HEALTHWATCH
A question of colour
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It is a minor skin problem yet it is considered a social evil. Dr. G.R. RATNAVEL writes about treating vitiligo.
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No Cause For Fear: there are many treatment options for leucoderma. The white patch.
LEUCODERMA, also known as vitiligo, is not a disease but a condition similar to greying of hairs. We don't get worried when our hair begins to turn grey yet leucoderma is considered a social evil. People who have vitiligo are shunned because often any white patch on the body is considered to be leprosy.
Causes unknown
While leprosy is a disease, which causes loss of sensation due to nerve involvement; vitiligo is a disorder, which is not contagious, not harmful, has no complications and is not hereditary. Patients often relate it to diet but this is not true. Diet has no relation to this problem, which is essentially one of pigmentation. Neither is it caused by daily use of soaps, shampoos or deodarant.
In most cases, the causes of vitiligo are unknown. The white patch is caused by a war between the melanocytes and immune cells of the body. Melanocytes are the cells that produce melanin, which determines the colour of the skin.
The melanocytes are absent in vitiligious skin. There are different types of vitiligo — mucosal, segmental, acrofascial or mixed. Only about 20 per cent are resistant to therapy.
Vitiligo on hairy areas responds better to treatment than when it appears on non-hairy parts like the oral cavity.
Treatment
Treatment is of two types — medical and surgical. The first involves use of drugs like psoralens, steroids, clofazamine depending on the site, number of patches and type of vitiligo.
When it is spreading or active, steroids are used to stabilise the condition. With a planned schedule, the patient may not end up with side effects. Psoralen, used extensively along with phototherapy, (also called PUVA therapy) normally cures 60-70 per cent of vitiligo.
After treatment.
When medical management fails, surgery is the only option left. Usually a combination of the two sees about 90 per cent of the cases being cured. Micro punch grafting is the premier therapy where normal skin in transplanted to areas affected by leucoderma. After about four to five months, the areas with the transplant see repigmentation.
Split skin grafting is another technique in which the white patch is covered by skin after it is abraded. This is a fast cosmetic procedure. The failure rate is a little higher than punch grafting. But if the skin graft is accepted, this is the best curative procedure.
Another procedure, which can be called permanent make up, is micropigmentation. Iron oxide pigments of various shades are mixed to match the skin colour and implanted into the skin. This lasts for around 20 years.
A technique in the trial stage is melanocyte culture where melanocytes from a donor area are cultured and then put into affected areas.
With so many options, vitiligo should no longer be considered a dreaded disease.
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