What is Vitiligo?
Vitiligo is a skin condition where the skin loses its pigments in certain areas, forming light coloured patches amongst normal skin. The patches that lose their colour become white, with defined margins and shapes.
What is the cause?
Vitiligo happens because the skin’s cells that make the pigment melanin (which gives the skin its colour) are destroyed. The cells are called melanocytes and they produce melanin, the colouring pigment. Vitiligo can appear anywhere on the skin, including the face, neck, arms etc and also affect the mucous membrane and the eye. In rare cases, vitiligo can even cause patches of hair to become white, or affect the inside of the mouth because the pigment cells work here too.
There are no definite clear causes of vitiligo. But most dermatologists agree that the immune system itself is a main cause. Dermatologists classify vitiligo as an autoimmune disease – that is, the immune system mistakenly attacks some part of the body thinking it is harmful. Vitiligo is probably caused when the immune system destroys the melanocytes in the skin.
The second major cause is genetics. Vitiligo can be caused by genes being passed on. Other random causes like sunburn (causes melanocytes to destroy themselves) or emotional stress can weaken the immune system, causing vitiligo.
Who are more prone to vitiligo?
Vitiligo can affect people from any race, age or ethnicity. But it is more noticeable in people with dark skin. People with other autoimmune diseases, diabetes or thyroid disorders are also more likely to get vitiligo. The disease also has a genetic cause. There is no conclusive proof linking any of this but these are results of case studies.
Why does vitiligo need dermatologist intervention?
Vitiligo is neither fatal nor contagious. But it can have various emotional and physiological ramifications. The blatantly visible skin abnormality can make the patient shy away from human interaction for the fear of ostracising. Since vitiligo affects a person’s skin without much pain or other damage, it is considered a cosmetic problem, affecting only their looks. But the underlying cause for vitiligo (the body attacking its own melanocytes and colouring pigments) clearly makes it a medical condition.
A dermatologist can give an accurate diagnosis and confirm the presence of vitiligo. They can also offer suggestions and treatment methods to cope with the various side effects and issues that might arise.
What are the symptoms?
The first major symptom of vitiligo is the presence of white patches in the skin. This symptom occurs due to the areas being depigmented and it usually is shown in the extremities. The next major symptom is the occurrence of skin lesions, more prominent in hands and wrists and then other areas. The first symptoms of vitiligo often occur in those places exposed to the sun. Some uncommon but definitive symptoms include hair turning gray prematurely. Dark skinned people might also notice a symptom where there is loss of colour inside their mouths. In some cases, it remains localised to one or two areas and in other cases it may rapidly spread all over the body. It can occur at any age.
How is it diagnosed?
Dermatologists use a combination of medical history and physical examination to detect and diagnose vitiligo. They analyse family history or presence of vitiligo and other autoimmune diseases. Dermatologists also do a past analysis about presence of rashes, sunburns or other skin problems including premature greying. Skin biopsy and woods lamp examination aid diagnosis in difficult cases.
The physical examinations include checking the extent of vitiligo and how it has developed. Based on the number of white patches and how widespread they are, the dermatologists discuss the treatment methods with the patient. Dermatologists also advise against possible side effects.
What are the treatment methods?
There are various treatment methods available for vitiligo including medical, surgical and other options. The response to treatment varies widely and therapies which work on one person may not work in another, the time of response may vary, and the extent also. In general patches on lips, fingers and feet respond poorly.
The use of medicines – both as creams and for intake, usage of ultraviolet (UVA) and UVB light are considered treatment methods. In cases, the colour from the surrounding areas is also evened to match the white patches by tattooing.
Laser therapy can be used to remove limited stable patches of vitiligo. Systemic phototherapy is used for repigmentation in the early stages of the disease.
Surgical treatments include skin grafting using the healthy tissues from other parts of the body and attaching it to the places with vitiligo. It can be performed only if the patches have been stable for 2 years or more. If the area is smaller, it can be covered up by tattoos. Epidermal suspension, melanocyte culture and non culture transplants and punch mini grafting can also be considered treatment methods.
In case the medical and surgical treatments either are not acceptable or difficult to do, cosmetic makeup to cover up vitiligo is considered a good option. This includes usage of sunscreens and dyes to cover the white patches and avoid the sunburns on the extra sensitive skin.
Vitiligo has no known cure to completely eradicate the disease but the medications are constantly being improved and advances in surgery are giving better results. Dermatologists treat vitiligo and its associated side effects by all means available. Undergoing treatment for vitiligo in the early stages can prevent complications such as eye problems and other autoimmune diseases developing unawares.
For more information: http://skindoctorIndia.com/common-dermatologic-problems/vitiligo/
Dr. Rinky Kapoor, co founder of The Esthetic Clinic, Mumbai, India is one of India’s renowned dermatologists, cosmetologist and dermato- surgeon. She specialises in all types of skin diseases and strives to treat them effectively using a different combination of surgical and non surgical procedures. She is associated with the Fortis Hospitals, Mumbai, India.