The approach is especially effective if people are treated before all the melanocytes in the affected areas of skin are destroyed. “If 10 percent of the cells remain, they can be induced to creep in and repopulate the depigmented area,” Dr. Orlow said.
Another therapy that relies on medication used for other conditions is topical application of prostaglandin E2, a glaucoma therapy, on localized areas of vitiligo. In two studies, six months of this treatment produced moderate to complete repigmentation in a majority of patients, Dr. Orlow and colleagues reported in F1000 Research.
And in a study that used the topical glaucoma treatment latanoprost in combination with narrow-band UVB, greater repigmentation occurred than with either substance used alone.
Like most autoimmune conditions, vitiligo is an acquired disorder. Rarely are children born affected, though they may be genetically susceptible to developing an autoimmune disorder. People with vitiligo, including Ms. Pavlides’s 51-year-old son, often have other autoimmune disorders like thyroid disease, rheumatoid arthritis, diabetes or alopecia areata. In some families, premature graying of the hair results from an autoimmune loss of melanocytes in the hair follicles.
“There are families in which people are prone to autoimmune conditions, but each member gets a different one, and there are other families in which multiple people have vitiligo, perhaps because of something different about their pigment cells,” Dr. Orlow said.
Vitiligo can first show up in early childhood or as late in life as one’s 80s. It involves no microorganism and is not contagious, even though in some countries vitiligo patients are treated as if they had leprosy. The disorder typically starts as small irregular white patches on the skin that gradually enlarge and change shape. Its expression is often provoked by a physical, physiological or emotional stress, like a sunburn, certain chemical exposures, a car accident or a divorce. However, most of the time the triggering event is unknown.
A common underlying mechanism is oxidative stress, an inability of the body to neutralize damaging molecules like free radicals with antioxidants. This may explain the case of a man whose vitiligo regressed when he was taking a high dose of a statin to treat high cholesterol. Statins have, among their effects, the ability to scavenge free radicals.