Dr.Snehal Sriram, Consultant Dermatologist and Dermatosurgeon, Apollo Hospitals, Secunderabad, explains the treatment options for Vitiligo (also called leucoderma), a common dermatological problem.

What is vitiligo?

Vitiligo, commonly known as ‘leucoderma’, ‘sweta kustha’, ‘kodh’, ‘venn kustham’ or ‘charak’, is a disease in which the normal pigment or the colour of skin is lost in patches hence making those patches look chalk-white.
It affects all races the world over but predominantly is seen in India and Mexico. In India, 3% of the total population has vitiligo. The tendency to develop vitiligo runs in families, however only about 25% of cases usually have more than one family member affected with this condition.

What causes it?

Contrary to many popular myths, dietary habits, sex or religion do not play any role in development of vitiligo. The theory behind development of vitiligo is that in a background of genetic tendency, the body’s defence system becomes slightly faulty and it fails to recognise the colour producing cells of some areas as body’s own part. It launches an attack on them as if they were foreign elements and destroys them. Hence those patches look chalky white because the colour has been destroyed.

Also, certain chemicals including cosmetics like cheap lipsticks; rubber footwear, and some phenolic compounds can sometimes give rise to leucoderma in the area of contact with the chemical. Barring these few chemicals, there are no known external agents that cause vitiligo.

There are some factors that can trigger or exacerbate vitiligo in a susceptible individual. These include local injury, itching and friction, prolonged ‘stomach’ (gastrointestinal) upsets, emotional disturbances, psychological trauma, pregnancy, delivery and any major surgery.

Is vitiligo infectious? What is the relation between leucoderma and leprosy?

Leucoderma or vitiligo is not at all infectious. It cannot spread by any kind of contact – however close, or sharing of food, bed, clothing and other articles. It is perfectly safe to touch, hug, kiss and have sexual relations with a patient of leucoderma.

There is absolutely no relation between leprosy and leucoderma. Leprosy is a type of bacterial infection, while leucoderma is just absence of colour in some patches of skin.

More often than not(that is 60-75% of times), chances are that children of one parent with leucoderma may not develop leucoderma at all. However, the chances of transmitting leucoderma to children become a little more in case of cousin- marriages.

There is no reason not to marry a person with leucoderma. It is not infectious at all. If you have leucoderma, and you are not marrying your first cousin, 60-75% chances are that your child will have normal skin. Again, please remember that leucoderma is not a disease but a cosmetic problem only, and it is we who have to remove the stigma attached to it from our minds.

The course of the disease is a little unpredictable and it depends on the triggering factors like mental stress. Many a times the patches start regaining the colour on their own; or at times there may be new patches by the time the initial patches have repigmented (regained their colour); or some times the patches stop progressing and the disease may remain static for years without any change.

Yes! Today, we have many different types of approaches to treat vitiligo and a judicious individualistic combination of one or more treatment modalities depending upon the patient’s problem gives excellent results in treating vitiligo.

The treatment protocol for vitiligo can be divided into three aspects:

1. General:  Patient’s understanding and active participation is necessary for successful treatment of this condition. Good general health and balanced nutritious diet enriched with adequate vitamins and minerals are required. It is not required to avoid any particular food product, however a healthy diet is a must. Also, good mental health plays a vital role; worrying about the disease may worsen the disease. This becomes especially important in patients with vitiligo on the exposed parts like face, hands, and feet. These patients have to come to terms with the disease and the taboo attached to it in our society even in these modern days. This difficult task can be lightened by the use of camouflage materials while the treatment has been started and is yet to produce results.The white patches can be painted with suitable brownish eye-pencils, or makeup; also, different shades of camouflage paints (dermacolor) are available which merge imperceptibly with normal skin and will last until washed off. Another important factor to remember,: any further physical contact with chemicals causing vitiligo (listed above) should be avoided.

2. Medicinal:  Of the plethora of medicines available, the most consistent and popular therapies are photochemotherapy and steroids. Photochemotherapy is the most widely employed one and gives good results. The principle of this treatment being – ingestion or application of certain chemicals followed by exposure to special ultraviolet light or even the natural sunlight leads to increase in pigmentation. Steroids usually in the form of creams and ointments can also be used especially to treat limited areas. Oral steroids can be given for a short period to arrest the progression of the disease. Other drugs like placental extract preparations and certain agents that change the body’s immune response have also been successful. Recently antioxidants have been in vogue for treating vitiligo, they do help when used in combination with other therapies, but generally do not produce good results when used alone. And for any medicinal treatment to be effective, it has to be continued consistently over a long term.

3. Surgical:  This treatment is of value in cases where the disease has stopped progressing for a long time and a trial of medicinal treatment has failed to produce good results. There are different types of surgical methods like minipunch grafting, split thickness skin grafting and suction blister grafting, all of them entail grafting a normal patch of the patient’s skin on the vitiligo patch, hence producing instant ‘colour’ in most cases. These are minor surgical procedures without many side effects and can be done under local anaesthesia. They have become particularly popular these days, and can be performed both - by dermatologists trained in dermatosurgery and by plastic surgeons. The main requirement for any vitiligo surgery is that the disease should be stable; otherwise the whole grafting becomes a futile exercise. Hence general policy should be to give medical treatment till the patches have repigmented or at least become stable, and then, to take care of the remaining patches with skin grafting.

Although vitiligo is considered a dreaded disease because of the social stigma attached to it, it is only a minor cosmetic problem and is definitely treatable. It is important for the patient not to be disheartened and without attempting to conceal the disorder consult a specialist at the earliest as early patches respond best to medicinal treatment. Widespread awareness of the benign and treatable nature of the disease and social acceptance of this common condition can certainly go a long way in removing the taboo of leucoderma and will make the patients confident to come forward and seek treatment.