Vitiligo
What is it?
What causes vitiligo?
Contrary to commonly held social stigma vitiligo is neither infectious nor contagious. Leprosy, with which vitiligo is confused by the lay public, is, and although leprosy is on the verge of extinction it needs to be ruled out in a given case. Vitiligo is the slow death of pigment-producing cells (melanocytes) which occurs on account of the complex interplay between genes (some people have melanocytes that are delicate and therefore more prone to damage and this is suggested by a family history of vitiligo), environmental factors (exposure to phenolic compounds in household products, exposure to rubber chemicals particularly curing agents in rubber footwear & sunburns), aberrations in internal health (insulin resistance and metabolic syndrome), nutritional deficiencies (vitamin B12 and vitamin D3), physical trauma and psychologic stress. This results in an immune system malfunction and consequent immune damage to melanocytes. Vitiligo, thus, is a good example of an autoimmune disease. Rarely, melanocytes may be damaged directly by caustic chemicals, or toxins elaborated and released by nerve cells. In summary, the cause of vitiligo is complex and only partially understood.Get Closer with Us
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What is the natural course of vitiligo?
Vitiligo typically starts early in life, commonly in children and in young adults, although it may make its appearance at any age. There is no gender difference. In children, eyelids are the most common site of onset in our experience, and in adults, it starts from sites more prone to wear such as hands, ankles, lips, genitals, etc. However, there are many exceptions and many variations. The onset is always insidious, and vitiligo progresses in severity both in terms of size and number of patches in “fits and starts” with an ever-increasing burden of disease. As a rule vitiligo patches do not spontaneously repigment, except in the early stages of the disease, and sometimes in children.
Types of vitiligo
There are three main types of vitiligo. The most common type (Vitiligo Vulgaris) involves both sides of the body somewhat symmetrically with white patches seemingly randomly distributed on the face, neck, torso, and limbs. There appears to be a predilection for pressure/friction areas (for example, waistband area), in some it is the body folds that are more affected, nipples may be affected, and black hair may turn white (leukonychia, this is regarded as an adverse prognostic sign!). Acro-facial vitiligo, also called Lip-Tip vitiligo, refers to patients who show predominant involvement of hands (especially fingers), feet, lips, and genitalia (particularly prepuce and glans penis in males). Segmental vitiligo refers to vitiligo occurring on one side of the body and confined to one anatomic segment, for example, vitiligo occurring on one arm only and correlating with the known distribution of one or several nerves. The three types may overlap and combine in some instances.
Vitiligo and Diet
We disagree with entrenched notions that sour foods, vitamin C (in foods or as a supplement), white foods (curd/yogurt), fermented foods (pickles, etc) are bad for vitiligo. We allow such foods to vitiligo patients under our treatment. However, we make a case for moderating sugared foods, milk and dairy products (paneer, ice cream), refined carbohydrates (white flour, potatoes, rice, junk foods) from the point of view of insulin resistance which is a major cause of immune system malfunction in our patient population. Is successful vitiligo treatment permanent? We believe it is as we address the underlying immune system directly and indirectly, through medications and appropriate lifestyle optimization. We guide our patients on prevention at the time of discharge from our care.
Management of vitiligo
Vitiligo is treatable, vitiligo is curable. There are two key requirements in successful treatment: arrest the disease expeditiously, this takes 4-6 weeks to achieve; repigment the disease and make the patches disappear, and this takes longer, up to two years, and depends on a number of clinical considerations. In the way, we treat vitiligo patients, those who have the disease for less than six months it is possible to complete their treatment on average in six months. For those vitiligo patients who have a longstanding disease, we are able to give a good estimate of how long our treatment will be and what percentage of the disease will be medically corrected. We treat vitiligo holistically and permanently. Each treatment plan is highly individualized and meticulously executed. We employ combination protocols in which the following drugs are considered:
Hydroxychloroquine (HCQS), Levamisole (Dicaris), Azathioprine (Azoran, AZR), Mycophenolate mofetil (Cellcept, MMF). Oral steroids are used for young children and, very occasionally, for galloping vitiligo in adults. Topical treatments are combined with oral medications and include Tacrolimus/ Pimecrolimus, steroid creams, psoralens (Melanocyl ointment), and pseudo catalase (Vitix Gel). Natural sun exposure or phototherapy (Narrow-band UVB) are included. We do not recommend oral psoralens (Methoxalen, Trisoralen, Melanocyl tablets) particularly in children but also in adults for concerns about premature cataracts. We perform vitiligo surgery (autologous melanocyte transplantation, punch grafts) in our clinic for residual vitiligo that fails to repigment with medical treatment. We offer and supervise complete depigmentation treatment in highly selected patients where such an option is requested and chosen by the patient.
Assessment of vitiligo
There is no specific diagnostic test for vitiligo. A Wood’s Light (blacklight) examination in a dark room is routinely performed to confirm the loss of melanin pigment in the white patches. A histopathological test (skin biopsy) is sometimes performed to rule out skin diseases that may mimic vitiligo. Blood tests are routinely done at Sparsh Skin Clinic to assess the immune system and to know possible reasons for immune system disturbance. Blood tests also detect underlying nutritional deficiencies and establish the baseline health parameters that help select and monitor drug treatments.