Vitiligo is a disease in which there is milky white discoloration of the skin in some areas due to autoimmunity. Though it goes unnoticed in white skin of western population, it is easily noticeable in colored skin like Indian skin.
There is a lot of stigma associated with the disease. People even call it with wrong names like leukoderma or leprosy.
For the people uninitiated, leprosy is a bacterial infection causing slightly whitish discolored patches with loss of sensation over the patches, thickened nerves, tingling numbness of peripheries.
Leukoderma is white discoloration of skin due to known or evident causes like physical or chemical injury to the skin.
Vitiligo, in contrast, is a disease whose cause is not known. It can affect any age group from congenital vitiligo, childhood vitiligo to vitiligo among elderly. There is no cause known, dietary, environmental or occupational though there is mild genetic predisposition.
The melanocytes are destroyed slowly and the area develops white patches of different morphology. There are many types of vitiligo like generalised vitiligo, lip-finger tip vitiligo, segental vitiligo etc.
The diagnosis is done clinically, by dermoscopy and through skin biopsy.
The treatment is easier in hair-bearing areas as there are some melanocytes still persisting among hair follicles within vitiligo patches.
The treatment includes oral agents , topical agents , phtotherapy , surgical management, micropigmentation where skin colored pigments are tattooed into skin, cosmetic camouflage like makeup etc.
Oral medicines are of generally 3 types.
1. Nutritional supplements like antioxidants, vit D3 etc.
2. Photosensitizing agents like psoralens which make skin absorb more UV Rays and thereby aid melanin synthesis.
3. Immunosuppressants to reduce autoimmunity; like steroids and steroid sparing agents like azathioprine, methotrexate etc. There is a new molecule tofacitinib which seems to promising too.
Topical agents are very important agents in vitiligo as they can be used without oral medicines in limited area involvent of vitiligo. They include topical psoralens, steroids, fluorouracil, calcipotriol, tacrolimus, pimecrolimus, tofacitinib etc.
Phototherapy using UVA, narrowband UVB, Excimer laser also are very important tools.
Surgeries are only done in stable vitiligo patches which means the patch is not showing any change, neither increase nor decrease in pigmentation for the past 6 months to 2 years.The surgeries include skin grafting, punch grafting, blister grafting, non cultured melanocyte suspension transfer etc.
This is all about the medical aspect of vitiligo.
My information about the disease is certainly not complete as this blog post is meant for general population and the intention of posting it is not just to impart knowledge regarding the disease, but also to drive home completely different aspect of the problem.
The reality is that the medical or the surgical treatment in vitiligo is "frying pan into fire" like scenario for both doctors and the patients alike.
Vitiligo is completely an unpredictable disease. Still the prediction which is more appropriate is that the disease is going to recur. The disease activity usually occurs in bouts and stopping the activity means using steroids or immunosuppressants. These are certainly not good for our body.
Topical treatment is a big story in itself and a disappointing one. Some agents maynot work in some people, they are expensive, require time for application, can irritate skin.
In spite of all the efforts the results are not perfect and patches generally recur.
The patients are so ashamed of the disease that they spend huge amount of money, time and their mindspace on treatment and eventually get disillusioned.
Many go into depression. The quality of life of the patient and his/her family members gets extremely poor. Children lag behind in their studies. Marriages get cancelled. There are just too many sad stories.
And surprisingly all of this is just because we have a patchy skin due to auto immunity.
I am sure each one of us carries some kind of auto immune process in the body at any given point of time. But most are small, hidden or unknown.
But the skin is the biggest visible organ and our society puts too much emphasis on skin color and we as a society have lost immensely due to our lack of insight into the problem.
Ironically the same society considers the fair skin to be the best one and when this small white patch appears on skin it becomes the black dot on that person's life.
Many a time I try to convince my patients to abandon the treatment and live life happily because they are fighting a losing battle. Unfortunately none accepts this option.
I hope that in the coming years we see more acceptance of vitiligo in the society and every vitiligo patient gets to live life proudly and happily.
