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Q. What is vitiligo ?

It is a condition that is characterized by appearance of white patches over the skin. It is also known as leukoderma. It affects 0.5-1% of the world population, i.e. ~ 5-10 out of every 1000 people develop the disease.

Q. What causes it ?

  • The normal skin colour is due to melanin which is synthesized by cells called melanocytes.
  • There are several proposed theories, most accepted hypothesis is that those suffering from vitiligo have antibodies that destroy some of there own melanocytes (autoimmune disease). This malfunctioning of melanocytes can reverse/improve on its own or with treatment.

Q. What are the symptoms of vitiligo ?

  • Vitiligo is characterized by presence of white patches over the skin, and the patches develop without any previous disease or injury. There is usually no itching, redness, pain or scaling – so if you have any of these symptoms before or after the white patches develop then you probably donot have vitiligo. Loss of sensation is also not a feature of vitiligo.
  • Remember there are many causes of white patches other than vitiligo.Don’t jump to conclusions without consulting a dermatologist.

Q. What is the course of the disease ?

Vitiligo can start at any age and in half the people, it starts before the age of 20. Its course is hard to predict, but itgenerally tends to progress slowly with periods of stability. However, it may progress faster in some and may remain static after a point in others. The hair over the patch may or may not turn white. New patches may appear at sites of injury. Some patches may improve spontaneously.Repigmentation tends to begin perifollicularly(around hairs) initially in addition pigment also comes from the surrounding normal skin. Therefore white patches on non hair bearing area and over joints tend to repigment slowly then other sites.

Q. Will every patient of vitiligo ultimatelyprogress to whole body involvement ?

No, most cases of vitiligo have limited disease (few patches), few new patches can occur with time and old patches can gain colour even without any treatment, and it is rare for a person with few patches to progress to generalized vitiligo.

Q. How is vitiligo diagnosed ?

Diagnosis is made by examining the patient’s skin i.e. by clinical examination. No tests are usually required.

Q. Who is likely to get the disease?

It can occur to anybody of any age, sex or race. It is more obvious (not more common) in people with dark skin. However, why a particular person is affected, and others are not, is not yet known.

Q. Is it contagious ?

No vitiligo is not contagiousand it does not spread by touching, speaking, sleeping, sitting or eating with individuals having vitiligo.

Q. Is it caused by eating milk or milk products, or sour foods, or combination thereof? Do other foods have any role in causing or worsening the disease ?

  • NO, it is neither caused nor aggravated by any food items.
  • Patients with vitiligo need not follow any dietary restrictions such as milk or milk products, fish, meat, eggs, sour fruits (orange, lemon) etc. They can eat a normal diet.

Q. Is it inherited ?

  • Generally NOT. Only a few patients have another family member with vitiligo.
  • Most people do not transmit the disease to their children.

Q. Is there any harm in marrying a person with vitiligo ?

  • Vitiligo is notcontagious and does not spread by contact (physical, nor sexual) and children born to a parent with vitiligo are very likely not to have vitiligo.
  • Thus, a person with vitiligo is as eligible for marriage as anyone else and there is no harm in marrying a person with vitiligo.

Q. Will vitiligo affect my ability to work?

Vitiligo has no effect on physical function or the ability to work.

Q. What kind of clothes can I wear ?

The kind of clothing does not have anything to do with vitiligo. You can wear all clothes that a normal person does.

Q. Apart from the skin, does vitiligo affect any other body functions?

The effects of vitiligo are confined to the skin.

Q. What are the available treatment options for vitiligo ?

Several options are available depending on extent of disease, progress of the disease to treat.

Medical Therapies:-

Medical treatments usually given for unstable Vitiligo. Choice of treatment depends on body surface area involved, number of new patches coming out in last 1 – 3 months, and which part of the body involved and side effects of the treatment. Phototherapy (PUVA, PUVA-sol, NB-UVB) can be used in selected cases.

Surgical Therapies:-

Surgical therapies are done in patients with stable vitiligo (no new patches for 1 year or no increase in size of any old patch).

Autologous Melanocyte Transplants:

  • Most advanced and highly effective.
  • Pigment forming melanocytes are harvested from a small skin graft taken from normal pigmented area in a chemical solution. These melanocytes are concentrated in a medium and spread over white patches. It gives a very natural colour matches with surrounding skin and even a very small graft can treat a 10 times larger area.

Hair transplantation:

Hair follicle is a good reservoir of melanocytes. In this technique hair follicles are transplanted in the Vitiligo patch. The melanocytes in roots of hair follicle spreads and repigment the surrounding area. Kindly note Dr. Kavish Chouhan and Dr. Amrendra kumar are the pioneer of body hair transplant in Vitiligo which is now widely practiced by vitiligo surgeons around the world.

Suction blister grafting:

In this procedure, the doctor creates blisters on the patient's pigmented skin by using suction. The tops of the blisters are then cut out and transplanted to a depigmented skin area.

Autologous Skin Grafts:

In an autologous (use of a person's own tissues) skin graft, the doctor removes skin from one area of a patient's body and attaches it to another area. This type of skin grafting is sometimes used for patients with small patches of vitiligo.

PUNCH Grafting:

  • Old technique, not practiced now a day’s except in very selected cases.
  • Risk of irregular patch pigmentation (cobble stoning).

Q. What is the response to treatment ?

  • Most people show a satisfactory response with medical treatment( e.g. topical steroids, phototherapy, tacrolimus, pimecrolimus etc.) and some show complete repigmentation with skin colour matching with the surrounding(Figure 3,4,5)but treatment needs to be taken for few to several months before this happens. Lesions on bony prominence & non hair bearing area e.g. finger tips and ankles tend to repigment slowly than at other sites.
  • Surgical modalities have good repigmentation rate if done properly but they are indicated only in cases with stable disease (No new white patch for 1 year). In some cases more than one treatment sessions are required.
  • Some newlesions may appear during the treatment. Also, white patches that have become normal may lose their colour again. This is not a cause for alarm and does not mean that the treatment is not working. There is no benefit from changing doctors frequently as most skin specialists are trained to treat vitiligo appropriately.
  • Most people benefit from the treatment but it is difficult to predict how much pigmentation will occur and how much time this will take for a particular person.

Q. Should I try alternate systems of medicine like ayurvedic treatment? They claim excellent results.

  • Some of the treatments used in Allopathic system of medicine have been adopted from Ayurvedic and Unani systems of medicine. Dietary restrictions and other lifestyle changes are frequently recommended and some people find these quite cumbersome. However, remember occasionally allopathic medications including steroids are prescribed under the guise of ayurvedic or homeopathic medicines. Keeping these points in mind, you may decide on which system of medicine you wish to try.
  • In general,it is not a good idea to take treatment from 2 or more systems at the same time.
  • Finally, claims of permanent cure must be carefully scrutinized; they are unlikely to be true.

Q. What should I do ?

Apart from the medical or surgical treatment you are undergoing:

  • Keep your confidence high.
  • You could use cosmetic camouflage- many patients manage just with this.
  • Try to ignore advice provided by all and sundry- often raises hope without result or causes desperation. Don’t get waylaid by this and try to lead a normal social life.

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