Vitiligo is a skin disease that causes the loss of pigment (color) from areas of skin resulting in irregular white patches. The extent and rate of color loss from vitiligo is unpredictable. It can affect the skin on any part of your body. It may also affect hair, the inside of the mouth and even the eyes. Actual cause is unknown but it is thought to be due to an autoimmune problem where immune cells destroy the cells that produce skin pigment (melanocytes). Vitiligo does not cause any problem to health, but its appearance is a taboo or stigma for our society. Treatment for vitiligo may improve the appearance of the affected skin but does not cure the disease. Vitiligo can start at any age, but most often appears before age 20.
What Treatment Options Are Available?
The main goal of treating vitiligo is to reduce the contrast in color between affected and unaffected skin. The choice of therapy depends on the number of white patches; their location, sizes, and how widespread they are. Each patient responds differently to therapy, and a particular treatment may not work for everyone. Current treatment options for vitiligo include medication, surgery, and adjunctive therapies (used along with surgical or medical treatments).
A number of medical therapies, most of which are applied topically, can reduce the appearance of vitiligo. It is useful in early stages. Topical therapy. Creams, including corticosteroids, may be helpful in repigmenting (returning the color to) white patches, particularly if they are applied in the initial stages of the disease.
Light treatment. Light therapy or excimer laser treatments are also used to treat vitiligo, although results may not be permanent. Phototherapy, a medical procedure in which your skin is carefully exposed to controlled ultraviolet light. Phototherapy may be given alone, or after you take a drug that makes your skin sensitive to light.
Psoralen photochemotherapy. Also known as psoralen and ultraviolet A (PUVA) therapy, this is an effective treatment for many patients. PUVA therapy enhances skin re-pigmentation. An oral psoralen compound is given to the patient. Two hours later, the de-pigmented patch on his body is exposed to ultraviolet-A (UVA) rays, for a fixed time duration.
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 recommended.
Surgical Therapies- Surgical techniques may be an option when topical creams and light therapy do not work. These include:
Miniature punch grafting. Multiple thin grafts of 2 - 2.5 mm diameter are taken from the donor site by special punches and grafted on to the dermabraded white patch. Once the grafts are 'taken up' the patient is advised to take PUVA or PUVA SOL. Re pigmentation occurs in 3 - 6 months and good cosmetic result is obtained.
Ultra thin skin grafting. The white portion of skin is dermabraded or laser ablated very superficially and a very thin skin graft (ultra thin) consisting of epidermis is grafted onto the part of stable vitiligo. A very thin skin graft (ultra thin) consisting of epidermis is grafted onto the part of stable vitiligo. This is the most satisfactory method of treatment of vitiligo, but vitiligo must be stabled for at least 2 years for any surgical treatment to be useful or effective. The graft falls off by 8 -10 days but there takes place a cellular uptake of melanocytes on to the abraded skin which gradually starts pigmenting, it takes 8-10 weeks for the pigmentation to merge and match with the surrounding skin color.
Suction blister grafting. A prolonged suction is applied to the graft donor site this raises a large blister and a thin graft containing only the epidermis is obtained. This is grafted on to the dermabraded recipient surface.
Melanocyte culture and transplantation. Melanocytes are cultured in a special artificial culture media. The depigmented recipient site is dermabraded or laser ablated and the melanocyte suspension is applied to it. The area is covered with a collagen dressing and immobilized. Large areas can be covered with this method and excellent cosmetic results obtained.
Micro pigmentation (tattooing). Tattooing is injecting artificial pigment into the depigmented area. After selecting the pigment shade which matches the surrounding skin color, the pigment granules are implanted into the depigmented patch either with a manual or electrically driven needles. It works best for the lip area, particularly in people with dark skin. Tattooing tends to fade over time. In addition, tattooing of the lips may lead to episodes of blister outbreaks caused by the herpes simplex virus. Hence, tattooing is usually not advised unless the patch is in an inoperable site.
Several cover-up makeups (waterproof skin colors) can mask vitiligo. Some patients with vitiligo cover depigmented patches with makeup or self-tanning lotions. These cosmetic products can be particularly effective for people whose vitiligo is limited to exposed areas of the body. Self-tanning lotions have an advantage over makeup in that the color will last for several days and will not come off with washing.
What is the right time to perform surgery on vitiligo spots?
When the de-pigmented patch does not increase in size for a period of two years, it is said to be stable. This is the right time to perform vitiligo surgery. If the patch is growing or is in an active phase, it needs treatment with medicines and / or PUVA till it stops growing.