Vitiligo

Vitiligo or Leucoderma is a chronic disorder of skin which is characterized by total loss of pigment in the skin. The exact cause of Vitiligo is still not known .Only 20 to 30% of people suffering from the disease give positive family history.

Typical lesion is well defined milky-white patch. It appears between 10 and 20 yrs but can appear at any age. It can appear on any part of the body. Usually after initial speed of the disease (unstable stage) there are long periods of stability. During this period patches do not increase in size and no new patches appear on the body. However sometimes appearance of a new patch does not affect the stability of older patches. This stable phase lasts for many years, may be lifelong in some patients. About 20% of the patients experience spontaneous repigmentation of all or some of the patches. Small Percentage of patients may experience reactivation of disease. The exact cause of this recovery or deterioration is not known. Segmental Vitiligo is localized and most stable type.

Treatment - Medical :

This treatment should be undertaken under guidance of dermatologist

The current drugs that can be used to cure Leucoderma are

• Psoralens-like melanocyl,etc where in the patients upon taking the medicines have to expose to sunlight or ultraviolet light
• Steroids-to suppress the spread of the disease and to help in pigmentation
• Immunomodulators- to suppress the immune system from destroying the Melanocytes.
• Narrow band ultraviolet treatment is the best medical treatment for Vitiligo and it involves exposure to ultraviolet treatment without taking medications prior to exposure, pigmentation appears within few sitting if the patient is responding to treatment.

Surgical Treatment:Can be considered if

The patches have stopped spreadingThere is no new development of fresh new white patches If all the wounds are healing with normal pigmentation

The different surgical treatment include Skin grafting

• Epidermal Grafting: In this method a blister is produced by suction at donor site. The roof the blister is cut and is grafted on the affected area after scrubbing the superficial skin. The procedure does not cause any scarring but is more time consuming, blistering may be painful and very small areas can be treated by this method.
• Punch Grafting: Mini grafting is performed by implanting small –punch-grafts 3 to 4 mm apart within minute holes into the Leucoderma area. This procedure may give uneven pigmentation. Cobblestone appearance and scarring at the donor’s site. All the above surgical methods give donor to recipient ratio 1:1 except mini punch grafting which gives the ratio of 1:3.

Transplantation in Melanocytes in Vitiligo:-

The treatment being hailed as a break through advancement is based on actually growing (culturing) pigment producing cells, (Melanocytes) in laboratory and grafting them to the affected area. A slightly modified procedure is being done and now the cells are harvested from a small piece of donor skin and transplanted onto the patch immediately without culturing the cells with the same results. In this process a superficial skin biopsy (skin sample) of size approx. 2X5 cm is taken from the patients affected area. The pigment cells are extracted from this sample. Superficial skin is then dermabraded (scraped superficially). Harvested Melanocytes are then applied to the derabraded area and with a special dressing; the treated area is protected carefully for one week .The patient is encouraged to expose the treated area to sun or ultraviolet radiation three days per week. Pigmentation appears usually at four weeks and keeps on spreading up to 3 months.

The entire procedure is done under local anesthesia and is completed in 2 to 3 hours, and patients are allowed to return home without the need for hospitalization.