Skin Disorder : Vitiligo ( White Patch )
- Vitiligo[p] is a relatively common chronic disorder that causes depigmentation in patches of skin.
- It occurs when the melanocytes, the cells responsible for skin pigmentation which are derived from the neural crest, die or are unable to function. The precise pathogenesis, or cause, of vitiligo is complex and not yet fully understood.
Signs and symptoms :
- The most notable symptom of vitiligo is depigmentation of patches of skin that occurs on the extremities. Although patches are initially small in size, they can often start to enlarge and change shape.
- When skin lesions occur, they are most prominent on the face, hands and wrists. Depigmentation is particularly noticeable around body orifices, such as the mouth, eyes, nostrils, genitalia and umbilicus.
- Some lesions have a tendency to hyperpigment around the edges. In a more general sense, vitiligo is similar in appearance to leprosy.
- Patients who are stigmatised for their condition may experience depression and similar mood disorder.
Treatment:
1. The traditional treatment (if any) given by most dermatologists is corticosteroid cream.
2. Phototherapy may also be beneficial. Using exposure to long-wave ultraviolet (UVA) light from the sun or from UVA, together with Psoralen, called “PUVA”, or with UVB Narrowband lamps (without Psoralen), can help in many cases.
3. Alternatively, some people with vitiligo opt for chemical depigmentation, which uses 20% monobenzone (monobenzylether of hydroquinone). This process is irreversible and generally ends up with complete or mostly complete depigmentation.
Myths and Realities
MYTHS
- Vitiligo is rare and contagious
- All white patchesof the skin is vitiligo
- Vitiligo is similar to leprosy
- Vitiligo is 100% hereditary
- Vitiligo is caused/aggravated by sour foods fish and milk, or any other food Item
- Vitiligo is harmful internally
- Vitil igo spreads all over the body eventually and cannot be treated
- Vitiligo treatment by modern medicine (allopathy) is harmful and ineffective
REALITIES
- Vitiligo affects 2% of the population and is never contagious
- All umber of conditions other than vitiligo cause vrhite)light coloured patches such as white moles. injury. etc
- Vitiligo is only a cosmetic problem and is notrelated to leprosy
- Vittligo is hereditary in a small minority of cases
- There is no evidence to suggest this association
- Vitiligo does not cause any harm internally
- Vitiligo mostly remains localised and is treatable by medical or surgical modalities by a dermatologist
- Modern medicine provides the most safe and effective options for the treatment of vitiligo
Myths and Realities
What is vitiligo ?
• Vitiligo (leucoderma) is a common harmless cosmetic skin condition associated with white patches on the skin affecting 1-2% of the population, treated mostly for aesthetic reasons.
What causes vitiligo ?
• Vitiligo is caused by destruction of pigment bearing cells of the skin by as yet incompletely known mechanisms.
Which parts of the body are most commonly affected ?
• Though any part of the body may be involved, the most resistant cases involve the lips, hands and feet.
What are the treatment options in vitiligo ?
• Medical therapy includes the use of medications to stop the destruction of pigment bearing cells and bring back pigment to areas where it has been lost.
What are the means of stopping destruction of pigment bearing cells?
• This can be done by tablets and creams that prevent the body from destroying its pigment bearing cells. These are prescribed in generally harmless doses.
What are the means of bringing back pigment to areas where it has been lost?
• This is done by medical or surgical means. Tablet/lotion forms of psoralens are the most commonly used medications. This is generally combined with sun exposure or use of more specific Ultraviolet A in safe doses and under controlled conditions. Narrow band ultravolent B and the modalities in which psoralcns arc not required. Surgical modalities aim to introduce pigment bearing cells where they have been lost, from the patient’s own reservoir in other parts of the body.
When are surgical modalities restored to ?
This is mostly required in case medical thotapy is not able to brign back pigment to areas from where it has been lost. Certain areas of the body, such as the lips and tips of hands and feet & vitiligo affecting a segment of the body are comparatively resistant to medical therapy and raquire surgery more frequently.
Are all patients of vitiligo suitable candidates for surgery ?
• No. Patients are suitable for surgery if disease is stable (nut progressive with no new patches for one year). Medical treatment is usually necessary to stabilise vitiligo.
What are the surgical methods of treating vitiligo ?
• Surgical methods include taking skin grafts and placing them on prepared vitiligoius skin. This can he done by placing the tissue directly or after suitable preparation and culture. With the advent of culture methods, much larger areas of the body can be treated than was previously possible.
What is micropigmentaticm ?
• Micropigmentation or tattooing is a modality in which inert pigment (usually iron oxides) of colour matching the skin is introduced with needles. This is effective in certain areas of the body only.
Does vitiligo surgery involve a major operation ?
• No. The procedure is done under local anaesthesia and mostly does not take long. If done by a trained dermatologist, the rislc of cornpli cations is negligible.
How long does treatment of tiling take ?
• Medical treatment may take an average of 1.2 years. Following surgery, pigment conies hack in 2.3 months. However, medical treatment may need to be continued to achieve optimal results of surgery. Surgery for residual areas may also be necessary.
Is there any option for patients awaiting results of medical or surgical treatment or not interested in medical or surgical therapy ?
• Yes, cosmetic camouflage with colour the shade of the patient’s skin can be a good option. After application,vitiligo lesions are not discernible at all.
What are the options for patients who have lost most of their pigment from all over the body ?
• A chemical can be used to remove small residual islands of pigment leading to a more uniform colour. This takes upto a year.
Is there hope for all patients of vitiligo ?
• Yes. There is definitely hope and present modalities of treatment as well as research has offered undeniable hope to patients of vitiligo.