What is Vitiligo?

Vitiligo is a type of skin condition in which depigmented patches may start appearing on different parts of a person’s body. The skin of the affected person may start to lose pigmentation in small patches and to varying degrees and may even be completely white. These spots do not follow any pattern and could appear anywhere on the body including eyes, hair and inside of the mouth. It is more noticeable among people with dark skin as compared to that of a light skin colour. Vitiligo mostly results due to autoimmune or thyroid disease, and may have association in the family genes.
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Vitiligo is not a rare disease and may affect 1% of the population although in different regions this may vary from 0.2-3% of population. Generally it starts after the age of 20 but may rarely be seen earlier than that.
 

Causes and Diagnosis

Vitiligo is not a contagious disease. It is not threatening to the life of a person. Although due to the cosmetic appearance it causes social stigma leading to psychological stress disturb the mental health of the affected person.
 
Causes
The main causes of Vitiligo as explained by the doctors are as below:
● Autoimmune reasons: Sometimes our body’s self-defence wrongly identifies the parts of the color producing cell as not its own and starts destroying them.
Neuro-chemical reasons: Certain chemicals secreted by nerves may be responsible for destroying the pigment producing cells or the pigment itself. Sometimes the chemicals involved in production itself may cause cell death due to their oxidant or oxidant nature.
Other reasons: Hereditary inheritance has been a known factor. Sometimes the pigment producing cells simply are defective and do not produce the color pigment
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Diagnosis

The most important basis for diagnosis is clinical findings of lighter color patches. History check of family medical history for hereditary factors is sought.
 
As we know that vitiligo may be associated with certain autoimmune disease, diabetes, thyroid or other endocrine disorders, certain types of anemia, and sometimes other skin and hair diseases tests may be advised for checking or ruling out these. Blood tests to check for autoimmune disease may be done.
 
Sometimes biopsy may be taken of the patch to know the cause of depigmentation.
Another method of diagnosing Vitiligo is using an ultraviolet light for identification of the affected area. In this method, under the wood’s light, the affected skin of the patient will change colour; usually a fluorescent one to expose the changes in pigmentation of the affected person.
 

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Types of Vitiligo

According to the study conducted by the medical scientists, Vitiligo can be classified into two categories:
Segmental Vitiligo
Often diagnosed in early age, it occurs in segments and has rapid on-set. Generally, it spreads to parts of the body for about one year and stabilizes afterwards. The facial area is most prone to affect from segmental Vitiligo.
 
Non-Segmental Vitiligo
It can appear at any stage of life and has progressive on-set. It mostly spreads to different parts of the body throughout the life of the affected person. Often associated with hereditary factors, it involves many relapses and flare ups.
 

Treatments for Vitiligo

Unfortunately there is still no absolute cure for Vitiligo. The most common suggestions would be to cover the patches with makeup or to apply a generous amount of sunscreen while going out. But for people looking for long lasting solutions, doctors do recommend some treatments to help regulate the spread or to prevent from the further spread of the white patches. Vitiligo treatment can cost from 30,000 INR to 1,00,000 INR depending on the duration of the treatment. Although it may not prove to be a permanent solution, it could last for years with continuous care. One should be extremely careful during the treatment of Vitiligo, as it could leave behind several side effects.
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Creams or Medication
At an early stage of Vitiligo when there are only a few patches, doctor may suggest the use of cream such as Corticosteroid or some similar medication. This treatment might take a long time to show significant changes. It could also show some side effects like thinning of skin or forming of lines on the skin.
 
Depigmentation
For patients with large patches, which are widespread, lightening the natural colour of the normal skin around light patches may be done so that the patches are less noticeable. As prescribed by the dermatologist, the depigmentation cream strips the skin of its natural colour completely. Some patches might be visible under the sunlight but one can get away with them through depigmentation cream. This method is rarely used because it could drastically change the appearance of the person and requires commitment.
 
Light Therapy
An effective method used to treat Vitiligo, it uses UVA light therapy to treat the affected areas of the skin. Under light therapy, the patient is treated by keeping under a UVA light in a kind of a box. This treatment requires regular sittings and might not last longer than a year. There might be a difference in the colour of the treated skin as compared to the original skin but that will soon get better.
Under UVA treatment, the person will be treated by using psoralen and UVA light to normalise the colour of the skin. It will need regular care to show any sign of improvement. There might be some side effects as well with the usage of psoralen.
 

Surgery

Usually, surgery might be the most effective solution when none of the above options work for the patient. This has to be performed when the disease has been stable for significant time and not spreading. It is effective on 90% of the patients, but it is up to the doctors to choose the appropriate option. Sometimes, the doctors use surgery in combination with light therapy for the optimum result
 

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Various surgical procedures for different types of patients include as below:
Micro Pigmentation/Tattoo
The surgeon will add pigments to the affected area of the skin using special instruments. This method is mostly effective for certain specific areas with dark skin like for lips, nipple areola, genitals etc.
 
Skin Grafting
It is effective for the patients with localized segmental patches. In this method, the doctors will use skin graft from the non-affected areas to graft in the affected areas.
 
Blister Grafting
In this procedure, blisters are created in the normal, pigmented areas of the skin and then melanocytes are harvested and transferred to the affected area. The patient remains under observation for a few hours and then sent home with some instructions.
 
Some risks involved with the surgical treatment of Vitiligo include:
● Risk of infection on the treated area if proper precautions are not followed.
● Permanent scarring of skin
● Noticeable change between treated areas and normal skin areas.
● The results might not be permanent
 
To take care of the skin after treatment, the patients should abide by some important instructions:
● Wear sunscreen every time the patient goes out to avoid over exposure to harmful rays of the sun.

● Cover the skin with a scarf to prevent from radiations, pollution or any dust particles.
 
To get the best results of Vitiligo treatment, it is important to consult a skilled and experienced doctor!

 

 
The information is being provided by CosmeticSurgery.in and have no intention to replace the medical advice of your doctor. Please consult your doctor directly for advice about a specific medical condition. This document was last reviewed by Dr. Sumit Malhotra, Plastic Surgeon on: 12-JUN-2020

Surgery Before & After Photos