Monobenzone are both obtained from a compounding pharmacy.
Corticosteroid – in vitiligo, generally refers to topical or oral medication used to moderate or suppress an inappropriate stress or immune response. Examples of topical corticosteroids used are betamethasone, clobetasol, mometasone and fluocinonide. These drugs must be used with caution, under a doctor’s supervision, as they can systemically suppress the immune system or cause other side effects. Corticosteroids are not the same thing referred to as ‘steroids’ that athletes are punished for using; those are anabolic steroids. Corticosteroids will not increase your athletic performance or abilities.
Depigmentation – the process by which remaining pigment is removed in patients with extensive vitiligo. The most common method is using monobenzone, but there are reports of using laser or other methods as well.
Environmental Trigger – Non-genetic, outside cause of an initial onset or spread of vitiligo. While all environmental triggers have not been identified, some that are known or thought to be involved are stress (both emotional and physical, such as skin trauma or illness), phenols (chemicals found in hair dyes and photographic chemicals, among others), and food allergies. These triggers may vary from person to person, or may take widely different levels of exposure to begin a response, so they can be difficult to identify.
Excimer Laser – laser used in treating skin diseases that operates at 308 nm on the UV spectrum. Laser treatments can generate quicker results than other forms of light therapy. but is more expensive and inefficient for large areas/coverage of vitiligo. Often recommended only for smaller areas of stable vitiligo.
Focal Vitiligo – vitiligo that occurs in only one small area of the body.
Free Radical – unstable oxygen molecules, produced by the body through the normal metabolism of amino acids and fats, that can react with and destroy healthy cells, including altering a cell’s DNA. In vitiligo, free radicals produce an excess of hydrogen peroxide in the skin, which destroys/damages melanocytes and results in pigment loss.
Gene – the basic unit of heredity, composed of DNA, which triggers various functions in the body. Each person has thousands of genes, inherited from both parents, that determine the body’s characteristics and functions.
Generalized Vitiligo – vitiligo that appears on both sides of the body, often in a mirror effect where areas of pigment loss will be in approximately the same location on both sides. Generalized vitiligo is the most common form.
Genetics – the study of heredity through genes, in order to understand how the body works. In vitiligo, understanding the genes involved in vitiligo and how they are passed through families can possibly lead to better treatment options. Vitiligo is considered a genetic disease because it is often seen in more than one family member and often is associated with families with a history of related autoimmune diseases, like diabetes and thyroid disease. Genetic factors work in association with environmental triggers, unknown for vitiligo, to cause disease.
Genome Wide Association Study (GWAS) – the study/identification of disease-causing genes over the entire genetic spectrum (human genome) by comparing genetic patterns of patients with a certain disease to healthy people (controls). Dr. Richard Spritz has been working on a GWAS of vitiligo in conjunction with Vit-Gene, a group of vitiligo researchers from around the world. See the Research section of the menus for more information about the study or how you can participate.
Homeopathy – holistic therapy using very small amounts of substances that cause various symptoms in healthy people to stimulate the immune system to “heal” those symptoms in people who are ill with them. Homeopathy has not been shown to be successful for vitiligo.
Hyperactive immune system – when the immune system gets overactive and begins attacking things other than viruses and bacteria, like melanocytes in vitiligo. Taking products that “boost” the immune system, like echinacea, goldenseal, and astragalus, can stimulate autoimmunity.
Immunomodulator – something that moderates, or modulates, the immune response rather than boosting it or suppressing it. Protopic and Elidel are examples of immunomodulators used for vitiligo.
Itch – Deep, below-the-surface itching that occurs in about 12% of those with vitiligo. Itch can appear when an area is active, whether in depigmenting or repigmenting.
Koebner Phenomenon – a response to skin trauma, such as scratches, cuts, or excessive friction, that results in pigment loss, or spread of vitiligo, in that area.
Melanin – pigment in the skin responsible for its color. Melanin consists of two sub-types: pheomelanin is red, and eumelanin is very dark brown. The combination is determined by genes and produces a wide variety of skin tones.
Melanocyte – cell responsible for pigment formation.
Melanocyte transplant – method where the melanocytes, and sometimes keratinocytes, are removed from a donor sample of skin (taken from another part of the patient’s body) and transplanted to an area with vitiligo. Melanocyte transplants can be done with only the donor sample, or they can be done with melanocytes cultured in larger quantities from the original sample. Not widely available in the US, though there are a couple of current studies looking into it.
Micropigmentation – injecting very small amounts of pigment into areas with vitiligo; basically, tattooing with “skin” color rather than a design.
Monobenzone/”Mono” – common name of monobenzyl ether of hydroquinone, the medication used to remove the remaining pigment in people with extensive vitiligo. Formerly sold as the brand name Benoquin, which is no longer available.
Narrowband (NB) UVB – a portion of the UV spectrum from 311-313 nanometers (nm) widely used to treat a variety of skin conditions, including vitiligo. NB has been shown through studies to have results at least as good as those from PUVA, with fewer side effects, so it has largely supplanted PUVA as the treatment of choice in widespread vitiligo. NB units range from handheld devices to panels to full-body cabins and require a prescription in the United States.
Neurogenic – originating in the nerves or nervous system. Segmental vitiligo often follows a nerve path through the body.
Nonsegmental Vitiligo (NSV) – vitiligo not confined to one side of the body; more typically known as generalized vitiligo. See Generalized Vitiligo
Oxidative Stress – a condition where the body’s antioxidant balance is off, resulting in an excess of free radicals, which can destroy healthy pigment cells in vitiligo patients, and lead to heart problems, cancer, and other diseases.
Phenol – member of a class of organic compounds widely used in antiseptics, dyes, resins, preservatives, and detergents. Phenols are a known trigger of an initial outbreak or spread of vitiligo. Sources of phenols are hair dyes and photographic chemicals, and they are widely used in cosmetics as a preservative, though in very small quantities (phenoxyethanol). Ingredients with phenol, phenyl, or similar in their names are likely to be phenolic.
Phototherapy – the process of using light for treatment. Vitiligo treatments using phototherapy include PUVA, narrowband UVB, and excimer laser, as well as natural sunlight.
Polygenic – caused by more than one gene. Vitiligo is caused by many genes working together, so it is polygenic.
Polyphenol – a chemical, not to be confused with “bad” phenol, that acts as an antioxidant and protects the body from oxidative stress/free radical damage. Tea (especially green tea), fruits, vegetables, and legumes are excellent sources of polyphenols.
Pseudocatalase/PCAT/PCKUS – one theory of vitiligo holds that there is too much hydrogen peroxide in the skin because of a deficiency of catalase, an enzyme that breaks hydrogen peroxide into water and hydrogen. Pseudocatalase is a cream obtained from a compounding pharmacy that attempts to stimulate the same response in conjunction with brief treatments of narrowband UVB. PCKUS is the version of pseudocatalase developed by Dr. Karin Schallreuter that is only available from her offices in England or Germany.
Psoralen – technically, the psoralea plant, but practically, a product that makes the skin more sensitive to light treatments with sun or UVA, allowing the light to stimulate the pigment cells at a lower dose than would be necessary without the psoralens.
Punch Graft – small (1-2mm) circular sections of skin removed from a donor area and transplanted to an area with vitiligo. More available in the US, but surgical treatments are generally recommended only for small areas of stable vitiligo. Segmental vitiligo is often a good candidate for grafting or other surgical treatments, since it tends to be stable after the initial spread.
PUVA – Psoralen + UVA light. Some form of medication that makes the skin more sensitive to UVA light, whether topical or oral, is used along with a UVA light box or sunlight to stimulate pigment production. Once the most common treatment, it has now been mostly replaced by narrowband UVB, which has fewer side effects.
Segmental Vitiligo (SV) – vitiligo that appears only on one side of the body. Some physicians and researchers think that segmental, or some forms of it, may be a separate disease from generalized vitiligo.
Stable Vitiligo – vitiligo that has not spread over a set period of time, usually 6 months or a year. Research studies will often specify that a patient must be stable before enrolling.
Suction Blister Grafting – see Blister Grafting
Surgical Treatments – any of the grafting or transplant techniques, such as punch grafting, suction blister grafting, melanocyte transplants, etc.
Tacrolimus – generic name for Protopic, a topical immunomodulator used for treating vitiligo. Available in India as Tacroz Forte.
Tattooing – see Micropigmentation
T-cell – a type of white blood cell that seeks out invading viruses and bacteria to destroy them. In vitiligo, the T-cells can be mis-directed towards melanocytes.
Ultraviolet Spectrum (UV) – often known as visible light, and consists of four sub-spectrums. UVA ranges from 315-400 nm and is the portion of the light spectrum responsible for tanning, as well as aging, as it reaches deepest into the skin. UVB ranges from 280-315 nm and is responsible for burning. The NB spectrum from 311-313 is used because a therapeutic level of rays can be received before burning occurs. UVC ranges from 185-280 and is typically used as a germicide against yeast, molds, viruses and bacteria. UVV ranges from 100-185 and is an ozone generator. For vitiligo, only the UVA and UVB ranges are used.
V-Tar – a prescription coal tar product used for treating vitiligo. V-Tar is applied once weekly and is one of the few treatments for vitiligo that does not need some form of light therapy to work. However, because of its photo- sensitizing properties, patients using V-tar are advised to avoid direct sunlight, or use a sunscreen on the treated areas for 3 days post application. It is only available from the one compounding pharmacy that developed it.