Vitiligo: Types, Causes, Treatment
What is vitiligo?
Vitiligo is a skin disease characterized by the presence of depigmented or white patches over the skin. Overlying hair may also turn white. This could affect any part of the body like the face, hands, lips, or even the scalp or genital area.
What causes vitiligo?
Vitiligo is caused by an autoimmune condition, where the body’s lymphocytes attack and destroy the melanocytes, the cells of the skin which produce melanin (the brown pigment of the skin). Thus, there is a loss of pigmentation, and the skin appears white.
Though the cause is autoimmune, there may be genetic and environmental factors that play a role in the development of vitiligo. Smoking and stress also have a negative impact on the development of vitiligo.
What are the types of vitiligo?
Vitiligo has been classified based on where it is located: generalized (when it is present all over the body), localized or segmental ( when it is present only over a particular area of the body), acral (only on the fingers or toes, and lips). It can be also differentiated as stable (when no new patches have appeared for over a year) or unstable.
What is the medical treatment for vitiligo?
The medical treatment of vitiligo is to help arrest the further spread of vitiligo and to help repigment the skin. These include topical steroid creams, topical immunomodulator creams, and peptide serums. The oral treatment includes steroid and non-steroid immunomodulators. Additionally, oral antioxidants are also prescribed.
What are the laser and light treatments for vitiligo?
- The effect of light on the skin is well described. Narrowband UVB light and UVA light have immunosuppressive effects localized to the skin and epidermis and can be used to help control and repigment the depigmented skin. However, multiple sessions, up to three times a week are needed for 12 to 16 weeks to see improvement.
- Excimer laser light at 308 nm is an effective treatment to help repigment vitiligo.
These treatments can be used alone or in combination with medical treatments or after surgical management to enhance the results. These treatments can be used in stable and unstable vitiligo.
What are the surgical treatments for vitiligo?
The idea of surgical treatments of vitiligo is the transfer of viable melanocytes or cell suspensions from one part of the skin to the area of vitiligo. The area from where the viable melanocytes are harvested is called the donor area. The area of vitiligo where the treatment is done is called the recipient area.
- The cells can be harvested as an Ultra-Thin Split Skin graft, where a thin layer of skin is harvested. However, this can be used to cover only small areas of vitiligo, like on the lip.
- Mini punch grafting was the method used earlier and is largely discontinued due to the availability of newer surgical treatment techniques.
- Non-cultured melanocyte cell suspension technique has now become the gold standard for the surgical treatment of vitiligo. This method uses a cell suspension from the donor area, and it can be used for a recipient area up to 9 to 10 times the size of the donor area.
The drawback of any surgical technique is that they cannot be used to treat unstable vitiligo.
What are the cosmetic camouflage options for vitiligo?
The treatment of vitiligo can be long drawn and some patients desire immediate camouflage to conceal their skin problem. Numerous cosmetic creams that are long-lasting and give significant cover are now available for these patients.
Dermal micro-pigmentation or tattooing for vitiligo is another option for someone who desires quick results.