What Is Vitiligo?
Vitiligo, also known as white patch disease, is characterized by amelanotic or hypomelanotic patches anywhere over the body. To date, there is no definite etiology known for vitiligo. This skin disease has great social consequences in our modern society in spite of it being non-contagious in nature.
What Are the Causes and Pathogenesis of Vitiligo?
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A positive family history of vitiligo is relatively common in those with extensive diseases.
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It can also be associated with other autoimmune diseases.
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Trauma and sunburn may (through the Kobner phenomenon) precipitate the appearance of vitiligo.
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The pathogenesis is unclear, and melanocytes may be the target of a cell-mediated autoimmune attack, but it is unknown why only focal areas are affected.
What are the Stages of Vitiligo?
Vitiligo can be divided into three stages:
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Active or progressive stage.
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Stable or quiescent stage.
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Repigmenting stage.
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The active or progressive disease stage is when the depigmented lesions or white patches are increasing in size or number and borders are not well defined.
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A stable or quiescent disease stage is when there are no new lesions or patches or changes in existing lesions and borders are well defined.
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The Repigmenting disease stage is where there is marginal pigmentation around hair follicles.
What Are the Types of Vitiligo?
There are five different types of vitiligo, and it depends on where you have it.
1) Generalized:
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It is the most common type.
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The discolored patches are seen all over the body.
2) Segmental:
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The discolored patches are seen on one area of the body, for example, face, hands, etc.
3) Non-segmental:
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It is the most common type.
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Symmetrical white patches are seen with slower development.
4) Focal:
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It mostly occurs in young children.
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It stays in one spot and does not spread.
5) Trichrome:
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It is a combination of three discolorations with heavy discoloration in an area, followed by an area of lighter discoloration and regular skin color.
6) Universal:
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It is very rare.
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Almost 80% of the skin is discolored.
Who Is More Likely to Get Vitiligo?
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Vitiligo is an acquired condition affecting 1% of the population worldwide, and it is the focal loss of melanocytes resulting in the development of patches with hypopigmentation.
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It occurs equally in men and women.
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It occurs at the early stages of life, that is, between 10 to 30 years of age, and it mostly shows before 40 years of age.
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It occurs with a family history of vitiligo and in people with or family history of premature grey hairs.
How Is Vitiligo Clinically Identified?
1. Generalized Vitiligo - It is often symmetrical and involves hands, wrists, knees, and neck, as well as areas around body orifices. The hair of the scalp, beard, eyebrows, and lashes may also depigment.
2. Segmental Vitiligo - It is restricted to one part of the body but not necessarily a dermatome (skin supplied by a single spinal nerve). The depigmentation patches are sharply defined, and in Caucasians may be surrounded by hyperpigmentation.
Within the depigmentation, the spotted perifollicular pigment may be seen and is often the first sign of repigmentation; also, sensations in the depigmented patches are normal.
Wood’s light examination enhances the contrast between pigmented and non-pigmented skin. The course is unpredictable, but most patches remain unchanged or enlarged, and a few patches start to repigment spontaneously.
3. Non-segmental Vitiligo - It most commonly occurs on the face, neck, hands, and the areas which are commonly exposed to the sun. It is subdivided into generalized (no specific area), mucosal (lips and mucous membrane), acrofacial (fingers and toes), universal (seen in most areas of the body), and focal (one particular area).
Common areas include:
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Backs of the hands.
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Arms.
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Eyes.
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Knees.
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Elbows.
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Feet.
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Mouth.
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Armpit and groin.
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Nose.
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Navel.
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Genitals and rectal area.
What is the Surgical Treatment for Vitiligo?
General Management of Vitiligo:
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Various modalities have been used to treat vitiligo, which includes phototherapy, photochemotherapy, topical and systemic steroids, immunomodulating agents like Levamisole, calcineurin inhibitors like Tacrolimus, etc.
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Protecting the patches from excessive sun exposure with clothing or sunscreen may be helpful to avoid sunburn.
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Camouflage cosmetics may be beneficial, particularly in those with dark skin, and also topical corticosteroids are highly effective.
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Phototherapy with narrowband UVB or PUVA can be used. Narrowband UVB is the most effective repigmentary treatment available for generalized vitiligo, but even very prolonged courses often do not produce a satisfactory outcome.
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The absence of leucotrichia (white hairs in the area of vitiligo) and a trichrome pattern (three colors – normal skin color, hypopigmentation, and depigmentation) are good prognostic features.
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Vitiligo on the face, trunk, and proximal limbs are more likely to respond than that on hands and feet. Autologous melanocyte transfer, using a range of techniques, including split-skin grafts and blister roof grafts, is sometimes used on dermabraded (skin used in dermabrasion technique) recipient skin.
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The impact of vitiligo differs markedly between populations. For example, in the Indian subcontinent, the effects are more readily visible than in pale-skinned individuals in northern Europe.
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Depigmentation is also seen in Hansen’s disease (leprosy), which means that individuals with vitiligo are often marked out.
Surgical Management of Vitiligo:
Many patients get complete repigmentation with medical treatment, but a vast number of patients do not respond satisfactorily to medical treatment. Hence, the need for surgical treatment is required.
Surgical treatment for vitiligo is indicated when the disease is stable and resistant to conventional medical therapy. The advantage of surgical treatment is that it provides long-lasting pigmentary cover over a short period of time.
There are various surgical modalities, such as-
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Punch grafting.
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Thin split-thickness skin grafting.
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Suction blister grafting.
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Tattooing.
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Dermabrasion.
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Cultured skin grafting.
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Others, including trypsinized autologous grafting, excision, etc.
Surgical treatment for vitiligo is indicated for patches resistant and stable for at least one year of time. If a small area or small patches are depigmented, it can be treated with punch grafting and suction blister grafting. If a large area or large patches are involved, thin split-thickness skin grafting, dermabrasion, and culture techniques like melanocytes transplantation are useful.
What Are the Complications of Vitiligo?
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Sunburn.
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Eye problems.
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Ear problems.
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Excessive tear production.
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Psychological stress.
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Depression.
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Problems with self-esteem.
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Vitiligo is likely to develop other autoimmune disorders, but it is not seen in all vitiligo patients, but some of them may tend to develop any of the following. They are:
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Thyroid problems.
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Hashimoto’s thyroiditis.
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Type 1 diabetes.
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Pernicious anemia.
To know more about the treatment options of vitiligo, consult a vitiligo specialist online.