Vitiligo also known as leucoderma, simply means white (leuco) skin (derma), that is a disorder where the skin loses its normal color. Due to destruction of the melanin (pigment) cells due to lesser known processes (largely what is called as an auto-immune disorder) the normal skin starts loosing pigments from various parts of the skin, in a varying speed and extent.
Treatment of vitiligo usually takes a long time. In certain cases treatment helps arrest the spread of de-pigmentation and may bring back the pigmentation in some cases. In majority of the cases, medical therapy only achieves stabilization of the spread but re-pigmentation does not occur. To achieve re-pigmentation where the vitiligo is stable and does not spread various dermato-surgical techniques are used.
Symptoms
Vitiligo is a milky white de-pigmented spot or spots that may vary from a single white spot to multiple spots on your skin. It varies in shape and sizes. In some cases generalized de-pigmentation is observed all over the body. It has a tendency to start as a single spot and gradually grow in size and number. It may be present with a single or several spots on limbs or abdomen or back and then spreading to other parts of the body.
Causes
The exact cause for the pigment disorder remains unknown. However, there are theories suggesting
There are factors, internal and external, which either predispose or trigger or maintain the process which leads to development of vitiligo.
The familial incidence of 20 to 30% is observed in the family members. If one or more of the parents have vitiligo, there are more chances of one developing the same. However, it is not a rule. At the same time, numerous cases of vitiligo do not have a relevant family history of Vitiligo.
Laser Treatment
PUVA is an acronym for psoralen, a light-sensitizing medication that helps enhance skin re-pigmentation. An oral or external application psoralen compound is given to the patient. The de-pigmented patch on his body is exposed to Ultraviolet-A (UVA) rays for a specific duration. Alternative to UVA is exposure to sun rays. The latter is known as PUVA SOL therapy. Treatment with UVB rays is another option. The most recent treatment is the use of Excimer laser.
Surgical methods
Different methods are available and selection of the appropriate surgical technique for the best results.
Miniature Punch Grafting
Multiple thin grafts of 2 - 2.5 mm diameter are taken from the donor site by special punches and grafted on to the diseased area. Once the grafts are 'taken up' the patient is advised to take PUVA or PUVA SOL. Re pigmentation occurs in 3 - 6 months and good cosmetic result is obtained.
Ultra thin Skin Grafting
An untra thin skin graft consisting of epidermis is grafted onto the laser ablated part of stable vitiligo. The graft falls off in a week to 10 days but there takes place a cellular uptake of melanocytes on to the abraded skin which gradually starts pigmenting. It takes 2 - 3 months for the pigmentation to merge and match with the surrounding skin color.
Suction blister grafting.
A prolonged suction (negative pressure) is applied to the donor site this raises a large bleb and a thin graft containing only the epidermis is obtained. This is grafted on to the dermabraded recipient surface. This technique is time consuming but gives good cosmetic results.
Melanocyte culture and transplantation
Melanocytes are cultured in artificial culture media. The de-pigmented recipient site is dermabraded or laser ablated and the melanocyte suspension is applied to it. The area is covered with a collagen dressing and immobilized. Large areas can be covered with this method and excellent cosmetic results obtained.
Tattooing.
Tattooing is injecting artificial pigment into the depigmented area. After selecting the pigment shade which matches the surrounding skin color, the pigment granules are implanted into the depigmented patch either with a manual or electrically driven needles.
Though the patch resembles the surrounding normal skin, it may permanently fade or acquire a bluish hue after 1 - 2 years which is distinctly noticeable and may become unacceptable. Hence, tattooing is usually not advised unless the patch is in an inoperable site.
A small percentage of patients who receive more than 250 PUVA treatments could develop squamous cell cancers of the skin, though considered treatable.
The other Cosmetic Procedures are:
Few Popular Hospitals for Treatment of Vitiligo are:
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