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Vitiligo Skin Disease

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De-pigmentation of the skin in patches is known as vitiligo. Vitiligo is a chronic skin disorder and surfaces when the melanocytes (cells responsible for pigmentation) die or lose their functionality. Destruction of these pigments causes the white colored patches on the body. These patches can occur anywhere in the body including the inner layer of the mouth, retina and the nose. Hair, growing over the affected area turns white in color. Vitiligo skin disorder affects 1-2% of the population; it is common among men and women and also in all races.

Vitiligo is not infectious and is not harmful medically; it is just a cosmetic problem. It can be emotionally and psychologically disturbing though. Vitiligo usually sets in before the age of 40.

Vitiligo causes

The exact cause of vitiligo is not yet known. It is believed that vitiligo develops in people with autoimmune disease. Genetic and environmental factors are also considered as contributing factors. People with thyroid disorders are thought to be more susceptible to this disorder.

In a few cases the patches spread to various parts of the body, whereas in a few cases it does not. While it spreads gradually for most, in some people the patches spread rapidly.

Diagnosis of vitiligo

First the physician will conduct a thorough physical examination of the patient and will then run through the family history of the patient. The physician might take a biopsy sample of the affected skin and examine it for absence of melanocytes.

Vitiligo symptoms

White patches or de-pigmentation of the skin is the first symptom noticed by people who develop vitiligo. These patches usually develop on the sun-exposed areas of the body like the hands, arms, feet, face, and lips. White patches also develop around the mouth, eyes, nostrils, navel, genitals, armpits, rectum and groin.

Totalis vitiligo: Save a small portion of the body, all parts get de-pigmented.

Generalized pattern: This is most common pattern. De-pigmentation occurs evenly on either sides of the body.

Focal pattern: De-pigmentation is restricted to a particular area or to a few areas

Segmental pattern: De-pigmentation appears as patches and develops just on one side of the body

Vitiligo patches tend to have a peculiar tri-phased appearance where the center is nearly white and the surrounding zones have lesser levels of depigmentation. Apart from white patches on the skin, people with vitiligo also suffer from premature graying of hair in the scalp, eyebrows, eyelashes and beard. In advanced cases of vitiligo skin disorder, there might be inflammation too. Dark skinned people may observe a loss of color inside their mouths.

Vitiligo treatment

There is a common myth among people that vitiligo cannot be treated. This is not true; majority of patients can achieve good results. The current treatment options include

Cover-up: This treatment uses dyes or make-up to hide the white macules so that vitiligo is less visible. Few patients use self-tanning lotions and concealing creams to cover-up the affected area.

Restoration of normal skin color: This treatment option would include spot and whole body treatments. Topical Corticosteroid creams, topical oxsoralen and mini grafting are used in spot treatments and PUVA Photo chemotherapy (Oral Psoralens + UVA Irradiation) is used in whole body treatment.

Bleaching of normal skin with topical creams to remove normal skin pigment for an even color

Use of Sunscreens

Vitiligo self-care

These simple steps can protect the affected area of your skin from sunburns:

  • Wear SPF 45 sunscreen
  • Avoid mid-day sun exposure
  • Apply cover-up makeup to conceal the patches
  • Wear protective clothing and hats

Vitiligo protopic

Protopic (Tacrolimus) is a new generation medication being prescribed by a few dermatologists for vitiligo. Protopic works to repress or down-regulate the immune response in an area of vitiligo. Studies have revealed re-pigmentation success in a few cases but not in all who have used it. Protopic ointment is presently prescribed towards the treatment of moderate to severe eczema (atopic dermatitis). Protopic is the brand name of tacrolimus topical. Tacrolimus is used mainly to treat eczema but has proven to have good effects for vitiligo too.

The FDA has not endorsed the clinical investigation or use of protopic in vitiligo yet. The product is available in .03% and .1% strengths. This treatment is not safe for children under three years. For children less than sixteen .03% strength should be used and .1% dosage should be used for adults. The risks and side effects of protopic are not known completely. It is suggested that patients should discuss the usage of protopic with their doctors before use.

Dos and don'ts of protopic

  • Stop using protopic once the skin condition has cleared.

  • While applying the ointment, ensure the area is clean and dry.

  • Use only a small amount of ointment thus coating the skin surface with a thin layer.

  • Do not cover the area or bandage the area where the cream has been applied.

  • Do not shower or swim immediately after applying ointment.

  • Do not sit under the sun, UVA or UBV phototherapy treatments, sun lamps and tanning apparatus.

  • Wear lose clothing while going out and cover the treated skin with sunscreen.

  • If you have any problems with protopic application seek medical guidance immediately.

Vitiligo UVB

Ultra Violet radiation of short wavelength is one of the treatment options available for vitiligo. Affected body parts of the patient are exposed to narrow band UVB light. UVB spectrum 311-313 nm is used for treatment. UVB is a medium wave length, medium energy, ultraviolet radiation. It can bring about remarkable changes to the human skin.

Phototherapy with UVB is considered an effective long-term remedy for vitiligo. As UVB treatment is usually effective, additional topical or oral medicines are not required. UVB is also used in combination with PUVB (psoralens) and other medicines like methotrexate, coal tar, vitamin A&D etc. 3-5 sittings of phototherapy treatment with UVB is generally advised. The effects of this treatment can be seen after 6-8 months.

Home devices for UVB are also available these days. UVB has higher energy radiation when compared to UVA. The higher radiation emitted can cause severe side effects if it is not used with caution. Itching, sunburns and redness are the possible side effects of this treatment. Eyes have to be well-protected during the treatment else it can cause cataract of the eyes.

Excimer Laser Vitiligo

Excimer laser is a high intense beam of UV light. It is directed to the vitiligo spots or patches. This treatment is very effective and requires no supportive medications. This treatment has been approved by the FDA recently and is very expensive when compared to other types of treatments. This treatment employs a focused beam of laser light that is delivered through a sophisticated fibro-optic device.

The excimer laser system can treat ugly vitiligo patches quickly and effectively. The results vary from patient to patient. As the device focuses light specifically on the affected area, Xtrac delivers the required dosage of radiation that helps stimulate the melanocytes without exposing the healthy skin to UV radiation.

Treatment rendered depends on the total area affected. Treatment sessions last only for a few minutes. The Laser hand piece of the equipment moves over the affected area while focusing the laser light as per the determined dose.

Vitiligo in children

Children with vitiligo can be treated. A few treatments available for vitiligo are not appropriate for children. The treatments recommended for children include:

  • Creams

  • Ointments

  • NB-UVB

  • PUVA with topical psoralen - PUVA therapy that uses the psoralen pill is not recommended until after 12 years of age.

Children born to parents suffering from vitiligo are more susceptible to vitiligo than other children but it is not proven that children with parents suffering from vitiligo will develop vitiligo. If your child is suffering from vitiligo:

  • Assure the child that you love your child and that external appearance is not as important as character.

  • Take the child to a psychiatrist for counseling; this will support the emotional well-being of the child.

  • Choose the right treatment that will suit your child's requirements. Speak to the doctor on the various aspects of the treatment being provided.

  • Remember that you as a parent are an important person in your child's treatment. Make sure you understand the treatment and speak to the doctor on your child's progress.

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