What is vitiligo?
Vitiligo, often visible as white patches on the skin, is a condition of pigmentation disorder. When the cells that make pigment in the skin, called melanocytes, are destroyed white patches appear on the skin in various parts of the body. White patches also appear on both the mucous membranes that line the inside of the mouth and nose and the retina. As many as 65 million people the world over suffer from vitiligo.
How is Vitiligo caused?
There are different theories about the cause of vitiligo. The most common theory is that vitiligo is an autoimmune disease. Human bodies produce proteins called cytokines that, in vitiligo, alter their pigment-producing cells and cause these cells to die. Another theory is that people with vitiligo inherit a group of three genes that make them susceptible to de-pigmentation. Vitiligo may also be hereditary and may run in families.
What are the treatment options for vitiligo?
Various treatment options exist for vitiligo. Some involve topical applications while others are surgical options. Treatments administered topically are:
Topical steroid therapy:
White patches may be re-pigmented or removed with the help of steroid creams that are topically applied. This treatment is most helpful in the early stages of vitiligo. These creams are known to cause side effects and need to be monitored with care.
This therapy uses chemicals that react with ultraviolet light and cause darkening of the skin. Psoralen is ingested or applied topically and the area to be treated is exposed, for a specific time, to sunlight or ultraviolet light that comes from a special lamp. After the timed exposure, skin usually becomes pink and gradually darkens to match the surrounding skin. Two major potential side effects of this therapy are severe sunburn and blistering and too much darkening (hyper-pigmentation) of the treated patches or the normal skin surrounding the vitiligo.
De-pigmentation:Â De-pigmentation involves fading the rest of the skin on the body by application of a drug to match the areas that are already white. The major side effect of de-pigmentation therapy is inflammation (redness and swelling) of the skin, itching or dry skin. De-pigmentation is a permanent effect the area subjected to de-pigmentation will always be unusually sensitive to sunlight.
The main goal of treating vitiligo is to improve appearance. Therapy for vitiligo takes a long time-it usually must be continued for 6 to 18 months. The choice of therapy depends on the number of white patches; their location, sizes, and how widespread they are; and what you prefer in terms of treatment. Each patient responds differently to therapy, and a particular treatment may not work for everyone. Current treatment options for vitiligo include medication, surgery, and adjunctive therapies (used along with surgical or medical treatments).
Vitiligo can be treated surgically using the following methods:
Autologous skin grafts:
In this treatment, the doctor will remove normal or pigmented skin from one area of your body and graft or attach it to a de-pigmented area (where white patches appear). This type of skin grafting is sometimes used for patients with small patches of vitiligo. Scarring may occur after the grafting is performed. Such scars can be treated with various options and these may disappear over time.
This procedure is similar to tattooing which is normally done for fashion. The doctor will implant pigment on the white patch with the help of a surgical instrument. This treatment works best for patients with dark skin. However, sometimes it is difficult to match the tattoo perfectly to the colour of the surrounding skin and the tattooed are will not react to sunlight like the rest of the skin will. Tattooing may also fade over time.
Vitiligo or ‘white spot’ is not a medical disorder, yet has been frustrating to 1-3% of the population. It is characterized by areas of hypo or de-pigmentation on the skin surface due to destruction or loss of melanocytes. These are areas where the normal pigmentation of skin is missing or deficient. These spots can be many or few; they may be tiny or cover the body. While it is not a serious or life-threatening disorder, it has an impact on the social and psychological well-being of its victims. It can be localized or generalized, stable or spreading, childhood onset or adult onset.
Treatment options include phototherapies (UVA and UVB), 308nm excimer light and laser, immuno therapies and surgery. Skin City is the largest Vitiligo treatment center and has treated thousands of patients. Skin City has invented a new technique of Vitiligo mini skin grafting called ‘Cyanoacrylate lamination technique’. This research was accepted to present in an international conference of ASDS (American Society of Dermatology and Surgeons), Washington, 2011.
Who can undergo the treatment?
All vitiligo patients can undergo the treatment. However, patients with facial, neck, arm and trunk patches are ideal candidates for this treatment. Patients with old age, uncontrolled diabetes and those with involvement of >60% of body surface are discouraged from treatments.
Which Treatment is ideal?
No one treatment is ideal. Each individual treatment has their own benefits and disadvantages. The ideal treatment is combination of different modalities. This combination therapy is individualized depending upon the age, duration, type of vitiligo, area and extent of the disease.
Is the treatment permanent?
No treatment is necessarily permanent. Depending on the treatment, the remission period may vary. De-pigmentation of the treated area may not occur for a long period of time or in some cases the treatment can even be permanent.