Vitiligo also known as leucoderma, simply means white (leuco), skin
(derma); i.e. a disorder where the skin loses its normal color. The
typical appearance of vitiligo is milky white de-pigmented spots. It has
a tendency to start as a single spot and gradually grow in size and
number. Melanin is the pigment that gives the skin its characteristic
color. Vitiligo is caused by a loss of pigment in the skin, due to
destruction of pigment-forming cells known as melanocytes. Patients who
are stigmatized for their condition may experience depression and
similar mood disorders.
The actual causes of vitiligo are not completely known and are still
to be explored. Children whose parents have the disorder are more likely
to develop vitiligo. People with leukoderma may have premature graying
of the scalp hair, eyelashes, eyebrows, and beard.
Vitiligo generally appears in one of three patterns:
1. Focal pattern - depigmentation is limited to one or only a few areas
2. Segmental pattern - depigmented patches develop on only one side of the body
3. Generalized pattern - most common. Depigmentation occurs symmetrically on both sides of the body
There are a number of ways to alter the appearance of vitiligo. The
choice of therapy depends on the number, location and sizes of white
patches. The treatment options can be categorized under medical,
surgical, and adjunctive therapies.
MEDICAL
1. Psoralen photochemotherapy or PUVA therapy: Psoralen is a drug
that contains chemicals that react with ultraviolet light to cause
darkening of the skin. Psoralen can be taken by mouth (orally) or
applying it to the skin (topically).
a. Topical psoralen photochemotherapy: used for people with a small
number of depigmented patches affecting a limited part of the body.
b. Oral psoralen photochemotherapy: used for people with extensive
vitiligo ( more than 20 percent of the body) or for people who do not
respond to topical PUVA therapy.
2. Topical Steroid Therapy: Steriod creams are the simplest and safest treatment for vitiligo.
3. Lately, UVB narrowband has replaced PUVA since this treatment does
not involve Psoralen.The effect of the UVB narrowband lamp is
sufficient.
4. Depigmentation: It involves fading the rest of the skin on the
body to match the areas that are already white. It is recommended for
people who have vitiligo on more than 70% of their bodies.
SURGICAL - Autologous Skin grafts- Melanocytic Transfer-Suction Blister Epidermal Grafts
These are recommended for patients whose vitiligo has remained stable
for at least 2 years. The plastic surgeon first abrades the superficial
layer of the skin of white patches. Then very very thin skin grafts are
harvested from the thighs by grafting handle or suction blisters. The
skin grafts are then applied to the abraded areas.
The melanin producing cells of the skin graft start producing
pigmentation at the new areas, thus giving a natural result. Surgical
treatment is not recommended for patients who lose color (pigment) when
they suffer a small cut or scrape.
ADDITIONAL THERAPIES
• Cosmetics
• Sunscreens
• Tattoing
The author (Dr K.D.Aneja) is a leading plastic surgeon based at
Chandigarh, India. He has treated many patients of vitiligo with
excellent results. he can be contacted at
tips@newcosmeticsurgery.com or 9876611404.
by Jonathan Peters