Vitiligo

Vitiligo

What causes vitiligo? 6 possible conditions
 
 
 
Vitiligo is a condition in which you lose the pigment of your skin. Pigment, or melanin, causes skin color and is produced by cells called “melanocytes.”
 
Most people with vitiligo lose pigment in patches of normally pigmented skin, which is replaced by flat, white patches with irregular borders. This loss of pigmentation can occur in small patches on one side of the body or in large areas covering over 50 percent of the body. These patches are usually areas of your body that are exposed to the sun, such as your:
 
hands
face
arms
feet
However, your genitalia can also be affected.
 
Vitiligo can be treated but not cured. You’ll need to manage the disorder throughout your life. The National Vitiligo Foundation estimates that 0.5 to 1 percent of the general population has vitiligo.
 
The condition isn’t contagious, doesn’t cause pain, and isn’t medically dangerous. Vitiligo affects males and females of all races equally. The loss of pigment, called depigmentation, is more noticeable in people with dark skin.
 
What Causes Vitiligo?
The exact cause of vitiligo is unknown, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Researchers think that vitiligo could be an autoimmune response, meaning that the body attacks itself. In this case, your body destroys its own melanocytes so that the pigment is lost. Vitiligo also appears to be an inherited condition. Up to 30 percent of people who have vitiligo have a family member with the same condition.
 
Links exist between vitiligo and other autoimmune diseases, such as alopecia areata, hyperthyroidism, Addison’s Disease, and the genetic disease pernicious anemia.
 
Symptoms of Vitiligo
The main symptom of vitiligo is the absence of pigment on the skin. Three different patterns of depigmentation are possible:
 
In a focal pattern, the loss of skin color appears in only a few small areas.
In a segmental pattern, depigmentation occurs on one side of the body.
In a generalized pattern, the loss of melanin occurs on both sides of the body in a symmetrical pattern.
The generalized pattern is the most common type of vitiligo. Depigmentation in any of the three patterns can appear on your:
 
face
arms
underarms
legs
hands
feet
lips
groin
The lining of the inside of your mouth may also lose color.
 
Premature graying of scalp and facial hair can also be a sign of vitiligo. This includes your eyebrows and eyelashes.
 
Diagnosing Vitiligo
Your doctor will review your medical history and possibly test a skin sample to diagnose vitiligo. Family history of the condition and reports of sunburns or blistering are considered. According to the NIAMS, sun damage may trigger vitiligo symptoms in some patients. A skin biopsy can reveal the complete absence of pigment and may confirm the diagnosis.
 
Your doctor might also run blood tests to check your vitamin B-12 levels and thyroid function. An overactive thyroid and a deficiency of B-12 are often associated with vitiligo. Running these tests can help you get prompt treatment for any related conditions if needed.
 
Treatment and Management
Vitiligo is painless and benign. The goal of treatment is to restore pigment to your skin, which is cosmetic. Treating vitiligo is a long-term commitment. Most therapies don’t show results for several months. Treatments include the following:
 
Steroids
 
Topical medications can be effective ways to repigment the white patches of skin. Topical steroid medications are used in children and adults. Steroids must be applied to the skin daily for at least three months before you can expect to see results. Steroid creams can have some adverse effects, including a thinning of the skin or streaks of color on the skin.
 
Immunomodulators
 
Another group of drugs called immunomodulators may also treat vitiligo. These are ointments that contain the active ingredient tacrolimus or pimecrolimus. According to the Mayo Clinic, people who have small areas of pigment loss on the face and neck usually see results with immunomodulators.
 
Ultraviolet Light
 
Ultraviolet light therapy can restore pigment in some people with vitiligo. Most often, you are required to take a medication called psoralen, which causes the skin to be more sensitive to the light treatment. Psoralen is available in both topical and oral forms. The combination of psoralen and UVA rays is called PUVA treatment. It darkens the light areas of your skin.
 
Since you’re more sensitive to sunlight when using psoralen, you should protect the rest of your body with sunscreen. You can get PUVA treatment several times per week in your doctor’s office.
 
Depigmentation
 
When repigmentation of the white patches fails, depigmenting the rest of your body is another treatment option. Depigmentation is reserved for those who present with vitiligo on more than half of their body. The goal is to match your normal pigmented skin to the areas affected by vitiligo.
 
A medication called monobenzone is applied to your skin to lighten the pigmented areas. This topical medication can bleach the skin of other people who may come into direct contact with you. Therefore, skin-to-skin contact must be avoided for two hours after treatment.
 
Noninvasive management of vitiligo can include makeup and sunless tanners. Tanning doesn’t help restore pigment loss from vitiligo, according to the NIAMS. Tanning makes the difference between normal and depigmented skin tone more obvious. You should use sunscreen with UVA and UVB protection to protect your skin.
 
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Hashimoto's Disease
 
 
Overview
Hashimoto’s disease damages your thyroid function. It’s also called chronic lymphocytic thyroiditis, or just chronic thyroiditis. In the U.S., Hashimoto’s is the most common cause of hypothyroidism (an underactive thyroid).
 
Your thyroid releases hormones that regulate your metabolism, body temperature, muscle strength, and many other functions of the body.
 
 
What causes Hashimoto’s disease?
Hashimoto’s disease is an autoimmune disorder. The condition creates antibodies that attack the cells of the thyroid. Doctors do not know why this happens, but some scientists believe genetic factors may be involved.
 
 
Am I at risk for developing Hashimoto’s disease?
The cause of Hashimoto’s disease is not known. However, several risk factors have been identified for the disease. It is seven times more likely to occur in women than men, especially women who have been pregnant. Your risk may also be higher if you have a family history of autoimmune diseases, including:
 
Graves’ disease
type 1 diabetes
lupus
rheumatoid arthritis
vitiligo
Addison’s disease
 
 
 
 
What are the symptoms of Hashimoto’s disease?
Symptoms of Hashimoto’s are not unique to the disease. Instead, it causes the symptoms of an underactive thyroid. Signs that your thyroid isn’t working properly include:
 
constipation
dry, pale skin
hoarse voice
high cholesterol
depression
lower body muscle weakness
fatigue
feeling sluggish
cold intolerance
thinning hair
irregular or heavy periods
problems with fertility
 
 
 
You may have Hashimoto’s for many years before you experience any symptoms. The disease can progress for a long time before it causes noticeable thyroid damage.
 
Some people with this condition develop an enlarged thyroid. Known as a goiter, this may cause the front of your neck to become swollen. A goiter rarely causes any pain. However, it may make swallowing difficult, or cause your throat feel full.
 
Hashimoto’s disease diagnosis
Your doctor may suspect this condition if you have the symptoms of an underactive thyroid. If so, they’ll check your thyroid-stimulating hormone (TSH) levels with a blood test. This common test is one of the best ways to screen for Hashimoto’s. TSH hormone levels are high when thyroid activity is low because the body is working hard to stimulate the thyroid gland to produce more thyroid hormones.
 
Your doctor may also use blood tests to check your levels of:
 
other thyroid hormones
antibodies
cholesterol
These tests can help confirm your diagnosis.
 
 
 
Treatment of Hashimoto’s disease
Not all people with Hashimoto’s need treatment. If your thyroid is functioning normally, your doctor may just want to monitor you for changes.
 
If your thyroid isn’t producing enough hormones, you may need medication. Levothyroxine is a synthetic hormone that replaces the missing thyroid hormone thyroxine. It has virtually no side effects. If you need this drug, you’ll likely be on it for the rest of your life.
 
Regular use of levothyroxine can return your thyroid hormone levels to normal. When this happens, your symptoms will usually disappear. However, you’ll probably need regular tests to monitor your hormone levels. This allows your doctor to adjust your dose as necessary.
 
 
 
 
Treatment of Hashimoto’s disease
Not all people with Hashimoto’s need treatment. If your thyroid is functioning normally, your doctor may just want to monitor you for changes.
 
If your thyroid isn’t producing enough hormones, you may need medication. Levothyroxine is a synthetic hormone that replaces the missing thyroid hormone thyroxine. It has virtually no side effects. If you need this drug, you’ll likely be on it for the rest of your life.
 
Regular use of levothyroxine can return your thyroid hormone levels to normal. When this happens, your symptoms will usually disappear. However, you’ll probably need regular tests to monitor your hormone levels. This allows your doctor to adjust your dose as necessary.
 
 
 
 
Complications related to Hashimoto’s
If left untreated, Hashimoto’s disease can cause complications, some of which can be severe. These can include:
 
heart problems, including heart failure
anemia
confusion and loss of consciousness
high cholesterol
decreased libido
depression
 
 
 
 
Hashimoto’s can also cause problems during pregnancy. Recent research suggests that women with this condition are more likely to give birth to babies with heart, brain, and kidney defects.
 
In order to limit these complications, it’s important to monitor thyroid function over the course of pregnancy in women who have thyroid problems. For women with no known thyroid disorders, routine thyroid screening isn’t recommended during pregnancy, according to the American College of Obstetrics and Gynecology.--
 
 
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Addison's Disease
 
What Are the Symptoms of Addison’s Disease?
 
Symptoms
People who have Addison’s disease may experience the following symptoms:
 
weakness in the muscles
fatigue and tiredness
darkening in skin color
weight loss or decreased appetite
a decrease in heart rate or blood pressure
low blood sugar levels
fainting spells
sores in the mouth
cravings for salt
nausea
vomiting
irritability or depression
If Addison’s disease goes untreated for too long, it can become an Addisonian crisis. An Addisonian crisis is a life threatening medical emergency. Call 911 immediately if you or someone you know begins to experience:
 
mental status changes (confusion, fear, or restlessness)
loss of consciousness
high fever
sudden pain in the lower back, belly, or legs
An untreated Addisonian crisis can lead to shock and death.
 
Part 3 of 7: Causes
What Causes Addison’s Disease?
Causes
There are two major classifications for Addison’s disease: primary adrenal insufficiency and secondary adrenal insufficiency. In order to treat your disease, your doctor will need to find out which type is responsible for your condition.
 
Primary Adrenal Insufficiency
Primary adrenal Insufficiency occurs when your adrenal glands are damaged so severely that they can no longer produce hormones. This type of Addison’s disease is most often caused when your immune system attacks the adrenal glands. This is called an autoimmune disease. In an autoimmune disease, your body’s immune system mistakes any organ or area of the body for a virus, bacteria, or another outside invader.
 
Other causes of primary adrenal insufficiency include:
 
Prolonged administration of glucocorticoids (e.g. prednisone)    
Infections in your body
Cancer and abnormal growths (tumors)
Certain blood thinners used to control clotting in the blood
Secondary Adrenal Insufficiency
Secondary adrenal insufficiency occurs when the pituitary gland (located in your brain) can’t produce adrenocorticotropic hormone (ACTH). ACTH tells the adrenal gland when to release hormones.
 
It’s also possible to develop adrenal insufficiency if you do not take the corticosteroid medications your doctor prescribes. Corticosteroids help control chronic health conditions like asthma.
 
Part 4 of 7: Risk Factors
Who Is at Risk for Addison’s Disease?
Risk Factors
You may be at a higher risk for Addison’s disease if you:
 
have cancer
take anticoagulants (blood thinners)
have chronic infections like tuberculosis
had surgery to remove any part of your adrenal gland
have an autoimmune disease, like type 1 diabetes or Graves’ disease
Part 5 of 7: Diagnosis
Diagnosing Addison’s Disease
Diagnosis
Your doctor will ask you about your medical history and the symptoms you’ve been experiencing. They will do a physical examination and they may order some lab tests to check your potassium and sodium levels. Your doctor may also order imaging tests and measure your hormone levels.
 
Part 6 of 7: Treatment
How is Addison’s Disease Treated?
Treatment
Your treatment will depend on what is causing your condition. Your doctor may prescribe medications that regulate the adrenal gland.
 
Following the treatment plan that your doctor creates for you is very important. Untreated Addison’s disease can lead to an Addisonian crisis.
 
If your condition has gone untreated for too long, and has progressed to a life-threatening condition called Addisonian crisis, your physician may prescribe medication to treat that first. Addisonian crisis causes low blood pressure, high potassium in the blood, and low blood sugar levels.
 
Medications
You may need to take a combination of glucocorticoids medications (drugs that stop inflammation) to improve your health. These medications will be taken for the rest of your life and you cannot miss a dose.
 
Hormone replacements may be prescribed to replace hormones that your adrenal glands are not making.
 
Home Care
Keep an emergency kit that contains your medications on hand at all times. Ask your doctor to write a prescription for an injectable corticosteroid for emergencies. You may also want to keep a medical alert card in your wallet and a bracelet on your wrist to let others know about your condition.
 
Alternative Therapies
It’s important to keep your stress level down if you Addison’s disease. Major life events, such as a death of a loved one or an injury, can raise your stress level and affect the way you respond to your medications. Talk to your doctor about alternative ways to relieve stress, such as yoga and meditation.
 
Part 7 of 7: The Long Term Outlook
What Is Expected in the Long Term?
Outlook
People with Addison’s disease will have to get treatment for the rest of their lives. Treatments, such as hormone replacement medications, will make symptoms more manageable.
 
As long as you follow the treatment plan your doctor creates for you, it is possible to live a productive life.
 
Always take your medications exactly as directed. Taking too little or too much medicine may be dangerous to your health. Your treatment plan may need to be reevaluated and changed throughout your life. For this reason, it’s important that you see your doctor regularly. 
 
 
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Pernicious Anemia
 
 
Anemia is a medical condition in which the blood is low in normal red blood cells. Pernicious anemia is one of the vitamin B-12 deficiency anemias. It’s caused by an inability to absorb the vitamin B-12 needed for your body to make enough healthy red blood cells. Pernicious anemia is a rare condition, with a prevalence of .1 percent in the general population and 1.9 percent in people who are older than 60 years, according to the Journal of Blood Medicine.
 
This type of anemia is called “pernicious” because it was once considered a deadly disease. This was due to the lack of available treatment. Today, though, the disease is relatively easy to treat with B-12 injections or supplements. However, if left untreated, vitamin B-12 deficiency can lead to severe complications.
 
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Part 2 of 9: Symptoms
What are the symptoms of pernicious anemia?
The progression of pernicious anemia is slow. It may be difficult to recognize the symptoms because you may have become used to not feeling well.
 
Commonly overlooked symptoms include:
 
weakness
headaches
chest pain
weight loss
In rare cases of pernicious anemia, people may have neurological symptoms. These can include:
 
an unsteady gait
spasticity, which is stiffness and tightness in the muscles
peripheral neuropathy, which is numbness in the arms and legs
progressive lesions of the spinal cord
memory loss
Other symptoms of a B-12 deficiency, which can overlap with pernicious anemia, include:
 
nausea and vomiting
confusion
depression
constipation
loss of appetite
heartburn
Part 3 of 9: Causes
What causes pernicious anemia?
Lack of vitamin B-12
People with anemia have low levels of normal red blood cells (RBCs). Vitamin B-12 plays a role in creating RBCs, so the body requires an adequate intake of vitamin B-12. Vitamin B-12 is found in:
 
meat
poultry
shellfish
eggs
dairy products
fortified soy, nut, and rice milks
nutritional supplements
Lack of IF
Your body also needs a type of protein called intrinsic factor (IF) to absorb vitamin B-12. IF is a protein produced by cells in the stomach. After you consume vitamin B-12, it travels to your stomach where it binds with IF. The two are then absorbed in the last part of your small intestine.
 
In most cases of pernicious anemia, the body’s immune system attacks and destroys the cells that produce IF in the stomach. If these cells are destroyed, the body can’t make IF and can’t absorb vitamin B-12.
 
Macrocytes
Without enough vitamin B-12, the body will produce abnormally large red blood cells called macrocytes. Because of their large size, these abnormal cells may not be able to leave the bone marrow, where red blood cells are made, and enter the bloodstream. This decreases the amount of oxygen-carrying red blood cells in the bloodstream and can lead to fatigue and weakness.
 
Pernicious anemia is a type of macrocytic anemia. It’s sometimes called megaloblastic anemia because of the abnormally large size of the red blood cells produced.
 
Pernicious anemia is not the only kind of macrocytic anemia. Other causes of abnormally large red blood cells include:
 
long-term use of certain medications and antibiotics, such as methotrexate and azathioprine
chronic obstructive pulmonary disease (COPD)
chronic alcoholism
folate (vitamin B-9) deficiency caused by poor diet or conditions that affect absorption
Part 4 of 9: Distinction
B-12 deficiency vs. pernicious anemia
Other vitamin B-12 deficiencies, such as those caused by poor diet, are often confused with pernicious anemia. Pernicious anemia is strictly an autoimmune disorder. It results from a lack of IF and poor B-12 absorption. This vitamin deficiency can be treated by altering your diet or adding a B-12 supplement or B-12 injection to your healthcare regimen.
 
In people with B-12 deficiencies or regular anemia, the body can absorb B-12. On the other hand, someone with pernicious anemia struggles to do so. Pernicious anemia is also seen in children who are born with a genetic defect that prevents them from making IF.
 
Risk factors for pernicious anemia
Some individuals are more likely than others to develop pernicious anemia. Risk factors include:
 
having a family history of the disease
being of Northern European or Scandinavian descent
having type 1 diabetes, an autoimmune condition, or certain intestinal diseases such as Crohn’s disease
having had part of your stomach or intestines removed
being 60 years or older
being strictly vegetarian and not taking a B-12 supplement
Your risk of developing pernicious anemia also increases as you get older.
 
Diagnosing pernicious anemia
Your doctor will usually need to do several tests to diagnose you with pernicious anemia. These include:
 
Complete blood count: This test measures vitamin B-12 and iron levels in blood serum.
 
Vitamin B-12 deficiency test: Your doctor can assess your vitamin B-12 levels through a blood test. Low levels indicate a deficiency.
 
Biopsy: Your doctor may also want to see if there has been any damage to your stomach walls. They can diagnose this through a biopsy. The biopsy involves removing a sample of the stomach’s cells. The cells are then examined microscopically for any damage.
 
IF deficiency test: Intrinsic factor deficiency is tested through a blood sample. The blood is tested for antibodies against IF and the stomach’s cells.
 
In a healthy immune system, antibodies are responsible for finding bacteria or viruses. They then mark the invading germs for destruction. In an autoimmune disease such as pernicious anemia, the body’s antibodies stop distinguishing between diseased and healthy tissue. In this case, the antibodies destroy the cells making IF.
 
 
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Hyperthyroidism
 
Hyperthyroidism is a condition of the thyroid. The thyroid is a small, butterfly-shaped gland located at the front of your neck. It produces tetraiodothyronine (T4) and triiodothyronine (T3), which are two primary hormones that control how your cells use energy. Your thyroid gland regulates your metabolism through the release of these hormones.
 
Hyperthyroidism occurs when the thyroid makes too much T4, T3, or both. Diagnosis of overactive thyroid and treatment of the underlying cause can relieve symptoms and prevent complications.
 
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Part 2 of 7: Causes
What causes hyperthyroidism?
A variety of conditions can cause hyperthyroidism. Graves' disease, an autoimmune disorder, is the most common cause of hyperthyroidism. It causes antibodies to stimulate the thyroid to secrete too much hormone. Graves’ disease occurs more often in women than in men. It tends to run in families, which suggests a genetic link. You should tell your doctor if your relatives have had the condition.
 
Other causes of hyperthyroidism include:
 
excess iodine, a key ingredient in T4 and T3
thyroiditis, or inflammation of the thyroid, which causes T4 and T3 to leak out of the gland
tumors of the ovaries or testes
benign tumors of the thyroid or pituitary gland
large amounts of tetraiodothyronine taken through dietary supplements or medication
Part 3 of 7: Symptoms
What are the symptoms of hyperthyroidism?
High amounts of T4, T3, or both can cause an excessively high metabolic rate. This is called a hypermetabolic state. When in a hypermetabolic state, you may experience a rapid heart rate, elevated blood pressure, and hand tremors. You may also sweat a lot and develop a low tolerance for heat. Hyperthyroidism can cause more frequent bowel movements, weight loss, and, in women, irregular menstrual cycles.
 
Visibly, the thyroid gland itself can swell into a goiter, which can be either symmetrical or one-sided. Your eyes may also appear quite prominent, which is a sign of exophthalmos, a condition that’s related to Graves’ disease.
 
Other symptoms of hyperthyroidism include:
 
increased appetite
nervousness
restlessness
inability to concentrate
weakness
irregular heartbeat
difficulty sleeping
fine, brittle hair
itching
hair loss
nausea and vomiting
breast development in men
The following symptoms require immediate medical attention:
 
dizziness
shortness of breath
loss of consciousness
fast, irregular heart rate
Hyperthyroidism can also cause atrial fibrillation, a dangerous arrhythmia that can lead to strokes, as well as congestive heart failure.
 
Read more: The effects of atrial fibrillation on the body
 
Part 4 of 7: Diagnosis
How do doctors diagnose hyperthyroidism?
Your first step in diagnosis is to get a complete medical history and physical exam. This can reveal these common signs of hyperthyroidism:
 
weight loss
rapid pulse
elevated blood pressure
protruding eyes
enlarged thyroid gland
Other tests may be performed to further evaluate your diagnosis. These include:
 
Cholesterol test
Your doctor may need to check your cholesterol levels. Low cholesterol can be a sign of an elevated metabolic rate, in which your body is burning through cholesterol quickly.
 
T4, free T4, T3
These tests measure how much thyroid hormone (T4 and T3) is in your blood.
 
Thyroid stimulating hormone level test
Thyroid stimulating hormone (TSH) is a pituitary gland hormone that stimulates the thyroid gland to produce hormones. When thyroid hormone levels are normal or high, your TSH should be lower. An abnormally low TSH can be the first sign of hyperthyroidism.
 
Triglyceride test
Your triglyceride level may also be tested. Similar to low cholesterol, low triglycerides can be a sign of an elevated metabolic rate.
 
Thyroid scan and uptake
This allows your doctor to see if your thyroid is overactive. In particular, it can reveal whether the entire thyroid or just a single area of the gland is causing the overactivity.
 
Ultrasound
Ultrasounds can measure the size of the entire thyroid gland, as well as any masses within it. Doctors can also use ultrasounds to determine if a mass is solid or cystic.
 
CT or MRI scans
A CT or MRI can show if a pituitary tumor is present that’s causing the condition.
 
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Alopecia Areata
 
What Is Alopecia Areata?
Highlights
Alopecia areata is an autoimmune disease that causes hair to fall out in small, random patches. The hair loss usually affects the scalp, but it can also occur in other areas of the body.
The exact cause of alopecia areata isn’t known. However, it most often occurs in people who have a family history of other autoimmune disorders, such as type 1 diabetes or rheumatoid arthritis.
Although there’s no cure for alopecia areata, treatment can help the hair grow back more quickly and may prevent future hair loss.
Alopecia areata is a disease that causes hair to fall out in small patches. It develops when the immune system attacks the hair follicles, resulting in hair loss. Sudden hair loss may occur on the scalp and other parts of the body. The condition rarely results in total hair loss, or alopecia universalis, but it can prevent hair from growing back. When hair does grow back, it’s possible for the hair to fall out again. The extent of hair loss and regrowth varies from person-to-person.
 
There’s currently no cure for alopecia areata. However, there are treatments that may help hair grow back more quickly and that can prevent future hair loss. There are also resources available to help people cope with the disease.
 
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Part 2 of 6: Symptoms
What Are the Symptoms of Alopecia Areata?
The main symptom of alopecia areata is hair loss. Hair usually falls out in small round patches on the scalp. These patches are usually several centimeters or less. Hair loss might also occur on other parts of the body. You may first notice clumps of hair on your pillow or in the shower. However, other types of diseases can also cause hair to fall out in a similar pattern. Hair loss alone shouldn’t be used to diagnose alopecia areata.
 
In rare cases, some people may experience more extensive hair loss. This is usually an indication of another type of alopecia, such as:
 
alopecia totalis, which is the loss of all hair on the scalp
alopecia universalis, which is the loss of all hair on the entire body
The hair loss associated with alopecia areata is unpredictable and random. The hair may grow back at any time and then may fall out again. The extent of hair loss and regrowth varies greatly from person-to-person.
 
Part 3 of 6: Causes
What Causes Alopecia Areata?
Alopecia areata is an autoimmune disease. An autoimmune disease develops when the immune system mistakes healthy cells for foreign substances. Normally, the immune system defends your body against foreign invaders, such as viruses and bacteria. If you have alopecia areata, however, your immune system mistakenly attacks your hair follicles. Hair follicles are the structures from which hairs grow. The follicles become smaller and stop producing hair, leading to hair loss.
 
Researchers don’t know what triggers the immune system to attack hair follicles, so the exact cause of this condition isn’t known. However, it most often occurs in people who have a family history of other autoimmune diseases, such as type 1 diabetes or rheumatoid arthritis. This is why some scientists suspect that genetics may contribute to the development of alopecia areata. They also believe that certain factors in the environment are needed to trigger alopecia areata in people who are genetically predisposed to the disease.
 
Part 4 of 6: Diagnosis
How Is Alopecia Areata Diagnosed?
Your doctor will review your symptoms to determine if you have alopecia areata. They may be able to diagnose alopecia areata simply by looking at the extent of your hair loss and by examining a few hair samples under a microscope.
 
Your doctor may also perform a scalp biopsy to rule out other conditions that cause hair loss, including fungal infections, such as tinea capitis. During a scalp biopsy, your doctor will remove a small piece of skin on your scalp for analysis.
 
Blood tests might be done if other autoimmune conditions are suspected. The specific blood test performed depends on the particular disorder your doctor suspects. However, your doctor will likely test for the presence of one or more abnormal antibodies. If these autoantibodies are found in your blood, it usually means that you have an autoimmune disorder.
 
Other blood tests that can help rule out other conditions include the following:
 
C-reactive protein and erythrocyte sedimentation rate
iron levels
antinuclear antibody test
thyroid hormones
free and total testosterone
follicle stimulating and luteinizing hormone
 
 
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Albinism
 
What Is Albinism?
Albinism is a rare group of genetic disorders that cause the skin, hair, or eyes to have little or no color. Albinism is also associated with vision problems. According to the National Organization for Albinism and Hypopigmentation, about 1 in 18,000 to 20,000 people in the United States has a form of albinism.
 
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Part 2 of 8: Types
What Are the Types of Albinism?
 Type 1
Different gene defects characterize the numerous types of albinism. Types of albinism include:
 
Oculocutaneous Albinism (OCA)
OCA affects the skin, hair, and eyes. There are several subtypes of OCA:
 
OCA1
OCA2
OCA3
OCA4
OCA1
OCA1 is due to a defect in the tyrosinase enzyme. There are two subtypes of OCA1.
 
OCA1a: People with OCA1a have a complete absence of melanin, the pigment that gives skin, eyes, and hair their coloring. People with this subtype have white hair, very pale skin, and light eyes.
OCA1b: People with OCA1b produce some melanin. They have light-colored skin, hair, and eyes. Their coloring may increase as they age.
OCA2
OCA2 is less severe than OCA1. It’s due to a defect in the OCA2 gene that results in reduced melanin production. People with OCA2 are born with light coloring and skin, and their hair may be yellow, blond, or light brown. OCA2 is most common in Sub-Saharan Africans, African Americans, and Native Americans.
 
OCA3
OCA3 is a defect in the TYRP1 gene. It usually affects dark-skinned people, particularly black South Africans. People with OCA3 have reddish-brown skin, reddish hair, and hazel or brown eyes.
 
OCA4
OCA4 is due to a defect in the SLC45A2 protein. It results in a minimal production of melanin and commonly appears in people of East Asian descent. People with OCA4 have symptoms similar to those in people with OCA2.
 
Ocular Albinism (OA)
OA is the result of a gene mutation on the X chromosome and occurs almost exclusively in males. This type of albinism only affects the eyes. People with OA have normal hair, skin, and eye coloring, but have no coloring in the retina (the back of the eye).
 
Hermansky-Pudlak Syndrome (HPS)
HPS is a rare form of albinism that is due to a defect in one of eight genes. It produces symptoms similar to OCA, and occurs with lung, bowel, and bleeding disorders.
 
Chediak-Higashi Syndrome
Chediak-Higashi syndrome is another rare form of albinism that is the result of a defect in the LYST gene. It produces symptoms similar to OCA, but may not affect all areas of the skin. Hair is usually brown or blond with a silvery sheen, and the skin is usually creamy white to grayish. People with Chediak-Higashi syndrome have a defect in the white blood cells, increasing their risk of infections.
 
Griscelli Syndrome (GS)
GS is an extremely rare genetic disorder. It’s due to a defect in one of three genes. There only have been 60 known cases of GS worldwide since 1978. GS occurs with albinism (but may not affect the entire body), immune problems, and neurological problems. GS usually results in death within the first decade of life.
 
Part 3 of 8: Causes
What Causes Albinism?
Causes
A defect in one of several genes that produce or distribute melanin causes albinism. The defect may result in the absence of melanin production, or a reduced amount of melanin production. The defective gene passes down from both parents to the child and causes albinism.
 
Part 4 of 8: Risk Factors
Who Is at Risk for Albinism?
Risk Factors
Albinism is an inherited disorder that’s present at birth. Children are at risk of being born with albinism if they have parents with albinism, or parents who carry the gene for albinism.
 
Part 5 of 8: Symptoms
What Are the Symptoms of Albinism?
Symptoms
People with albinism will have the following symptoms:
 
an absence of color in the hair, skin, or eyes
lighter than normal coloring of the hair, skin, or eyes
patches of skin that have an absence of color
Albinism occurs with vision problems, which may include:
 
strabismus (crossed eyes)
photophobia (sensitivity to light)
nystagmus (involuntary rapid eye movements)
impaired vision or blindness
astigmatism
Part 6 of 8: Diagnosis
How Is Albinism Diagnosed?
Diagnosis
The most accurate way to diagnose albinism is through genetic testing to detect defective genes related to albinism. Less accurate ways of detecting albinism include an evaluation of symptoms by your doctor or an electroretinogram test. This test measures the response of the light-sensitive cells in the eyes to reveal eye problems associated with albinism.
 
 
 
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Fungal Nail Infection
Overview
Fungal infections can affect any part of the body. Fungi are normally present in and on the body alongside various bacteria. When a fungus begins to overgrow, you can get an infection.
 
Onychomycosis, also called tinea unguium, is a fungal infection that affects either the fingernails or toenails. Fungal infections normally develop over time, so any immediate difference in the way your nail looks or feels may be too subtle to notice at first.
 
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Part 2 of 8: Causes
Why Does It Develop?
Causes
A fungal nail infection occurs from the overgrowth of fungi in, under, or on the nail. Fungi thrive in warm, moist environments, so this type of environment can cause them to naturally overpopulate. The same fungi that cause jock itch, athlete’s foot, and ringworm can cause nail infections.
 
Fungi that are already present in or on your body can cause nail infections. If you have come in contact with someone else who has a fungal infection, it may have spread to you. According to the American Academy of Dermatology (AAD), fungal infections affect toenails more commonly than fingernails because your toes are usually confined to your shoes, where they’re in a warm, moist environment.
 
If you get a manicure or pedicure at a nail salon, be sure to ask how the staff disinfects their tools and how often they do it. Tools, such as emery boards and nail clippers, can spread fungal infections from person-to-person if they’re not sanitized.
 
Part 3 of 8: Risk Factors
Who Is at Risk for Fungal Infections?
Risk Factors
There are many different causes of fungal nail infections, and each cause has a treatment of its own. Although many of the causes of a fungal nail infection are preventable, some risk factors increase the likelihood of developing it. You’re more likely to develop a fungal nail infection if you:
 
have diabetes
have a disease that causes poor circulation
are over age 65
wear artificial nails
swim in a public swimming pool
have a nail injury
have a skin injury around the nail
have moist fingers or toes for an extended time
have a weakened immune system
wear closed-toe shoes, such as tennis shoes or boots
Nail infections occur more often in men than in women, and the infections are found in adults more often than in children. If you have family members who often get these types of fungal infections, you’re more likely to get them as well. Older adults are at the highest risk for getting fungal infections of the nails because they have poorer circulation and their nails grow more slowly and thicken as they age.
 
Part 4 of 8: Symptoms
What Does It Look Like?
Symptoms
A fungal infection of the nail may affect part of the nail, the entire nail, or several nails.
 
Visible Signs
Visible signs of a fungal nail infection include:
 
scaling under the nail, which is called subungual hyperkeratosis
white or yellow streaks on the nail, which is called lateral onychomycosis
a crumbling corner or tip of the nail, which is called distal onychomycosis
flaking white areas on the nail’s surface, which may include pits in the nail
the appearance of yellow spots at the bottom of the nail, which is called proximal onychomycosis
loss of the nail
Common Signs
Common signs of a fungal nail infection include:
 
a distorted nail that may lift off from the nail bed
an odor coming from the infected nail
a brittle or thickened nail
Part 5 of 8: Diagnosis
How Do I Know If I Have a Fungal Nail Infection?
Diagnosis
Because other infections can affect the nail and mimic symptoms of fungal nail infection, the only way to confirm a diagnosis is to see a doctor. They will take a scraping of the nail and look under a microscope for signs of a fungus. In some cases, your doctor may have to send the sample to a lab for analysis and identification.
 
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