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Vitiligo

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Vitiligo also known leucoderma or white spot disease is a pigmentary disorder where the skin and mucosa lose its pigment.  It affects 0.5 to 1% of population.  Gujarat has the highest prevalence in the world with 8.8% of population affected. It affects both men and women equally though women are more likely to seek treatment.  There are well defined depigmented lesions which can affect any part of body. It occurs due to destruction of melanocytes (pigment producing cells). In occur at any age. It is genetically determined. The exact cause of vitiligo is not known. Autoimmune causes, neurogenic disturbance and oxidative stress are suspected causes.

Vitiligo lesions may be itchy. There is an increased chance of sunburn hence these lesions should be protected from the sun( by covering the lesion or application of sunscreen).

Types of vitiligo:

There are three types of vitiligo: localised, generalised or universal.

Localised : It can be focal or segmental.

Focal vitiligo is a single lesion which can occur in any part. It may remain stagnant or completely repigment. It could also be a part of evolving progressive vitiligo.

Segmental vitiligo :  It affects a specific part or segment of the body. These lesions do not usually spread beyond their segment. They have sharply defined margins and have many shapes and patterns.  It can affect any body part though it is more commonly seen on head and neck area and trunk. 

Features of segmental vitiligo:

  • White hair (leucotrichia) is present within and outside the lesion
  • Becomes stagnant in size after a growth phase which lasts for around 1 year
  • Respond well to surgical therapy (ie suction blister grafting, melanocyte transfer)
  • Respond poorly to medical therapy such as topical creams, ointments and oral medicines.

Generalised

They can occur in any part of the body and are not confined to a particular segment. They have varying rates of progression. Generalised vitiligo are of three types: vitiligo vulgaris, acrofacial vitiligo or mixed.

Features:

  • Usually symmetrical
  • Increase in size with time
  • May affect only face and limb ( acrofacial vitiligo)
  • May affect fingers, wrists, axillae, groin, mouth eyes and genitals (vitiligo vulgaris)
  • Medical therapy can bring about variable amount of improvement in pigmentation
  • Surgical therapy can be given in stagnant lesions where there has been no progression for a period of atleast 1 year.
  • Occurs at sites of friction or injury

Universal
There is global loss of melanocytes from the entire skin and mucosa.

Associations of vitiligo:

Vitiligo maybe associated with thyroid dysfunction and other autoimmune disorders

Important: Many patients are made to believe that vitiligo is related to diet. They have many restrictions on food. There is no scientific proof to suggest the relation between diet and vitiligo. Hence, we strongly advocate against following any such dietary restrictions.

Vitiligo at Dermafollix:

  • Educate the patient regarding prognosis and outcome
  • Precautions to be taken
  • Medical therapy to halt progression
  • Phototherapy to cause repigmentation and halt progression
  • Surgical therapy: punch grafting, suction blister grafting, Split thickness grafting and melanocyte transfer.