What is vitiligo?
Vitiligo (leucoderma) is a common harmless
cosmetic skin condition associated with white
patches on the skin affecting 1-2% of the population,
treated mostly for aesthetic reasons.
What causes vitiligo?
Vitiligo is caused by destruction of pigment bearing
cells of the skin by as yet incompletely known
mechanisms.
Which parts of the body are most commonly
affected?
Though any part of the body may be involved, the
most resistant cases involve the lips, hands and feet
What are the treatment options in vitiligo?
Medical therapy includes the use of medications to
stop the destruction of pigment bearing cells and
bring back pigment to areas where it has been lost.
What are the means of stopping destruction of
pigment bearing cells?
This can be done by tablets and creams that prevent
the body from destroying its pigment bearing cells.
These are prescribed in generally harmless doses.
What are the means of bringing back pigment to
areas where it has been lost?
This is done by medical or surgical means.
Tablet/lotion forms of psoralens are the most
commonly used medications. This is generally
combined with sun exposure or use of more specific
Ultraviolet A in safe doses and under controlled
conditions. Narrow band Ultraviolet B and the excimer laser are comparatively newer and even safer
modalities in which psoralens are not required.
Surgical modalities aim to introduce pigment
bearing cells where they have been lost, from the
patient’s own reservoir in other parts of the body.
When are surgical modalities resorted to?
This is mostly required in case medical therapy is not
able to bring back pigment to areas from where it has
been lost. Certain areas of the body such as the lips
and tips of hands and feet & vitiligo affecting a
segment of the body are comparatively resistant to
medical therapy and require surgery more frequently.
Are all patients of vitiligo suitable candidates for
surgery?
No. Patients are suitable for surgery if disease is
stable (not progressive with no new patches for one
year). Medical treatment is usually necessary to
stabilise vitiligo.
What are the surgical methods of treating vitiligo?
Surgical methods include taking skin grafts and
placing them on prepared vitiliginous skin. This can
be done by placing the tissue directly or after suitable
preparation and culture. With the advent of culture
methods, much larger areas of the body can be
treated than was previously possible.
What is micropigmentation?
Micropigmentation or tattooing is a modality in
which inert pigment (usually iron oxides) of colour
matching the skin is introduced with needles. This is
effective in certain areas of the body only.
Does vitiligo surgery involve a major operation?
No. The procedure is done under local anaesthesia
and mostly does not take long. If done by a trained
dermatologist, the risk of complications is negligible.
How long does treatment of vitiligo take?
Medical treatment may take an average of 1-2 years.
Following surgery, pigment comes back in 2-3
months. However, medical treatment may need to be
continued to achieve optimal results of surgery.
Surgery for residual areas may also be necessary.
Is there any option for patients awaiting results of
medical or surgical treatment or not interested in
medical or surgical therapy?
Yes, cosmetic camouflage with colour the shade of
the patient’s skin can be a good option. After
application, vitiligo lesions are not discernible at all.
What are the options for patients who have lost most
of their pigment from all over the body?
A chemical can be used to remove small residual
islands of pigment leading to a more uniform colour.
This takes upto a year.
Is there hope for all patients of vitiligo?
Yes. There is definitely hope and present modalities
of treatment as well as research has offered
undeniable hope to patients of vitiligo.
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