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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. Dr K.D.Aneja is now one of the founding directors of Tricity Institute of Plastic Surgery ( http://www.newcosmeticsurgery.com/ ). This state of art facility is in Chandigarh and provides plastic and cosmetic surgery services in India and also for people from abroad. The other two surgeons Dr. Ankur Sood & Dr. SS Makkar make up for the 30+ years of combined experience of the team.
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