What is Vitiligo?


Vitiligo is a condition in which the pigment is lost from areas of the skin. It causes whitish patches. Sometimes occurs over large areas of the body. It occurs when melanocytes, the cells responsible for skin pigmentation, die or unable to function. Latest research also suggests that it may arise from autoimmune, genetic, oxidative stress, neural, or viral causes.


To whom Vitiligo happens?


Vitiligo affects at least 1% of the population. Even though most people with Vitiligo are in good general health, they face a greater risk of having hyperthyroidism or hypothyroidism, vitamin B12 deficiency, adrenal dysfunction, round patches of hair loss and or inflammation with the eyes. About 50% of all Vitiligo patients develop the disease in childhood/adolescence before the age of 20. Although largely similar to the disease in adults, childhood Vitiligo is a distinct subset of Vitiligo with a higher incidence of family history of autoimmune or endocrine diseases, early or premature graying.


What is cause of Vitiligo?


The cause of Vitiligo is not known, but there is strong evidence that people with Vitiligo inherit a group of three genes that make them susceptible to depigmentation. A combination of genetic, immunological and neurogenic factors is of major importance in most cases. Trauma of any kind (physical, mechanical, chemical, emotional) too can trigger off the disease process. Stress is often implicated as a trigger factor.


Is there a cure for Vitiligo?


Usually with continuous treatment and by doing a combination of treatments, a number of cases improve or clear. This may take a year or more. However there are certain stubborn areas like the tips of fingers and toes, lips, bony prominences that may take longer or not respond at all to treatment.


Medical Treatment :


A. Photo-chemotherapeutic treatment (PUVA Therapy) : In this photosensisting agents are taken either orally or topically followed by exposure to ultraviolet A (UVA) light. Commonly used psoralens are (8-methoxy psoralens or 4, 5,8trimethyl psoralens). Treatment is required twice a week for 6–12 months or longer. PUVA may cause side effects such as sunburn-type reactions or skin freckling.

B. Corticosteroids : These are used topically or orally depending upon the severity of the disease. They are often used as an attempt to check the spread of the disease.

C. Immunomodulators : These drugs can be used in the maintenance phase of the disease. Commonly used immunomodulators are Tacrolimus, Pimecrolimus. They help in bringing back the colour and also help to control the spread of the disease. They can be safely applied over a long period of time. Levamisole is a non-specific immuno modulatory oral drug, which may help in controlling the spread of Vitiligo in some cases. It can be used in children too.

D. Pseudo catalase : It is applied locally on the Vitiligo patch and is giving promising results.

E. Narrow band UVB Phototherapy : Narrowband UVB is now the most common form of phototherapy used to treat skin diseases. Narrow Band UVB for the treatment of Vitiligo has recently emerged as a promising therapy. It is the safest and most effective therapy for generalized Vitiligo. It involves the delivery of specific wavelength of UVB-311mm in a UVB chamber. Both adults and children can be treated with it. It has to be given 2-3 times per week. A minimum number of 15 to 20 sessions are required for optimal results. Patients attend two to five times weekly. The patient is placed in a specially designed cabinet containing fluorescent light tubes. The patient stands in the center of the cabinet, undressed except for underwear, and wears protective goggles. Usually the whole body is exposed to the UVB for a short time (seconds to minutes).

F. Targeted NB UVB Phototherapy : It is a variation of NB-UVB. In targeted phototherapy, the beam is focused only on areas affected by Vitiligo. It is a treatment of choice in patients with less than 30% body surface area involvement and the best treatment for children as the cumulative dose of radiation is very low and avoids needless exposure of uninvolved skin.

G. Monochromatic Excimer Laser : The xenon chloride gas ecximer laser offers a mean of delivering local monochromatic 308nm UV Phototherapy to the skin without photo thermal effects. Because the laser energy is delivered through a flexible hand piece, the adjacent normal skin is left untouched.

H. Excilite : It is a monochromatic Excimer light source (MEL @ 308nm) for fast treatment of Vitiligo. It is designed for the treatment of therapy resistant Vitiligo lesions on the skin and enables targeted exposure. It requires less time than other UV therapies including ecximer laser as it allows larger areas to be treated.

I. UVA/UVB Phototherapy : This allows delivery of light in the waveband of UVB and UVA 1(300-380nm) both to target and treat stubborn Vitiligo patches.

J. DE pigmenting agents : This treatment is reserved for patients in whom Vitiligo has affected 90% of the body and only a few dark patches of normal skin or areas of pigment remain. In such cases topical monobenzyl ether of hydroquinone is used to remove the color from the remaining pigmented areas in order to achieve a more uniform color.