Vitiligo

What is Vitiligo? 
Vitiligo is a pigmentation disorder in which melanocytes (the cells that make pigment) in the skin are destroyed. As a result, white patches appear on the skin in different parts of the body, the mucous membranes (tissues that line the inside of the mouth and nose), and the retina (inner layer of the eyeball). The hair that grows on areas affected by vitiligo sometimes turns white.

What is the cause?                                 
The cause of vitiligo is not known.

There is strong evidence that people with vitiligo inherit a group of three genes that     make them susceptible to depigmentation.

The most widely accepted view is that the depigmentation occurs because vitiligo is an    autoimmune disease-a disease in which a person's immune system reacts against the    body's own organs or tissues. 

Another theory is that melanocytes destroy themselves.

Finally, some people have reported that a single event such as sunburn or emotional    distress triggered vitiligo.

Who is at risk?  
About 0.5 to 1 percent of the world's population has vitiligo.  Half the people who have vitiligo develop it before age 20; most develop it before their 40th birthday.  Vitiligo seems to be somewhat more common in people with certain autoimmune diseases. These autoimmune diseases include hyperthyroidism (an overactive thyroid gland), adrenocortical insufficiency (the adrenal gland does not produce enough of the hormone called corticosteroid), alopecia areata (patches of baldness), and pernicious anemia (a low level of red blood cells caused by the failure of the body to absorb vitamin B12).

Vitiligo may also be hereditary.30 percent of people with vitiligo have a family member with the disease.

What are the symptoms of vitiligo?
People who develop vitiligo usually first notice white patches (depigmentation) on their skin.

Vitiligo generally appears in one of three patterns:

Focal pattern-the depigmentation is limited to one or only a few areas

Segmental pattern- depigmented patches develop on only one side of the body

Generalized pattern- the most common pattern. Depigmentation occurs symmetrically on    both sides of the body.

In addition to white patches on the skin, people with vitiligo may have premature graying of the scalp hair, eyelashes, eyebrows, and beard.

How is vitiligo diagnosed?   
Physical examination reveals white patches of skin on the body-particularly on sun-exposed areas, including the hands, feet, arms, face, and lips.

Important factors in the diagnosis include a family history of vitiligo; a rash, sunburn, or other skin trauma at the site of vitiligo 2 to 3 months before depigmentation started; stress or physical illness; and premature (before age 35) graying of the hair.

A biopsy of the affected skin will usually show a complete absence of pigment-producing melanocytes.

Because vitiligo may be associated with pernicious anemia or hyperthyroidism check the blood-cell count and thyroid function.

For some patients, the doctor may recommend an eye examination to check for uveitis (inflammation of part of the eye), which sometimes occurs with vitiligo.

What treatment options are available?          
Therapy for vitiligo takes a long time-it usually must be continued for 6 to 18 months. The choice of therapy depends on the number of white patches; their location, sizes, and how widespread they are; and what you prefer in terms of treatment. Each patient responds differently to therapy, and a particular treatment may not work for everyone. Current treatment options for vitiligo include medical, surgical, and adjunctive therapies.

Medical therapies

Topical Psoralen photo chemotherapy

Oral Psoralen photo chemotherapy

Depigmentation - this treatment involves fading the rest of the skin on the body to match    the areas that are already white. For people who have vitiligo on more than 50 percent of    their bodies, depigmentation may be the best treatment option.                                                                                                                                                            Surgical therapies                                                                                                                                                                                                                                     They are appropriate only for carefully selected patients who have vitiligo that has been stable for at least 3 years:

1. Autologous skin grafts—The doctor removes skin from one area of your body and attaches it to another area. 

2. Skin grafts using blisters—The doctor creates blisters on your pigmented skin by using heat, suction, or freezing cold. The tops of the blisters are then cut out and transplanted to a depigmented skin area.

3. Micro pigmentation (tattooing)—This procedure involves implanting pigment into the skin with a special surgical instrument. This procedure works best for the lip area, particularly in people with dark skin. However, it is difficult for the doctor to match perfectly the color of the skin of the surrounding area.

4. Autologous melanocyte transplants—In this procedure, the doctor takes a sample of your normal pigmented skin and places it in a laboratory dish containing a special cell-culture solution to grow melanocytes. When the melanocytes in the culture solution have multiplied, the doctor transplants them to your depigmented skin patches.

                                                                                                                              Additional therapies

Sunscreens, Cosmetic camouflage, Counseling and support groups. Eximer laser 318 nm has been found to be effective in treating localized stable vitiligo especially of the hair bearing areas.