Vitiligo & Leucoderma Treatment Cure


Brief Overview:

Vitiligo is a skin disease which results in loss of skin colour in patches. In this, depigmentation / hypopigmentation of a part/entire skin takes place. This is because the melanocytes which are the cells responsible for pigmentation of skin, die or are not capable of functioning. The rate and extent of colour loss from vitiligo is uncertain. The skin on any part of the body can get affected by Vitiligo. The other parts which are likely to get affected are – hair, the inside of the mouth and even the eyes.

Vitiligo

Vitiligo

All types of skin get affected with Vitiligo & Leucoderma, however it is more commonly observed in people with dark complexion. This condition is neither life-threatening nor contagious. It can be stressful or make you feel bad about yourself. When treated, the condition can’t be completely cured but there may be complete/partial improvement in the appearance of the skin. However, chances of recurrence always exist.

The cause of hypopigmentation disorders like Vitiligo or leucoderma is not known. Researchers have connoted, that it may be as a result of genetic, autoimmune, oxidative stress, neural or viral causes. The incidence is less than 5% all around the world.

There are two types of Vitiligo:

  • Idiopathic – When the cause is not known
  • Chemical – It occurs due to skin bleaching or other substances

Clinical Presentation:

Signs & symptoms:

  • The most striking feature of Vitiligo is patchy regions of skin that are depigmented (lost their pigment) which is most likely to occur in the extremities (hands, legs, etc).
  • These patches are tiny at first. They change in size and shape, as the time progresses.
  • The sites where the skin lesions are likely to appear first are face, hands and wrists.
  • Also, the pigmented lesions are likely to be observed around the body orifices viz. eyes, nostrils, mouth, genitalia and umbilicus (navel).
  • Some lesions are most pigmented at the boundaries.
  • Vitiligo is considered as a ‘social stigma’. Most of the times, the affected individuals are distinguished differently from the other members of the society. Such individuals may suffer from mood swings or even go into depression in the later stage.

Predisposing factors:

Non-segmental – In non-segmental vitiligo (NSV), the pigmented patches are located symmetrically over the skin. As time advances, new patches arrive and can be generalized over larger portions of the body or may be confined to a specific area. Vitiligo where little pigmented skin is left behind, which involves almost all body areas, is termed as Vitiligo universalis. NSV can come about in any age group.

NSV is further categorized as follows:

  • Generalized Vitiligo: Commonest of the variety, widely and haphazardly distributed regions of depigmentation.
  • Focal Vitiligo: Commonly seen in children. One or few patches are present in single area.
  • Acrofacial Vitiligo: Fingers and area surrounding the orifices
  • Universal Vitiligo: Depigmentation involving almost entire body
  • Mucosal Vitiligo: Only the mucous membranes get depigmented.

Segmental – Segmental Vitiligo (SV) varies in etiology, appearance and prevalence from associated illness. This generally affects the regions of the skin that are linked with dorsal roots from spine and is most of the times affecting only one side of the body. It spreads even more rapidly compared to the non-segmental variety, and when not treated, it is much more static/stable in advancement and not linked with auto-immune diseases. Segmental vitiligo responds wonderfully with topical treatment and is quite a manageable skin condition.

Certain facts about Vitiligo:

  • In vitiligo, the melanocytes (pigment cells) are obliterated in certain regions of the skin.
  • Though the exact cause for vitiligo is unknown, many researchers propose it to be an autoimmune disorder, wherein the body’s immune system attacks mistakenly and kills certain cells within the body.
  • Vitiligo has a tendency to run in families.
  • Vitiligo is at times linked with other clinical conditions, which includes Thyroid dysfunction – Hyperthyroidism/hypothyroidism (overactive/underactive thyroid gland), alopecia areata (baldness in patches), pernicious anaemia (decreased RBC count as a result of insufficient absorption of Vit. B12), adrenocortical insufficiency (adrnal gland fails to produce sufficient amount corticosteroids).
  • Vitiligo is a painless condition and does not have any notable health repercussions, but despite that, it may have emotional and psychological sequelae.
  • Certain medical treatments may reduce the intensity of the disorder, however, it can be really tough to cure.

Diagnosis:

  • Physical examination, clinical history and laboratory investigations – form the base on which the diagnosis can be made.
  • A Skin Specialist is most likely to suspect Vitiligo, if a patient comes up with white patches on the skin, especially non-exposed areas like hands, feet, arms and lips.
  • A significant family history of Vitiligo may be a benchmark in making the diagnosis.
  • Certain other important aspects include – presence of a rash, sunburn, or othe skin trauma which occurred at the site of vitiligo 2-3 months prior to depigmentation; physical illness or stress; and early graying of hair (before the age of 35).
  • In order to confirm the diagnosis, the dermatologist may ask to take a small sample of the affected skin to study under the microscope. In case of Vitiligo, the skin sample may manifest with complete absence of melanocytes (pigment-producing skin cells). Whereas, if inflamed skin cells are observed in the sample, it may be suggestive of another skin condition apart from Vitiligo.
  • In the early phase of the disease, Ultraviolet light (UVA or black light), Wood’s lamp can be helpful in identifying and assessing the efficacy of treatment – Skin with vitiligo, on exposure to black light, will glow yellow, green or blue. Whereas, a healthy skin will not show any reaction, when exposed to black light.

Treatment:

There are multiple treatment options available for Vitiligo such as application of steroids creams and the combination of UV light (ultraviolet) in combination with creams.

  • Phototherapy: The most common treatment involves exposing the skin to UVB light from UVB lamps. This can be carried out at home or at clinic. It is extremely essential to regulate the time of exposure so that the skin does not burn due to over exposure.

If these spots are present on the neck and face and if they have been existent since not more than 3 years, the treatment may take a few weeks. Whereas, if in case the spots are seen on the extremities and are present since 3 years and more, the treatment may require a few months to get completed. At home, the treatment carried out everyday; and at a clinic, it is done 2-3 times a week. Home treatments are said to be more effective.

If a large number of spots are present on the body, an extensive body treatment may be required to carry out in a clinic or hospital, wherein UVB broadband and UVB narrowband, both kinds of lamps can be used.

A combination treatment of Phototherapy with UVA (ultraviolet A) light along with a medical drug Psoralen (PUVA), may be beneficial. This treatment requires 6-12 months or even longer duration. The side effects include – sun-burns or skin freckling.

Narrowband ultraviolet B (UVB) is preferred to PUVA, as it is safer less detrimental a treatment. It is done everyday at home or twice a week at a clinic.

  • Immune mediators such as tacrolimus and pimecrolimus have shown tentative results.
  • Skin camouflage: De-pigmenting the affected skin with topical drugs such as monobenzone, mequinol or hydroquinone, in case of an extensive vitiligo. This kind of treatment may yield an even colour to the skin. Treatment with monobenzone is vigorous and permanent. Sun-safety must be advised for the lifetime in order to avoid risks like severe sun burn or melanomas. It takes about a year to complete de-pigmentation treatment.
  • Melanocyte Transplantation: A study was published successfully on Melanocyte Transplantation in October 1992. The methodology involved taking a thin layer of pigmented skin from the gluteal region of the affected individual. The melanocytes were then isolated in a cellular suspension which was expanded in culture. A dermabrader was applied to the recepient area and then melanocyte graft was applied. As per the study, about 70-85% people regained pigmentation on the skin. The endurance of pigmentation varied from individual to individual.
  • Eximer laser: This is the latest and a good option for smaller area involvement and can give excellent results.Multiple sessions are required to achieve the desired result.

In summary, Vitiligo is a skin condition that occurs as a result of complete absence of pigmentation in the affected areas. Since, it is considered to be a ‘social stigma’ it is extremely important for a Dermatologist to counsel the patient psychologically. Though the condition can’t be completely cured, there are variety of treatments available which may reduce the severity of the condition.

In summary, oiling is NOT good for hair! In fact, it causes dandruff and seborrhoea which in turn causes loss of hair. Oiling your hair 30-45 minutes prior to washing your hair is a good practice. Keeping your hair oiled overnight is just NOT advisable!

 Dr Rinky Kapoor- Best Cosmetic Dermatologist (Cosmetologist) in Mumbai, IndiaDr. Rinky Kapoor is a top/ Best dermatologistCosmetic DermatologistLaser Skin Expert Doctor, currently based in Mumbai, India. She has won many awards as the Best Dermatologist in India, Top 10 Skin Doctor in India, etc. She specializes in all skin diseases & conditions and given her training as a dermato-surgeon, provides non surgical liposuction surgery, laser lipo & lipoplasty etc for weight reduction & cellulite reduction. Dr. Rinky Kapoor is trained at the iconic National Skin Centre, Singapore and completed her Fellowship in Cosmetic Dermatology & Lasers at the world renowned Stanford University, USA.

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