Name: dr kamal asnani

Vitiligo: A commonly misunderstood skin disorder in India

Vitiligo is a pigmentation disorder in which the cells that make pigment in the skin are destroyed. As a result, white patches appear on the skin in different parts of the body.
These patches are more commonly found on sun-exposed areas of the body, including the hands, feet, arms, face, and lips. Other common areas for white patches to appear are the armpits and groin, and around the mouth, eyes, nostrils, navel, genitals, and rectal areas. The disorder affects both sexes and all races equally however, it is more noticeable in people with dark skin. Half the people who have vitiligo develop it before age 20 most develop it before their 40th birthday. The reported incidence of vitiligo in various dermatological clinics now in India varies from 0.5 to 1.
Cause of vitiligo
The cause of vitiligo is not known, but doctors and researchers have several different theories. There is strong evidence that people with vitiligo inherit a group of three genes that make them susceptible to depigmentation. In fact, 30 percent of people with vitiligo have a family member with the disease. However, only 5 to 7 percent of children will get vitiligo even if a parent has it, and most people with vitiligo do not have a family history of the disorder.


The most widely accepted view is that the depigmentation occurs because vitiligo is an autoimmune disease—a disease in which a person’s immune system reacts against the body’s own organs or tissues. As such, people’s bodies produce proteins called cytokines that alter their pigment-producing cells and cause these cells to die. Another theory is that melanocytes destroy themselves. Finally, some people have reported that a single event such as sunburn or emotional distress triggered vitiligo however, these events have not been scientifically proven as causes of vitiligo.

There is no way to predict if generalized vitiligo will spread. The disorder is usually progressive, however, and over time the white patches will spread to other areas of the body. For some people, vitiligo spreads slowly, over many years. For other people, spreading occurs rapidly. Some people have reported additional depigmentation following periods of physical or emotional stress.

Diagnosis of vitiligo
The diagnosis of vitiligo is made based on a physical examination, medical history, and laboratory tests. To help confirm the diagnosis, the doctor may take a small sample (biopsy) of the affected skin to examine under a microscope.

While vitiligo is usually not harmful medically, its emotional and psychological effects can be devastating. Adolescents, who are often particularly concerned about their appearance, can be devastated by widespread vitiligo. In fact, in India, women with the disease are sometimes discriminated against in marriage. Developing vitiligo after marriage can be grounds for divorce.
Therapy for vitiligo
Fortunately, there are several strategies to help people cope with vitiligo. The main goal of treating vitiligo is to improve appearance. Therapy for vitiligo takes a long time—it usually must be continued for 6 to 18 months. Current treatment options for vitiligo include medical, surgical, and adjunctive therapies (therapies that can be used along with surgical or medical treatments).

Medical Therapies

A number of medical therapies, most of which are applied topically, can reduce the appearance of white patches with vitiligo. These are some of the most commonly used ones:

Topical steroid therapy—steroid creams may be helpful in repigmenting (returning the color to) white patches, particularly if they are applied in the initial stages of the disease. Corticosteriod creams are the simplest and safest treatment for vitiligo, but are not as effective as psoralen photochemotherapy.

Psoralen photochemotherapy—also known as psoralen and ultraviolet A therapy, or PUVA therapy, this is probably the most effective treatment for vitiligo available in the United States. The goal of PUVA therapy is to repigment the white patches. Psoralen is a drug that contains chemicals that react with ultraviolet light to cause darkening of the skin. The treatment involves taking psoralen by mouth (orally) or applying it to the skin (topically). This is followed by carefully timed exposure to sunlight or to ultraviolet A (UVA) light that comes from a special lamp.

Topical psoralen photochemotherapy—often used for people with a small number of depigmented patches affecting a limited part of the body, it is also used for children 2 years old and older who have localized patches of vitiligo.

Oral psoralen photochemotherapy—used for people with extensive vitiligo (affecting more than 20 percent of the body) or for people who do not respond to topical PUVA therapy, oral psoralen is not recommended for children under 10 years of age because it increases the risk of damage to the eyes caused by conditions such as cataracts.

Depigmentation—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 the best treatment option. Patients apply the drug monobenzylether of hydroquinone twice a day to pigmented areas until they match the already-depigmented areas.

Surgical Therapies

All surgical therapies must be considered only after proper medical therapy is provided. Surgical techniques are time-consuming and expensive and usually not paid for by insurance carriers. They are appropriate only for carefully selected patients who have vitiligo that has been stable for at least 3 years:

Autologous skin grafts—the doctor removes skin from one area of your body and attaches it to another area. This type of skin grafting is sometimes used for patients with small patches of vitiligo. Treatment with grafting takes time and is costly, and many people find it neither acceptable nor affordable.

Skin grafts using blisters—in this procedure, the doctor creates blisters on your pigmented skin by using heat, suction, or freezing cold. The tops of the blisters are then cut out and transplanted to a depigmented skin area.

Micropigmentation (tattooing)—this procedure involves implanting pigment into the skin with a special surgical instrument. This procedure works best for the lip area, particularly in people with dark skin.

Autologous melanocyte transplants—in this procedure, the doctor takes a sample of your normal pigmented skin and places it in a laboratory dish containing a special cell-culture solution to grow melanocytes. When the melanocytes in the culture solution have multiplied, the doctor transplants them to your depigmented skin patches. This procedure is currently experimental and is impractical for the routine care of people with vitiligo. It is also very expensive, and its side effects are not known.

Additional Therapies

Sunscreens—people who have vitiligo, particularly those with fair skin, should minimize sun exposure and use a sunscreen that provides protection from both the UVA and UVB forms of ultraviolet light. Sunscreen helps protect the skin from sunburn and long-term damage.

Cosmetics—some patients with vitiligo cover depigmented patches with stains, makeup, or self-tanning lotions. Self tanning lotions have an advantage over makeup in that the color will last for several days and will not come off with washing.

Counseling and support groups—A mental health counselor can also offer support and help in coping with vitiligo. In addition, it may be helpful to attend a vitiligo support group.

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