Vitiligo is a disorder characterized by appearance of white patches on various parts of the body. Vitiligo is an autoimmune disorder where the melanocytes which are the pigment producing cells in our skin are damaged. The exact cause for vitiligo is not known but several factors play an important role like genetic factors, stress, exposure to various chemicals etc.
Vitiligo is associated with lot of stigma, as colour forms an important part of appearance of an individual. Most of the stigma associated with vitiligo is unfortunate as it’s a simple non-contagious disorder. Patient suffering from vitiligo suffer from a severe depression and withdraw themselves from the society. This stress regarding the disease itself can cause worsening of vitiligo.
Vitiligo rarely can be associated with other autoimmune disorders like thyroid disorders, pernicious anaemia, alopecia areata etc. Vitiligo usually has an onset in 2nd to 3rd decades of life. The childhood vitiligo is also not very uncommon. The onset is most often related with a stressful event like loss of parent, loss of job etc.
Vitiligo appears as several clinical forms like
1. Focal vitiligo – appears as few white patches
2. Generalized vitiligo – where there is appearance of white patches all over body
3. Universal vitiligo – where almost entire colour the skin is lost
4. Segmental vitiligo – appears as localized white patches on one side of the body
5. Lip-Tip vitiligo – appears as white patches on lips and surrounding mouth and tip of fingers
In some of the cases the hair in the white patches can also become white. The characteristic feature of white patches in vitiligo is that the texture of the skin is entirely normal. The diagnosis of vitiligo is almost always clinical, rarely are some investigations required.
Treatment options for vitiligo are plenty, but as it is a chronic disease the treatment is prolonged and it may require treatment for 1-2 years, depending on the response. The various medical options for vitiligo include
1. For localized vitiligo – steroid ointments may be helpful or topical psoralen ointment or lotions can be used followed by exposure to sunlight.
2. For generalized vitiligo – systemic psoralens given with UVA or Sunlight is helpful. A good therapeutic option is Narrow-band UVB, with which the response is good and can be used in children. This phototherapy is given for 2-3 times/week and need to be continued for 3-6 months depending on the tolerance of the individual. It is a safe treatment without much adverse effects. For a vitiligo that is unstable and spreading a course of oral steroids for few weeks may be required to stabilise the disease.
3. Segmental vitiligo – doesn’t respond that well to treatment and is a very stable disease. Surgical management is a good option for segmental vitiligo.
4. Lip-tip vitiligo – It responds poorly to the medical line of treatment, surgical management is a good option provided the disease is stable.
5. Newer medical line of treatment includes use of immunomodulator creams like Tacrolimus, pimecrolimus. Beta-fibroblast growth factor lotion, lotion containing pseudocatalase and other enzymes. Excimer lasers can be used in management of vitiligo.
6. Diet – diet has no major influence on the course of vitiligo. But it is recommended that the patient reduces the intake of sour foods like lemon, orange, tomatoes etc.
7. Camouflaging with permanent make-up, tattoos can be used.
8. Advise for the patients suffering with vitiligo
Ø Have a positive attitude, don’t get depressed vitiligo can be treated
Ø Consult a good dermatologist, have patience as the treatment may be prolonged and in early part the response may not be dramatic
Ø Avoid injuries as vitiligo can develop at site of any types of trauma
Ø If the disease is widespread and sun exposed area is involved use a broad spectrum sunscreen to protect the skin.
Ø Follow the advice given by your doctor.
9. Surgical options for management of vitiligo require the disease to be stable. The type of procedure used depends on the shape of the patch, site and size. The various options used are
Ø Split-thickness skin grafting
Ø Miniature punch grafting
Ø Suction-blister grafting
Ø Melanocyte transplantation
Ø Dermabrasion
Ø Needling
Vitiligo is associated with lot of stigma, as colour forms an important part of appearance of an individual. Most of the stigma associated with vitiligo is unfortunate as it’s a simple non-contagious disorder. Patient suffering from vitiligo suffer from a severe depression and withdraw themselves from the society. This stress regarding the disease itself can cause worsening of vitiligo.
Vitiligo rarely can be associated with other autoimmune disorders like thyroid disorders, pernicious anaemia, alopecia areata etc. Vitiligo usually has an onset in 2nd to 3rd decades of life. The childhood vitiligo is also not very uncommon. The onset is most often related with a stressful event like loss of parent, loss of job etc.
Vitiligo appears as several clinical forms like
1. Focal vitiligo – appears as few white patches
2. Generalized vitiligo – where there is appearance of white patches all over body
3. Universal vitiligo – where almost entire colour the skin is lost
4. Segmental vitiligo – appears as localized white patches on one side of the body
5. Lip-Tip vitiligo – appears as white patches on lips and surrounding mouth and tip of fingers
In some of the cases the hair in the white patches can also become white. The characteristic feature of white patches in vitiligo is that the texture of the skin is entirely normal. The diagnosis of vitiligo is almost always clinical, rarely are some investigations required.
Treatment options for vitiligo are plenty, but as it is a chronic disease the treatment is prolonged and it may require treatment for 1-2 years, depending on the response. The various medical options for vitiligo include
1. For localized vitiligo – steroid ointments may be helpful or topical psoralen ointment or lotions can be used followed by exposure to sunlight.
2. For generalized vitiligo – systemic psoralens given with UVA or Sunlight is helpful. A good therapeutic option is Narrow-band UVB, with which the response is good and can be used in children. This phototherapy is given for 2-3 times/week and need to be continued for 3-6 months depending on the tolerance of the individual. It is a safe treatment without much adverse effects. For a vitiligo that is unstable and spreading a course of oral steroids for few weeks may be required to stabilise the disease.
3. Segmental vitiligo – doesn’t respond that well to treatment and is a very stable disease. Surgical management is a good option for segmental vitiligo.
4. Lip-tip vitiligo – It responds poorly to the medical line of treatment, surgical management is a good option provided the disease is stable.
5. Newer medical line of treatment includes use of immunomodulator creams like Tacrolimus, pimecrolimus. Beta-fibroblast growth factor lotion, lotion containing pseudocatalase and other enzymes. Excimer lasers can be used in management of vitiligo.
6. Diet – diet has no major influence on the course of vitiligo. But it is recommended that the patient reduces the intake of sour foods like lemon, orange, tomatoes etc.
7. Camouflaging with permanent make-up, tattoos can be used.
8. Advise for the patients suffering with vitiligo
Ø Have a positive attitude, don’t get depressed vitiligo can be treated
Ø Consult a good dermatologist, have patience as the treatment may be prolonged and in early part the response may not be dramatic
Ø Avoid injuries as vitiligo can develop at site of any types of trauma
Ø If the disease is widespread and sun exposed area is involved use a broad spectrum sunscreen to protect the skin.
Ø Follow the advice given by your doctor.
9. Surgical options for management of vitiligo require the disease to be stable. The type of procedure used depends on the shape of the patch, site and size. The various options used are
Ø Split-thickness skin grafting
Ø Miniature punch grafting
Ø Suction-blister grafting
Ø Melanocyte transplantation
Ø Dermabrasion
Ø Needling
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