Vitiligo Disease is a chronic disorder that causes depigmentation patches in skin. It occurs when the melanocytes, the cells responsible for skin pigmentation, die or are unable to function. The term Vitiligo is probably derived from the latin word Vitilus - meaning calf and was first used by roman physician Celsus of 1st century AD,The characteristics white patches of disease resembled the white patches of a spotted calf in India. Leukoderma is a generic name for relatively or absolutely lightened in colour.
vitiligo disease affects 1-2% of the population and affects both males and females of all races. Vitiligo can begin at any age although about fifty percent of people who have Vitiligo developed it before they turned 25. Vitiligo is more noticeable to people with darker skin color.
The cause of vitiligo disease is not known, but doctors and researchers have several different theories. There is strong evidence that people with vitiligo inherit a group of three genes that make them susceptible to depigmentation. The most widely accepted view is that the depigmentation occurs because vitiligo is an autoimmune disease-a disease in which a person's immune system reacts against the body's own organs or tissues. As such, people's bodies produce proteins called cytokines that alter their pigment-producing cells and cause these cells to die. Another theory is that melanocytes destroy themselves. Finally, some people have reported that a single event such as sunburn or emotional distress triggered vitiligo; however, these events have not been scientifically proven as causes of vitiligo.
Vitiligo disease is characterised by the appearance of depigmented patches(milky white) on the skin, common in sun exposed areas like hands, feet, arms, face and lips. Other common areas include armpits, groin, around the mouth, eyes, nostrils, navel and genitals. Rarely the patches show slight erythema, but as a rule they show only depigmentation and sensivity to light, the hair may be white or black but in a particular lesion, when hairy areas are involved the hair may turn white.
Vitiligo generally appears in one of the three patterns:
Clinical Examination: Depigmented patch is usually the diagnostic features of Vitiligo disease. There may be a predisposing history of a rash/sunburn or trauma at the site of patch 2-3 months prior to the onset or History of auto-immune disease in the family. A biopsy of affected skin confirms Vitiligo.
Sometimes the best treatment for vitiligo is no treatment at all. In fair-skinned individuals, avoiding tanning of normal skin can make areas of vitiligo almost unnoticeable because the (no pigment) white skin, of vitiligo has no natural protection from sun. These areas are easily sunburned, and people with vitiligo have an increased risk to skin cancer. They should wear a sunscreen with a SPF of at least 30 should be used on all areas of vitiligo not covered by clothing. Avoid the sun when it is most intense to avoid burns.
Disguising vitiligo with make-up, self-tanning compounds or dyes is a safe, easy way to make it less noticeable. Waterproof cosmetics to match almost all skin colors are available. Stains that dye the skin can be used to color the white patches to more closely match normal skin color. These stains gradually wear off. Self-tanning compounds contain a chemical called dihydroxyacetone that does not need melanocytes to make the skin a tan color. The color from self-tanning creams also slowly wears off. None of these change the disease, but they can improve appearance. Micropigmentation tatooing of small areas may be helpful.
If sunscreens and cover-ups are not satisfactory, your doctor may recommend other treatment. Treatment can be aimed at returning normal pigment (re-pigmentation) or destroying remaining pigment (depigmentation). None of the re-pigmentation methods are permanent cures.
Treatment of Vitiligo Disease in Children
Aggressive treatment is generally not used in children. Sunscreen and cover-up measures are usually the best treatments. Topical corticosteroids can also be used, but must be monitored. PUVA is usually not recommended until after age 12, and then the risks and benefits of this treatment must be carefully weighed.
Topical Corticosteroids — Creams containing corticosteroid compounds can be effective in returning pigment to small areas of vitiligo disease. These can be used along with other treatments. These agents can thin the skin or even cause stretch marks in certain areas. They should be used under your dermatologist's care.
PUVA is a form of repigmentation therapy where a type of medication known as psoralen is used. This chemical makes the skin very sensitive to light. Then the skin is treated with a special type of ultraviolet light call UVA. Sometimes, when vitiligo is limited to a few small areas, psoralens can be applied to the vitiligo areas before UVA treatments. Usually, however, psoralens are given in pill form. Treatment with PUVA has a 50 to 70% chance of returning color on the face, trunk, and upper arms and upper legs. Hands and feet respond very poorly. Usually at least a year of twice weekly treatments are required. PUVA must be given under close supervision by your dermatologist. Side effects of PUVA include sunburn-type reactions. When used long-term, freckling of the skin may result and there is an increased risk of skin cancer. Because psoralens also make the eyes more sensitive to light, UVA blocking eyeglasses must be worn from the time of exposure to psoralen until sunset that day to prevent an increased risk of cataracts. PUVA is not usually used in children under the age of 12, in pregnant or breast feeding women, or in individuals with certain medical conditions.
Narrow Band UVB (NBUVB)
This is a form of photo-therapy that requires the skin to be treated two, sometimes three, times a week for a few months. At this time this form of treatment is not widely available. It may be especially useful in treating children with vitiligo disease.
Transfer of skin from normal to white areas is useful for only a small group of vitiligo patients. It does not generally result in total return of pigment in treated areas.
Other Treatment Options
Other treatment options include a new topical class of drugs called immunomodulators. Due to their safety profile they may be useful in treating eyelids and children. Excimer lasers may be tried as well.
For some patients with extensive involvement, the most practical treatment for vitiligo disease 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.