Vitiligo ( Leukoderma / White patches )
Vitiligo ( Leukoderma / White patches )
Vitiligo ( Leukoderma / White patches ) – Vitiligo Treatment, Leukoderma Treatment, White patches
It is a skin condition of white patches resulting from loss of pigment. Any part of the body may be affected. Melanin, the pigment that determines color of skin, hair, and eyes, is produced in cells called melanocytes. If these cells die or cannot form melanin, the skin becomes lighter or completely white. Affected skin is particularly sensitive to sunlight.
This disease affects an estimated 1% of the world’s population. It affects individuals of all ethnic origins and both sexes, but is much more easily noticed on darker skin as areas that fail to tan. It is hereditary in one third of those affected. Vitiligo often starts on the hands, feet or face, and frequently pigment loss is progressive. Half the patients first notice vitiligo before 20 years of age. It often appears in an area of minor injury or sunburn.
The diagnosis of vitiligo is usually straightforward, and no special testing is needed. While vitiligo is a cosmetic problem and does not affect the health directly, it is disfiguring and may be psychologically traumatic.
Clinical symptoms and signs
White patches on the skin are the main sign of vitiligo. The patches may be on the hands, feet, arms, face, and lips. Other common areas for white patches are:
The armpits and groin
- Around the mouth
- Rectal areas.
In addition to white patches on the skin, People with vitiligo often have hair, eyelashes, eyebrows, and beard that turn gray early. Those with dark skin may notice a loss of color inside their mouths.
Vitiligo generally appears in one of three patterns:
Focal pattern: the depigmentation is limited to one or only a few areas.
Segmental pattern: some people develop depigmented patches on only one side of their bodies.
Generalized pattern: but for most people who have vitiligo, depigmentation occurs on different parts of the body.
Vitiligo treatment is aimed at stopping the spread of depigmentation and repigmenting areas of skin where color has been lost.
The choice of treatment depends on the spread and variance of the disease and access and preference of treatment for both patient and physician.
Current treatment options for vitiligo include medical, surgical, and other treatments. Most treatments are aimed at restoring color to the white patches of skin.
Medical treatments include:
- Topical medicines (such as steroid creams) that you put on the skin
- Light treatment using oral psoralen medicine plus ultraviolet A (UVA) light (PUVA) or specific wavelengths of ultraviolet B (broadband or narrowband UVB)
- Removing the color from other areas so they match the white patches (Dipigmentation).
- Topical Steroid Therapy
Steroids may be helpful in repigmenting the skin (returning the color to white patches), particularly if started early in the disease. Corticosteroids are a group of drugs similar to the hormones produced by the adrenal glands (such as cortisone).
The surgical treatments options are Melanocyte transplants, skin grafts , and Micropigmentation (tattooing)
It is the most advanced surgical method to treat vitiligo / leucoderma. Large areas can be treated. Repigmentation occurs in about 4 to 6 months and cosmetic results are superior to other surgical methods such as skin grafting and punchgrafting. Difficult areas like bony surface, areola, genitals and knuckles can be treated with excellent results.
The Procedure details
- First the medical history is taken and thorugh examination is done.
- In the operation theater, a thin shave biopsy of the skin is taken under local anaesthesia. This is taken at the top of the thigh.
- The biopsy is processed using an enzyme to separate the layers of skin and to make a skin cell suspension. This suspension contains melanocytes which produce the skin colour melanin.
- The area to be treated is gently abraded with dermabrasion, once again under local anaesthetic, and the skin cell mixture is applied. The skin cells immediately attach themselves and the healing and repigmentation process begins. The cells can do no harm as they are autologous ie the patient’s own cells.
After Procedure care
The treated site is protected by a dressing for one week. Depending on the site that was treated, no further dressing is required and you will need to follow the instructions that were given. There is usually no bruising or swelling. Some patients may feel minor discomfort at the biopsy and treated site for a few days which can be treated with a mild painkiller if wished. Recovery is remarkably quick.
When dressings are removed the treated area appears bright red. Repigmentation is seen after 4 to 6 weeks in brown skin population and 8 to 12 weeks in Caucasians. It takes about 6 months to achieve maximum results.
Complications & Side Effects
- Scarring and Koebner’s phenomenon are rare complications.
- There may be a hypopigmented ring at the borders of treated and repigmented patches in some patients. Usually this ring disappears automatically or with application of local steroids, or by repeat surgery.
- Skin infection. The oral antibiotics are prescribed for 7 days to prevent chances of infection.
Advantages Of Melanocyte Transplantation
It is a day care procedure. Patient can go home in 3 to 5 hours.
- A large area can be treated in one operative session.
- A very small piece of normal skin is sufficient to treat large affected area, e.g. 10cm2 of donor skin is enough to treat
- 100 cm2 of vitligo / leucoderma patches.
- Very good cosmetic results.
- Repigmentation is seen in 2 months and may take 4 to 6 months for maximum improvement and proper color matching.
- Very minimal or no side effects.
- No postoperative phototherapy required.
Autologous skin grafts:
In an autologous (use of a person’s own tissues) skin graft, the doctor removes skin from one area of a patient’s body and attaches it to another area. This type of skin grafting is sometimes used for patients with small patches of vitiligo. The doctor removes sections of the normal, pigmented skin (donor sites) and places them on the depigmented areas (recipient sites).
Skin grafts using blisters
In this procedure, the doctor creates blisters on the patient’s pigmented skin by using heat, suction, or freezing cold. The tops of the blisters are then cut out and transplanted to a depigmented skin area.
Tattooing implants pigment into the skin with a special surgical instrument. This procedure works best for the lip area, particularly in people with dark skin.
When is the patient fit for surgery ?
When the de-pigmented patch does not increase in size for a period of two years, it is said to be stable. This is the right time to perform vitiligo surgery.
What are the various surgical modalities available ?
Method to be used depends on the type and site of lesion. Hence, selection of the appropriate surgical technique is important for good cosmetic results.
- Miniature punch grafting.
- Ultra thin skin grafting.
- Suction blister grafting.
- Therapeutic spot or regional dermabrasion.
- Melanocyte transplantation.
What is 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.
What is ultra thin skin grafting?
A very thin skin graft (ultra thin) consisting of epidermis is grafted onto the dermabraded or laser ablated part of stable vitiligo. The graft falls off by 8 -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.
What is 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.
What is Melanocyte 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.
What is 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.