VitiligoVitiligo is a skin disorder in which patients develop white spots on the skin that differ in size and location. These spots occur when pigment cells called "melanocytes" are destroyed and the pigment melanin can no longer be produced. These melanocytes are present throughout the skin, hair, mouth, eyes and some part of the nervous system and they can be damaged or destroyed in any of these areas.
At High-riskVitiligo affects at least 1%-2% of the population. About 30% -40% patients report it as hereditary. Even though most people with Vitiligo are in good general health, they face a greater risk of having other auto immune disorders such as hyperthyroidism or hypothyroidism, vitamin B12 deficiency, Addison's disease (adrenal dysfunction), Alopecia areata (round patches of hair loss) and or uveitis (inflammation with the eyes). Although largely similar to the disease in adults, childhood Vitiligo has a higher incidence of family history of autoimmune or endocrine diseases, early or premature graying and poor response to topical PUVA.
CausesThe precise cause of Vitiligo is not known. Its a combination of genetic, immunological and neurogenic factors which holds major importance in most cases. Stress of any kind (physical, mechanical, chemical, emotional) too can trigger off the disease process.
TreatmentTreatment is to try and get back the pigment i.e repigmentation in the patches. However, one cannot predict the course and final outcome of this condition as many factors like stress and associated diseases come into play.
a) PUVA Therapy:In this photosensiting agents (Psoralens) are taken either orally or topically followed by exposure to ultraviolet A (UVA) light. Commonly used psoralens are (8-methoxy psoralens or 4,5,8trimethyl psoralens).
b) Corticosteroids:These are used topically or orally depending upon the severity of the disease. They are also used to arrest the spread of the disease.
c) Immunomodulators:These drugs can be used in the maintenance phase of the disease. Commonly used immunomodulators are Tacrolimus, Pimecrolimus. They help in bringing back the colour and also help to control the spread of the disease. They can be safely applied over a long period of time. Levamisole is a non-specific immuno modulatory oral drug, which may help in controlling the spread of Vitiligo in some cases. It can be used in children too.
d) Narrow band UVB Phototheraphy:Narrow Band UVB for the treatment of Vitiligo has recently emerged as a promising therapy. It is the safest and most effective therapy for generalized Vitiligo. Best results are seen on the face and neck and in Vitiligo present for shorter duration.
It involves the delivery of specific wavelength of UVB- in a UVB chamber. Both adults and children can be treated with it. It has to be given 2-3 times per week. At least 10-15 sessions may be required before we see an appreciable result.
Targeted NB UVB Phototherapy: is a treatment of choice in patients with less than 30% body surface area involvement and the best treatment for children as the cumulative dose of radiation is very low.