Definition And Description

Vitiligo is an affection characterized by a localized disappearance of the cutaneous pigment. It becomes noticeable by the development of one or more small pigmentless spots, the color of which varies from a dead white to a faint rosy hue, the particular tint depending on the activity of the circulation in the affected part. The hair, if there be any on the spot, loses its color and becomes white. Surrounding these pale patches there is frequently a border characterized by increased pigmentary deposit which gradually shades off into the hue of the normal surrounding skin. The appearance of one spot is usually followed by the development of others. The spots usually, for a time, increase in size and unite with neighboring ones after forming an irregular patch of considerable extent. A considerable and even the major part of the surface may be thus invaded. With the exception of the loss of color, the affected portions do not present any other anomaly, but appear to preserve their various functions unaltered. The parts most frequently affected are, in my experience, the hands, face, neck, and genitals.

The affection, once developed, may continue for an indefinite period, or after a time come to a standstill and remain in that condition for many years. Occasionally, spontaneous recovery may take place, that is, the skin may recover its normal coloration. This I have seen, and in one patient alternations of vitiligo and normal color has occurred a number of times.

The affection affects the negro as well as the Caucasian, and probably also the races of intermediate tint. I have never met with the affection in childhood in the white race, but have seen it from early adult life to old age.

Diagnosis

The affection can be confounded with but one or two others. These are partial albinism and certain phases of macular Leprosy. Albinism, when complete, consists in a congenital diffuse absence of pigment; when partial, of congenital white spots surrounded by skin of normal hue. Vitiligo, on the other hand, is an acquired affec-tion. The history of the case will be sufficient to determine the diagnosis. I have seen a case of macular leprosy in which there was a not very distant resemblance to Vitiligo, and I can readily imagine that there may be oases in which the likeness would be still more striking. The history of the case, however, and a close examination of the lesion, together with the fact that the white patches of leprosy are anaesthetic, will obviate any difficulties in the way of diagnosis.

Prognosis

Theprognosis is generally considered bad, that is, it has generally been considered impossible, in the majority of cases, to restore the lost pigment, and bring about a return to the natural color. Recent observation, however, lead me to take a more favorable view and to ex-press the belief that remedial agents are capable, in some instances, of greatly improving the condition of the parts.

Etiology

Nothing definite is known on the subject, and most of the speculations regarding it have not a sufficient basis of fact to even render them probable.

Treatment

Kaposi says (97, 2: 132): "We are not able to cure Vitiligo by any of the remedies or means at our disposal," but suggests that the striking contrast between the pigmented and unpigmented parts may be lessened by the use of such blistering preparations as will remove the color from the surrounding deeper pigmented parts. This is such an extraordinary proposition that we can hardly believe it is offered for serious consideration.

Fox (61, 402), however, says that "treatment is sometimes successful. A nutritious diet, a course of tonics - arsenic, iron, or the mineral acids - the correcting of any of the ill-effects of the action of malarial poison, residence in a cool locality, and the avoidance of fatigue, generally conduce to improvement. Locally, the use of friction and cold bathing, with iodine baths, are the best remedies."

Five years ago the author wrote (87, 374) as follows: "Personally I have never attempted any treatment whatever in cases of Vitiligo which have fallen under my notice," believing that treatment was useless. Since that time, however, I have had reason to change my mind, in consequence of having noticed the effect of strong sunlight on the patches in a patient under treatment for another affection. Briefly, the patient went fishing all day in a July sun with hands and wrists exposed, the backs of the hands being affected with Vitiligo. The exposed parts were sunburned, the vitiligonous patches very severely. After recovering from the effects of the sun, the patches were found to be very decidedly darkened in color, in fact tanned. This experience suggested to me the use of a burning-glass, the direct sunlight being concentrated on the white patches in such a manner that the heat is just supportable by the patient. This has, in one and the only instance in which I have tried it, proved of service.

Other cutaneous stimulants, as Hydrarg. bichloride, should, however, not be forgotten, and theoretical considerations would lead me to suggest the use of the galvanic current.

Barton speaks of the use of butternut-juice (Juglans cinerea). This is an easily tried remedy, but whether of permanent benefit I do not know. If, however, it is desired, for any temporary purpose, to stain the patches a darker hue, the juice of butter-nut or hickory-nut "shuck" will be found, at the proper season of the year, a very available means to this end, as every country boy that has ever gone nutting well knows.