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Key Words
| Antibodies |
Protective
protiens produced by the body's immune system to fight infectious
agents (bacteria or viruses) or other foreign substances.
Autoantibodies are abnormal antibodies that attack a part
of the body and cause autoimmune disease |
| Pigment |
Colouring
matter in the cells and tissues of the body |
| Pigmentation |
Colouring
of the Skin, Hair, Mucous membrane |
| Depigmentation |
Loss
of colour in the skin |
| Melanin |
Yellow,
Brown or Black pigment that determines skin colour |
| Melanocytes |
Special
cells that produce melanin |
The term Vitiligo
is probably derived from the latin word Vitilus - meaning calf
and was first used by roman physician Celsus of 1st century AD,The
characteristics white patches of disease resembled the white patches
of a spotted calf in India. Leukoderma is a generic
name for relatively or absolutely lightened in colour.
Incidence of Vitiligo
About 1-3% of the India's population is affected by Vitiligo.Vitiligo
is most common in the first and second decade of life and 95%
of people develop it before their 40th birthday.
Emotional & Psychological Aspects of Vitiligo
The appearance of a white patch can affect a persons emotional
& Psychological well-being. Patients can experience emotional
stress especially if Vitiligo develops on visible areas of the
body like face, hands, feet or genitals & though it is not
a contagious disease people with Vitiligo feel embarrassed, ashamed,
depressed or worried about how others will react.Patients need
to let their doctors know about their mental status so that appropriate
medical treatment can be given.
Causes of Vitiligo
Various causes are attributted to the disease. some of the common
ones are:
Hereditary
Vitiligo can run in families. Children whose parents have the
disorder are more likely to develop Vitiligo. However most children
will not get vitiligo even if a parent has it and most people
with vitiligo do not have a family history of the disorder.
Auto-immunity
This accounts for majority of the cases where-in the patients
own body produces antibodies that destroy melanocytes. There are
certain auto-immune diseases which are associated with Vitiligo
like:
Hyper Thyroidism (Overactive Thyroid Gland).
Adrenocortical Insufficiency (Decrease in level of Hormone called
corticosteriod).
Alopecia Aerate (Patches of Baldness).
Pernicious Anaemia (a low level of Haemoglobin caused by the failure
of the body to absorb Vitamin B12).
Diabetes Mellitus, Psoriasis.
Segmental Vitiligo
Here the lesion spreads along the course of a particular nerve.
It is thought that the nerve releases certain toxic substances
which may destroy the melanocytes.
Chemical / Contact leukoderma
This occurs at the site of contact of certain chemicals like rubber
gloves containing monobenzylether of hydroguinone, rubber condoms,
bindis, brassiere, watch strap, surgeons gloves, rubber chappal
straps.
Symptoms of Vitiligo
The disease is characterised by the appearance of depigmented
patches(milky white) on the skin, common in sun exposed areas
like hands, feet, arms, face and lips. Other common areas include
armpits, groin, around the mouth, eyes, nostrils, navel and genitals.
Rarely the patches show slight erythema, but as a rule they show
only depigmentation and sensivity to light, the hair may be white
or black but in a particular lesion, when hairy areas are involved
the hair may turn white.
Vitiligo generally appears in one of the three patterns:
Focal Pattern : Depigmentation is limited to
one or only few areas.
Segmental Pattern : Depigmentation develops on
only one side of the body.
Generalised Pattern : Depigmentation develops
on different parts of the body.
Diagnosis of Vitiligo
Clinical Examination
Depigmented patch is usually the diagnostic features of Vitiligo.
There may be a predisposing history of a rash/sunburn or trauma
at the site of patch 2-3 months prior to the onset or History
of auto-immune disease in the family. A biopsy of affected skin
confirms Vitiligo.
Treatment
The primary goal is to restore the function of the skin &
improve the patient's appreance. The choice of therapy depends
upon the number of patches, the size of patch & on patient's
preference for the treatment.
Topical steriod therapy.
Topical psoralen photochemotherapy.
Oral psoralen photochemotherapy.
Oral steroid therapy.
Depigmentation.
Surgical Therapy
Autologous skin Grafts.
Punch Grafts.
Autologous Melanocyte transplantation.
Medical Treatment
Several methods of treatments are available with varying success
rate. The most commonly used is called PUVA therapy where in patient
is given oral/topical psoralens followed by exposure to ultra-violet
light. The success rate is limited (Only 60% achieve more than
30% repigmentation) & difficult areas like hands, fingers,
feet, ankles, lips do not pigment.
Surgical treatment
This should be considered for patients in whom
Vitiligo has not changed over a period of one year.
Failed medical line of treatment.
No New hypopigmented patches should develop in this one year period.
All wound should heal with normal pigmentation.
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