Smooth white patches on various parts of the body caused by lack of natural pigment is known as vitiligo, and June 25th of 2011 the world vitiligo day was created to create awareness of this condition. Since then they have broadened their activities to handling bullying, social neglect, tremendous psychological trauma and disability.
Vitiligo is defined as a skin disorder characterized by smooth, white patches on various parts of the body, caused by the loss of the natural pigments.
There could be other symptoms, like
- Premature greying of the scalp, eyelashes, eyebrows,.
- Whitening or loss of colour of the mucous membrane inside the mouth.
- Loss of colour or colour change in the retina (eye)
Vitiligo can affect any part of the body, but de-pigmentation usually develops first on the areas of the skin like feet, arms, face and lips. The de-pigmentation could be
- Focal or limited to one or few areas of your body.
- Segmental Loss of skin colour usually on only one side of the body
- Generalized that is wide spread.
There is no definite age when it manifests, though in most cases 20-30 is the age when the patches begin either on the face above the eyes, or on the necks. Sometimes, armits, elbows, genitalia, hands or knees may be the first effected area. There is no gender or racial predilection seen.
When a person suffers from vitiligo there is no melanin in the skin, melanin is produced by the melancocytes and is responsible for the skin colour. The normal pigmented skin cells get replaced by flat cells, creating white patches with irregular borders.
Most vitiligo suffers are otherwise healthy and have normal skin texture and sensation. However people with autoimmune disorders like hypo or hyper thyroidism, Addison’s disease, Vitamin B12 deficiency seems to have greater incidence of vitiligo. Poor oral hygiene has be linked with incidence of Vitiligo.
The course of the disease is quite difficult to predicit from spontaneous regression; it can go to progressive spread. Vitiligo cannot be cured, it can only be managed. But it is not contagious and not painfully.
The goal of the treatment would be restore the skin pigmentation. Since treating any skin disease is long drawn process and impact of therapy may not be visible for several months. The various treatments available are.
- Topical steroids are quite effective in re-pigmentation however it takes almost about 3months before effects are seen. The steroid has to be applied three times daily on the skin. There could be adverse effects like thinning of the skin or streaks of colour on the skin.
- Topical immune-modulators are also prescribed. People with small areas of pigment loss on the face and neck see results with this.
- PUVA which is a combination of Psoralen which renders a person more sensitive to light and UVA rays are used to darken the light areas of skin. Psoralen could be either topical or oral. Since Psoralen renders the skin sensitive to light, the person also becomes more sensitive to sunlight so it is necessary to use sunscreens.
- De-pigmentation of the normal skin to match the white patches is done if other treatment procedures fail. This is considered only if more than half the body is affected by vitiligo. The medication used is called Monobenzone which is so potent that contact with other people should be avoided for at least two hours or they might land up getting bleached.
Non invasive management of vitiligo include make-up, skin products should ideally include UVA and UVB for protection from sunburns.
Surgery may be considered in very severe cases, skin from healthy area is taken and grafted the procedure is not only laborious it is also expensive and could cause tissue scaring. Most people with Vitiligo need lot of emotional support to deal with the chronic skin condition.
Studies are being carried out to stimulate melanocytes with a drug called afamelanotide, prostaglandin 2 is another component that is being tested and it is found useful when the vitiligo is localized. Oral Tofacitinib which is used in the treatment of rheumatoid arthritis has shown the potential to reverse colour loss.
Studies in alternative medicine has shown that Gingko Biloba could return skin colour, minor studies with alpha-lipoic acid, Folic acid, Vitamin C, Vitamin B12, and phototherapy could restore skin colour.
Hypnotherapy has proved helpful in many cases.
Vitiligo is non- infectious, whitening of the skin either locally or the entire body, it cannot be cured, but can be managed with medications and UVA therapy. In many cases hypnotherapy is known to help. Options like Gingko Biloba has also proved useful and more studies are conducted on it.