Vitiligo

Vitiligo 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-risk

Vitiligo 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.
Vitiligo

Causes

The 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.

Treatment

Treatment 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.

Medical treatment:

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.

e) Excimer Laser:

The xenon chloride gas ecximer laser offers delivering local monochromatic 308nm UV Phototherapy to the skin without photo thermal effects, the adjacent normal skin is left untouched,as only affected area is treated.

f) Depigmenting agents:

This treatment is reserved for patients in whom Vitiligo has affected 90% of the body and only a few dark patches of normal skin or areas of pigment remain. In such cases topical monobenzyl ether of hydroquinone is used to remove the colour from the remaining pigmented areas in order to achieve a more uniform colour.

Surgical treatment

Different techniques such as surgical excision, dermabrassion, tattooing, punch grafting, split skin Grafting and transplantation of invitro cultured epidermis-bearing melanocytes, it is reserved for stable cases with few localized stubborn patches.

Frequently Asked Questions

Is Vitiligo contagious?

No, Vitiligo does not spread from one person to the other.

Does diet have any role in Vitiligo?

There is no strong evidence to suggest the role of any dietary substance in the cause or spread of vitilgo. Except recent evidence does show that turmeric may have a role in it,so patients can be advised to cut down on turmeric.

Is Vitiligo and Leucoderma the same thing?

Vitiligo is the dermatological term used. Leucoderma broadly means white patches and could be due to reasons other than Vitiligo. Vitiligo is the dermatological term for white patches for autoimmune origin.

Does stress worsen or trigger Vitiligo?

Stress has been scientifically proven through various studies as a trigger.

Is there any way of preventing new lesions?

Patients should always protect their skin against excessive sun exposure. Vitiligo patients must avoid wearing artificial jewellery containing nickel, cobalt and other metals. Plastic slippers, bindies, hair dyes, fragrance can induce chemical Leucoderma. Patients should protect themselves against injury and friction on the skin. Vitiligo patients must also not wear tight clothes.

Is there a cure for Vitiligo?

Usually with continuous treatment and by doing a combination of treatments, a number of cases improve or clear. This may take at least a year. However there are certain areas like the tips of fingers and toes, lips, bony prominences that may take longer or may not respond to treatments. These are usually hairless areas and do not repigment as well.

What is the future of Vitiligo?

There is a lot of research going on regarding Vitiligo. "Stem Cell" therapy may change the way Vitiligo is treated. In future,we might get better immunomdulators as its an auto immune disease.