All about Vitiligo

Dr. Devraj Dogra, Dr. Mubashar Mir
Vitiligo is a disease that is characterised by white blotches on the skin due to loss of normal skin colour. It can affect the skin on any part of your body. It may also affect hair and the mucosal surfaces.
The colour of hair and skin is determined by a pigment present in human skin and hair known as melanin. Vitiligo occurs when the cells called melanocytes that produce melanin die or stop functioning. Vitiligo affects people of all skin types, but it may be more noticeable in people with darker skin like in Indian population. One thing that must be clear is that vitiligo is not life-threatening or contagious. However due to the obvious cosmetic blemish it can be stressful, patients often have inferiority complex and depression. Due to the myths and misconceptions surrounding the condition the patients often face social isolation and discord.

Today is World Vitiligo Day

What causes vitiligo?
Vitiligo is believed to occur due to destruction of pigment forming cells known as melanocytes. These cells produce the pigment known as melanin that gives colour to your skin, hair and eyes. The exact reason why this happens is still unknown however it may be related to:
Autoimmune Phenomenon: A disorder in which your immune system attacks and destroys the melanocytes in the skin.
Role Of Genetic Factors: Positive family history is seen in many patients of vitiligo pointing towards a role of hereditary genes.
A trigger event: Such as sunburn, stress or exposure to industrial chemicals
How does vitiligo present?
The key sign of vitiligo is patchy loss of skin colour in the form of depigmented chalky white or milky white patches. Usually, the mark first shows on sun-exposed sites and trauma prone sites, such as the hands, feet, arms, face elbows, knees etc. Also, the disease occurs more in the hyper-pigmented areas of the body like face, axilla, groin, areola and genitalia.
Other accompanying signs may include premature whitening or greying of the hair on your scalp, eyelashes, eyebrows or beard known as leukotrichia. It may also present as white patches in the mucosal tissue that line the inside of your mouth and nose. Vitiligo can start at any age, but often appears before age 20.It affects both the sexes equally but girls usually develop the disease early.Depending on the type of vitiligo the patches may be seen in different arrangements and configurations.
Patches may be diffusely present and bilaterally symmetrical. Thisis the most common type, called generalized vitiligo.
In segmentalvitiligo, patches involve particular segment of body area unilaterally. This type tends to occur at a younger age, usually progresses for a year or two and then stops.
In focal vitiligo, the white patches cover only a few areas focally.
It’s difficult to predict how your disease will progress. The forms of vitiligo other than segmental type usually follow a protracted and an unpredictable course. Sometimes the patches stop forming without treatment. Rarely, the skin gets its colour back.
Your doubts answered.
Because of the stigma associated with this less talked about disease there are a number of misconceptions associated and questions which need to be answered and understood clearly.
* Can vitiligo spread from one person to the other?
Vitiligo is neither infectious nor communicable. It does not spread from one person to the other. Vitiligo is a disease chiefly limited to depigmentation of human skin and hair. It is absolutely safe to play, share food and items with your friend or relative having vitiligo.
* Can vitiligo spread by intake of certain foods?
A common myth is that it occurs by intake of fish and milk together however the truth is that it has no relation with intake of milk, fish or both.
* It is said vitiligo is an incurable disease, is it so?
Patients suffering from vitiligo need not to be discouraged by such statements. The specialty of dermatology and dermatosurgery offers excellent results majority of cases of vitiligo.Due to the lack of information and dismay associated with disease patients often land up in unsafe hands of quacks and untrained people claiming cure. The unscientific and potentially harmful substances used by them often hasten the disease course besides pushing the patients towards serious side effects and comorbidities.
* All white patches are vitiligo?
No, all white patches are not vitiligo. There are many conditions when the white patches appear on skin. Thus, considering the nature of the disease it is highly recommended that any white patch should be examined by a dermatologist.
* Is Vitiligo Dangerous?
It must be understood that vitiligo is a disease limited to skin without any direct internal organ involvement. It is not a dangerous or life-threatening problem. Though, most patients have psychological impact, excessive anxiety and depression too. The patients need adequate counselling and reassurance about the nature of disease and that the disease is essentially a cosmetic problem without serious life-threatening complications.
* Is vitiligo related to albinism or skin cancers?
Vitiligo is not related to albinism or skin cancers. Albinism is a genetic disorder, the patients born with this have no melanin. These patients have white skin all over, including hair, iris and eyebrows, since birth. On the other hand, vitiligo patients have normal skin at birth. Later in life they develop abnormal immune response towards melanocytes causing their destruction. Similarly, vitiligo has no association with skin malignancies.
* What and how much to expect from treatment:
Generally speaking around 70 percent patients can be adequately managed with available therapies. With advent of recent dermatosurgical methods which mainly are based on the principle of transferring melanocytes from normal skin to the vitiliginous skinhave further increased the success rates in treatment and patient satisfaction.
Treatment in vitiligo is based on certain factors like age of the patient, the progression of disease, psychosocial considerations and the affordability and availability of treatment forms. The goal of treatment is to stop the disease progression and to induce regimentation.
Medical management forms the first line of treatment with the use of immunomodulatory drugs to control the activity of the disease and induce repigmentation. Photochemotherapy forms the backbone of medical management.Surgical and laser assisted techniques aim at repigmentation by grafting methods in cases of stable vitiligo and to remove the residual pigment in cases of extensive vitiligo.
Interesting work is being done in the field of targeted gene and stem cell therapy which holds promise in the future management of vitiligo. The concept of inducing resident and perilesional melanocytes and preventing using growth factors holds promise.
With introduction of safer drugs and effective surgical techniques successful treatment of patients of vitiligo awaits the patients along with a promise to offer much more in the near future.
(The authors are HoD & MD Resident , Department of Dermatology Venereology & Leprosy , GMC Jammu)