What is vitiligo?
Vitiligo is a chronic skin disorder that
causes areas of skin to lose colour. It presents as depigmented patches.
It is a skin
disorder in which the skin loses its colour resulting in light or white
patches. Vitiligo is a disorder of skin pigmentation where patients
will lose the melanocytes responsible for the dark pigmentation. It may also occur when cells producing melanin
are destroyed or do not function properly. If vitiligo appears on
areas that have hair, the hair may also turn white. The disorder can also
cause hair to lose its pigment and turn white.
Melanin is a chemical, produced by the skin cells, which gives skin its
colour. Exposed body sites, such as the face, elbows, knees, hands and
feet, are often involved, resulting in significant cosmetic concerns. The
condition can affect people of any race but is more noticeable in people with darker
skin and hair.
General vitiligo is believed to be an autoimmune condition,
which means the immune system mistakenly attacks pigment-producing cells
(melanocytes). The condition
affects up to 2 per cent of the world's population.
Vitiligo is not contagious. But people are often concerned
when they see people with vitiligo on their hands. Vitiligo affects the
way the world interacts with you. It can be frustrating and embarrassing, and
for some, it leads to clinical depression and anxiety.
Treatment
The choice of vitiligo treatment depends on your age, how much skin is
involved and where, how quickly the disease is progressing, and how it's
affecting your life.
Treatments are available to help restore skin colour or even out skin tone, though results vary and are unpredictable. If you and your doctor decide to treat your condition with a drug, surgery or therapy, the process may take many months to judge its effectiveness. And you may have to try more than one approach or a combination of approaches before you find the best vitiligo treatment that works for you.
Medications
No drug can stop the process of vitiligo — the loss of pigment
cells (melanocytes). Some drugs, used in combination or with light therapy, can
help restore some skin tone but rarely.
Therapy Treatments:
Excimer Laser
It is a promising therapy in treatment
of localized vitiligo especially in children with rapid onset of repigmentation
as early as 3 sessions of treatment. The excimer laser produces
monochromatic rays at 308 nm to treat limited, stable patches
of vitiligo. This new treatment is an efficacious, safe, and
well-tolerated treatment for vitiligo. However, therapy is
expensive. Localized lesions of vitiligo are treated twice
weekly for average sessions depending on the patient’s
condition.
Stem Cell
Therapy
Mesenchymal
stem cells have been found to have Immunomodulatory and immunosuppressive
properties. Administration of mesenchymal stem cells in vitiligo will prevent
further damage to melanocytes and reduce the progression of the disease. Mesenchymal
stem cells also boost pigmentation over a period of time.
Light Therapy
Phototherapy with narrowband ultraviolet B (UVB) has been shown to stop
or slow the progression of active vitiligo. It might be more effective when
used with corticosteroids or calcineurin inhibitors. You'll need therapy two to
three times a week. It could take one to three months before you notice any
change, and it could take six months or longer to get the full effect.
Possible side effects of narrowband ultraviolet B therapy
include redness, itching and burning. These side effects usually clear up
within a few hours after treatment.
PUVA Light Therapy
This treatment combines a plant-derived substance called
psoralen with light therapy (photochemotherapy) to return colour to the
light patches. After you take psoralen by mouth or apply it to the affected
skin, you're exposed to ultraviolet A (UVA) light. This approach, while
effective, is more difficult to administer and has been replaced in many
practices by narrow-band UVB therapy.
Unconventional Treatment
Some vitamins, minerals, amino acids, and enzymes have been
reported to restore skin colour in people who have vitiligo. Most have not been studied, so there
is no evidence to support these treatments and no knowledge of possible side
effects. Ginkgo biloba, an herb, has been studied in a
clinical trial. Results from this trial indicate that the herb may restore skin
colour and stop vitiligo from worsening. In the ginkgo Biloba trial, 10 patients given ginkgo Biloba
had a noticeable or complete return of skin color. Two patients taking the
placebo (contains no active ingredient) also had a noticeable or complete return
of skin color.
Because some patients taking the placebo regained their skin
colour, more study is needed.
Depigmentation
This treatment removes the remaining pigment from the skin. Removing the remaining colour (depigmentation). This
therapy may be an option if your vitiligo is widespread and other treatments
haven't worked. A depigmenting agent is applied to unaffected areas of the skin.
This gradually lightens the skin so that it blends with the discoloured areas.
The therapy is done once or twice a day for nine months or longer.
Very few patients opt for this treatment. Removing the rest of the pigment
leaves a person with completely white skin. It may be an option for an adult who has little pigment left
and another treatment has not worked. Removing the remaining pigment can be an
effective way to even out the skin colour, giving the person white skin. Depigmentation can take 1 to 4 years.
Once treatment is finished, some people see spots of pigment
on their skin from being out in the sun. To get rid of these spots, you can use
the cream to remove this colour.
Surgery
If light therapy, laser, stem
cell therapy and
medications don’t work, some people with stable diseases may be candidates for surgery. The
following techniques are intended to even out skin tone by restoring colour.
- ∞ Skin grafting
- ∞ Blister Grafting
∞
Cellular Suspension Transplant
Vitiligo surgery is used in stable diseases, i.e., vitiligo
that did not progress over a period of 6–12 months. Segmental vitiligo
generally has better surgical outcomes than non-segmental vitiligo. The outcome also depends on body site, with surgical treatment of genitals, lips,
eyelids, and bony prominences particularly variable.
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