Vitiligo Disease(Leukoderma) - Detailed Information

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Department of General Medicine

Vitiligo is a non contagious acquired and pigmentary  abnormality of the skin characterised by  sharply defined white patches of variable shape and dimensions  due to partial or complete loss of  pigment-forming cells known as melanocytes  from patches of skin. It is also known as  Leukoderma. The Melanocytes synthesize melanin from the amino acid tyrosine in the presence of an enzyme melanosome. For the production of skin colour melanin is the obligatory  pigment. 

It can affect the skin or any part of your body. It may also affect mucous membranes, Eyes,Inner ear, hair,Leptomeninges and even the inside of the mouth. It is rarely associated with autoimmune,oxidative stress,genetic,neural or viral causes.

Types of Vitiligo

Vitiligo is categorized, into three main types, based on the distribution of the lesions. These categories are further subdivided depending on specific features of the disease.

►Generalised  Vitiligo

• Acrofacial Vitiligo - It occurs on the parts away from the center of the body.
• Vulgaris Vitiligo - In this vitiligo Patches are scattered and widely distributed all over the body.
• Universal Vitiligo - Nearly complete depigmentation is occurs in this vitiligo.

►Localized  Vitiligo

Localized  Vitiligo are Three types

• Focal  Vitiligo - Lesions are limited to one or few areas; It does not progress.Commonly in a pattern parallel to the trigeminal nerve,lies beneath the face.
• Segmental  Vitiligo - Lesions  are unilateral and asymmetric in distribution,develop in  on one side of the body only. Occurs most commonly in children.
• Mucosal  Vitiligo - It mainly affected on the mucous membrane ie,inside the mouth and eyes.

Epidemiology

Vitiligo , the most common  disorder of pigmentation generally affects about  1% of the world population. It does not include sexual, racial or regional differences among the population but is more obvious in those with darker skin.

It can happen at any age 50% of cases diagnosed in those under age 20 years.

Etiology

Etiology is still unknown, cases occur due to combination of immunologic ,neurogenic and genetic factors , but some evidence based pathogenetic hypotheses have been also proposed to explain the environmental factors interact with genes that are inherited , lead to a tendency to induce the destruction of melanocytes  in epidermis.

Symptoms

The main sign of vitiligo is  White patches on the skin.These patches are seen in more common in areas where the skin is exposed to the sun.This patches are initially small, but frequently grow and change the shape. Other common areas  are Nostrils,Eyes,Navel and Genitels. Others  include ;

• Graying or whitening or  of the hair on your scalp, eye lashes and eyebrows.
• Loss of color in tissues that line the inside of mouth.
• Loss or change in color of  the inner layer of eye.

Diagnosis

Differential diagnosis of vitiligo is very difficult. Review of medical history and Perform a physical examination are the main way to diagnosis. For identification and to determine effectiveness of treatment; Ultraviolet light can be used in the early stage of disease.

Once the diagnosis of vitiligo has been made, doctor may want to check for thyroid disease, and other autoimmune conditions that are more common than usual in people with vitiligo. Some times ,the Skin Biopsy is also necessary .

Treatment

There are a number of treatments for vitiligo.The main goal of treating vitiligo is to improve the appearance of the skin. Examples include;

Solar protection - Minimising sun exposure and the usage of protective clothing and sunscreen for rotect against UV radiation.

Camouflage - The use of cosmetics, such as tanning lotions and make-up , to cover up the patches of depigmented skin. Use of  sunscreen with Sun Protection Factor (SPF)of 30 or higher , Also, the sunscreen should shield ultraviolet B light and ultraviolet A light (UVB and UVA). The Sunscreens that minimizes tanning, thereby limiting the contrast between affected and the normal skin. 

Topical steroids-Topical steroids are commonly available and are cheap and effective.In Vitiligo patients, Itmay use in the repigmentation of patches of depigmented skin .They act by suppressing the immune system to prevent the destruction of melanocytes, that slowing the progression of vitiligo and allowing for repigmentation. There may be a chance of side-effects, including ; dilated blood vessels ,atrophy of the skin, andabnormal hair growth.

Immunomodulators- Immunomodulators are relatively new treatment for vitiligo that has similar efficacy as topical steroids. Agents such as pimecrolimus and tacrolimus can be used to reduce the immune response against melanocytes. These drugs down regulate the expression ofdefinite genes involved in inflammation and immune response (interleukins and TNF-α) , allowing for repigmentation to occur.

Skin grafts- Surgeons detach healthy skin from the patients body, or from a donor, and transplant it to the affected area.

Melanocyte transplantation - The melanocyte transplantation means culturing normal melanocytes from a skin sample and transferring the new cells into the depigmented patches.

PUVA therapy  (Psoralen + Ultraviolet light A) or photochemotherapy is a type of ultraviolet radiation treatment. Itis a combination treatment first treat withof Psoralens and then exposing the skin to UVA (long wave ultraviolet radiation). PUVA is effective treatment with a high relapse rate and potential side effects including sunburn ,nausea,blistering etc.

Microphototherapy-In this approach, a narrow band UVB is focused only on the depigmented skin, so that unaffected skin are not exposed to UV irradiation. This therapy requires expensive equipment and trained personnel.

Systemic antioxidant therapy- An abnormal oxidative stress in vitiligo epidermis, the oral administration of antioxidant agents such as tocopherol, selenium, methionine and others, is given for long periods.

Reference

• Vitiligo ; From Wikipedia, the free encyclopedia.
• Diseases and Conditions Vitiligo;  From Mayo Clinic.
• Vitiligo ; American Academy of Dermatology.
• Vitiligo ;Orphanet by Professor Benvenuto Giannotti.
• Vitiligo ; Lighter shades of pale- the histopathology of disorders of pigmentation  ; by  Philip E. LeBoit, M.D.Depts. of Pathology and Dermatology University of California, San Francisco .
• Vitiligo ; From  Right Diagnosis.
• Vitiligo ; Ultraviolet B (UVB) Phototherapy in the Treatment of Vitiligo ; Kelly KyungHwa Park and Jenny Eileen Murase.
• Vitiligo ; American Osteopathic College of Dermatology.
• Vitiligo ;Medscape ;  Vlada Groysman, MD; Chief Editor: Dirk M Elston.