What is vitiligo?: Vitiligo is a common skin disease appearing as white patches over the skin, affecting 1-3% of world population. It is an auto immune disease where the skin turns to white colour without any reason.
Skin colour is determined by colour producing cells called melanocytes. They produce melanin, which gives brown to black colour of the skin. Here in vitiligo skin there is loss of melanocytes leading to lack of brown colour.
Who gets vitiligo? : In India this disease is seen in one to three of every 100 people. About half the people who develop it do so before the age of 20.It is mentioned in the literatures that it is seen in same family in about 10-20% of vitiligo patients. But most of the times we see vitiligo in patients where none in the family are affected.
Why do you get vitiligo? : Here body develops antibody towards its own melanocytes, which destroys these cells, & its colour producing pigment-melanin, thereby producing white patches on the skin. How does this happen exactly is not known.
How does vitiligo look? : It appears as white patches over the skin. However, the degree of pigment loss can vary within each vitiligo patch. There may be different shades of pigment in a patch, or a border of darker skin may circle an area of light skin. It can appear anywhere. Mostly it affects, face, arms, legs, genitals. Sometimes the hairs over the white patches may turn to white.
How long will vitiligo continue? : It is an unpredictable, chronic disease lasting for years with periods of activity & in activity. In some, one or few white patches appear & later new patches may never appear again. These patches may remain stationary for months to years or may spread once in a while. It often begins with a rapid loss of pigment. This may continue until, for unknown reasons, the process stops. Cycles of pigment loss, followed by times where the pigment doesn’t change, may continue indefinitely. In some regimentation can appear in 30-50% % of the patches without any treatment.
What are the types of vitiligo? :
Segmental vitiligo: Here white patches appear on one side of the body along the course of the nerve.
Lip & Tip vitiligo: Affects only the lips, fingers, toes, & genital areas. Difficult to treat as the response to treatment is poor.
Generalized vitiligo : Affects all over the body, most common type.
Focal vitiligo: Here it appears as one or few spots on any part of the body. Response to treatment is excellent.
Some facts about vitiligo:
It is not a contagious disease that means it does not spread by contact, sex, clothing’s, articles etc.
It is a disease of the skin only, doesn’t affect any internal organs or general health.
It is not related to leprosy.
Food like citrus fruits (lemon etc), fish, curds do not aggravate vitiligo.
What are the aggravating factors for vitiligo? :
Vitiligo spreads along the line of injury & scratching.
It increases due to emotional stress.
Excessive sunlight can cause blisters over the exposed white patches.
Leucoderma: Here white patches appear over the skin due to physical or chemical injury or due to eczema. Skin looses its melanocytes due injury like burns, using sticker bindi, pvc chappal or due to chronic eczema & appears as white patches over that affected area only. This condition does not spread to other parts of the body.
Treatment for vitiligo:
Even though there is no single medicine to cure vitiligo, there are various modalities of treatment available to control vitiligo.
For few spots of white patches, topical steroid or tacrolimus or pimecrolimus creams are given.
This treatment can be combined with topical psoralen solution or with decapeptide solution, followed by sunlight exposure or Ultraviolet-A rays exposure in a closed chamber-Phototherapy.
When large areas are involved oral or injectable steroids are given along with, topical steroids & oral psoralen. Oral psoralen is given & patient is asked to exposure to sunlight or UVA rays in phototherapy chamber.
Topical PUVA Therapy: Here psoralen lotion or ointment is applied over the white patch, taking care not to spill over the normal skin. Half an hour later white patch is exposed to sunlight or UVA chambers. The end point of treatment is redness. It takes one to two minutes to become red, which is the end point of treatment. In UVA chambers the timings is calculated according to joules/cm2, which the UVA chamber technician will adjust the dosage (1-3 J/cm2). The lotion/ointment has to be removed by washing with soap & water after the treatment. This has to be continued on alternate days for few months until normal colour is obtained.
Oral PUVA Therapy: Here oral tablet of psoralen is consumed with food & after two hours the skin is exposed to sunlight or UVA chambers. The end point of treatment is redness. It takes 5-10 minutes to become red in sunlight. In UVA chambers it is given in dosage of 3-5 J/cm2. Time taken in UVA chambers is hardly few minutes.
Narrow Band UVB Therapy: Here skin is exposed to Narrow Band UVB rays without any oral medications. It is ideal & safe treatment for pregnant women & children. Starting dose is from 300mj/cm2. End point of treatment is redness.
Precautions to be taken during PUVA therapy:
For Vitiligo therapy best timing to expose to sun is: 8 to 10 am & 2 to 4 pm
Patient should strictly follow the recommended duration of sun exposure as advised by the doctor. Over exposure will produce reactions like burning sensation, scaling, and blisters.
During sun exposure or UVA therapy in chambers, eyes should be protected with cloth patti or uva blocking sun glasses (not ordinary dark glasses).
After the exposure the white patches should not be exposed to sunlight & covered by sunscreen lotions & thick clothes, scarf, dupatta, gloves, goggles, umbrella, hat or helmet, jacket etc. These precautions should be continued as long as PUVA therapy is taken.
If there is any itching, burning sensation or blister occurring during treatment, immediately stop the treatment & contact your doctor at the earliest.
If there is no sun such as on a rainy day there is no need to take the medication.
If it is cloudy you can still exposure to sun, may be you can increase the exposure timing to few minutes only.
White patches on the exposed areas can be masked by using water proof camouflage creams which can be worn for a day. These cosmetics will not change the course of the disease, but help in improving the appearance.
White skin, of vitiligo has no natural protection from sun. These areas are easily sunburned. These patients should wear a sunscreen with a SPF of at least 15 & it should be used on all areas of vitiligo, which are exposed to sun. Avoid the sun when it is most intense to avoid burns.
FDA in USA recommends that PUVA therapy should not be given to children below 12 years, as it can harm the lens of the eyes. It has shown that lens mature by the age 4 years. According to our experience, PUVA can be given to children above the age of 6 years safely. Eyes should be protected with B2 Torret glasses & regularly checked & monitored.
Surgical Treatment:
If the usual treatment fails, &, vitiligo is stable (that is no new patches appearing for the last one year), then skin grafting or micro pigmentation tattooing will cover the vitiligo patches.
Split skin grafting or mini punch grafting will cover small to large patches & give good cosmetic results. Here patient own skin is removed from the thigh or buttock & grafted over the affected white patches, under local anesthesia.
Melanocyte culture graft, keratinocyte-melanocyte culture graft, keratinocyte-melanocyte suspension are the other new surgical treatment available for stable vitiligo.
For some patients with extensive involvement, the most practical treatment for vitiligo is to remove remaining pigment from normal skin and make the whole body an even white color. This is done with a chemical called monobenzylether of hydroquinone. This therapy takes about a year to complete. The pigment removal is permanent.
Since exact cause is not known there is no cure for vitiligo at present. But there are many medicines & new surgical treatment available to control vitiligo.
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