A Family Doctor's Tale - VITILIGO

DOC I HAVE VITILIGO

Many patients with vitiligo are fearful that they have a serious condition because of the change of the color of their skin.

It is actually a auto-immune disorder which causes the loss of pigmentation in the cells of the skin.

A simple treatment is by camouflage with cosmetics.


Vitiligo is a skin disorder which presents as white spots or patches on the skin.

It is not contagious.

The cause of Vitiligo is not known.

However many people with Vitiligo may have associated auto immune disease including thyroid disease and pernicous anemia.

Autoimmune conditions are conditions where the body's own cells attack its cells (in this case the skin cells)

There is a progressive loss of the pigment melanin which gives us our skin color.

The loss of pigment occurs when the pigment cells (melanocytes) are destroyed and melanin cannot be produced.

Signs and symptoms of Vitiligo are:

1.white spots or patches on the skin

Common sites affected by Vitilgo are:

1.Bony surfaces - back of hands and fingers,elbows and knees

2.Body orifices - around the eyes, mouth and nose

3.Body folds - armpits and groins

Vitiligo may also occurs over an area of injury such as a cut or burn.

The hair in the vitilgo patch may be white in color.

Diagnosis of Vitiligo is made by:

1.typical white patches or spots

2.skin biopsy for microscopic examination.

There are different treatments for Vitiligo:

1.Corticosteroid creams
Corticosteroid creams are effective against small patches or spot of vitilgo but there may be side effects such as skin thinning.

2.Topical Immunodulators
Tacrolimus or pimecrolimus are topical immunodulators which work by:

1.modulating the immune attack against the melanocytes on the skin and

2.stimulating the functions of the melanocytes

3. UltraViolet Light Treatments

a.Psoralen photochemotherapy(PUVA)

PUVA is a combination treatment involving

1.the use of the drug Psoralen(P)

2.and then exposing the skin to UltraViolet A light(UVA)

hence the term PUVA.

Psoralen makes the skin temporarily sensitive to UVA which is part of natural sunlight.

Psoralen can be applied to the skin as a solution or ingested orally with subsequent exposure to ultraviolet light A.

Patient treated with PUVA may need to undergo treatment for 1 year for satisfactory results.

Use of PUVA may result in sunburn and blister fromation.

b.Narrowband UVB

Narrowband UltraViolet light B treatment does not require Psoralen tablets before treatment.

In fact this treatment is safer and as effective if not better than PUVA. Again treatment may require 1 year before satisfactory results.

c.Focused Multiple Wavelength UltraViolet Therapy(Multiclear)

This is a form of targeted light therapy as only the vitiligo areas are treated.

It is useful for small localised lesions.

d.Excimer Laser

This laser emits a certain UVB wavelength but is more costly than Multiclear Light therapy.

4.Surgery

Surgical transplants are meant for patients with stable vitligo that fail to respond to topical or phototherapy.

Stable vitiligo means no new lesions or progressive lesions for 12 to 24 months.

Surgery involve tissue and cellular grafting.

5.Camuoflage Cosmetics.

Cover up camouflage provides good color and camouflage of vitiligo lesions.

They are particularly useful for white patches on the face ansd back of the hands.

6.Sunscreens

Areas of vitiligo exposed to the sun are very prone to sunburn as they lack protective pigments.

Patients should always use broad spectrum sunsceens to protected the affected vitiligo areas.

Prognosis of Vitiligo is generally fair.

Treatment takes time and patience.

Preventive measures can be taken for Vitiligo:
1.Sunscreens

2.Proper skin care