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Vitiligo
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.
Do people with vitiligo transmit it to their children?
Can I marry a person with leucoderma?
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.
What happens once a person develops vitiligo? How long
does it last?
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.
Can vitiligo be cured?
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:
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.
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.
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.
The Bottom line
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.
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