What is Vitiligo?
The term Vitiligo refers to a skin condition presenting as white patches on the body. The patches vary in size. There is no change in the texture of the involved skin ie. the skin is not scaly, thickened, or red. Furthermore, there are no symptoms eg. itch, burning, stinging, or pain.
Vitiligo is thought to be an inherited disease. There is usually a positive family history in most patients. The Koebner phenomenon may sometimes be seen in Vitiligo. In this situation, white patches develop at sites of injury. Usually, pigment cells in the upper part of the skin are involved (epidermis). Occasionally, however, pigment cells in the deeper part of the skin, around the hair follicles (roots of the hair), may be involved, in which case emerging hairs appear white.
Any part of the body may be affected in Vitiligo. The common sites of involvement include the trunk, lips, tips of the fingers and toes, and genitalia. The lesions may be small or may become confluent to form large patches.
How is vitiligo treated?
It is important to understand that this is a very difficult condition. The natural course and treatment success is unpredictable. The therapeutic options include the following:
- Topical corticosteroids
- Photosensitisers: Topical psoralens (an applied form of the medication) can be used to make the skin sensitive to sunlight.
- Oral trisoralens followed by sun exposure. Tablets are taken followed by sun exposure
- Topical khellin photosensitiser followed by exposure to sunlight.
- Topical immunomodulators eg. Tacrolimus
- Topical Vitamin D analogues
- Oral pulse steroids eg. Betamethasone 2 x week.
- Phototherapy- Narrowband UVB/ PUVA therapy
- Bleaching –applies to widespread vitiligo. The remaining normal skin may be treated with monobenzyl ether of hydroquinone.
Surgical therapies for stable vitiligo – this applies to techniques where normally pigmented skin is transplanted to the vitiligo areas. These include:
- punch skin grafting
- suction blister grafting
- Autologous cultured epidermal cell grafting
- Non-cultured melanocyte rich epidermal cell suspensions
- Excimer laser therapy