What is Vitiligo?
Vitiligo (White Patches) - Introduction
All of us are born with Melanocyte, the job of which is to manufacture melanin pigment in the skin, there are two types of cells in the epidermis the Melanocytes and the keratinocytes, the Melanocyte manufacture the pigment melanin which is then stored in the keratinocytes the storage cells in the skin.
So how is it that skin color varies from person to person and also in our own bodies some areas have different skin color like the lips, nipples, is because the Melanocytes in different areas are destined to lay down a particular level of melanin, this is what causes the skin color to vary.
The Melanocytes can also be stimulated with UV light like in sun light which causes more melanin to be produced, and this is what causes temporary skin tanning to occur, once the stimulation stops the cells do not manufacture melanin and the skin color tones down to your original level.
Vitiligo occurs when the Melanocytes are destroyed and hence the skin in that area stops manufacturing skin color and without Melanocytes all of us would be white in color, an exciting prospect for people who spend lot of money trying to become fair, but these same people become distressed when they see vitiligo on the skin.
Symptoms of Vitiligo
The only sign of vitiligo is the appearance of pale to white patches on the body ,in some cases this can be preceded by itching on skin, after a new patch appears, it can
» Increase in size for varying periods of time.
» New patches can appear in other areas of the body.
» Injuries suffered during this period can turn white in color.
This is called the unstable phase of vitiligo a period of time when the disease is very much active inside the body, and can last for months to years.
The only treatment for spreading patches is medical, no surgical option is possible during this period.
Patches can appear on any part of the body may be single,or multiple, may be restricted to one half of the body ,or appear symmetrically on both sides of the body depending upon the pattern of vitiligo.
At times the loss of skin color can happen around all body openings like ears, eyes, nostrils, mouth, umbilicus, anus and penis.
Like I said before Vitiligo can produce either a single patch, few patches or multiple patches on the body, accordingly we can classify it on a simpler level which a common person can understand into
1.Focal vitiligo : One or few patches appear on the body, in focal vitiligo if medical treatment fails to deliver results then Melanocyte transplant offers an excellent cure for it, once the patches have stopped spreading.
Chances of curing these patches are excellent.
2.Segmental Vitiligo : Here like the name suggest a segment of skin is affected by white patches, segmental vitiligo affects only one half of the body never crosses the midline ,does not respond well to medical treatment most of the times and responds very well to Melanocyte transplant surgery.
Chances of curing these patches are excellent.
3.Generalised Vitiligo : Here the patches are symmetrical and appear on both sides of the body, hence one can have patches from top to bottom and on both sides of the body, most common areas affected could be the eyes, bony prominences like elbows, wrist, fingers, knees and foot ,and to top it up patches can also appear on the chest ,abdomen, lips, nipples,& genitals and legs.
These patches can respond well to medical and surgical options, medical works in all the areas of the body that have black hairs and the rest that does not respond well to medical treatment can be finished with Melanocyte transplant surgery.
Chances of curing these patches are excellent.
4.Acro Facial Vitiligo : A Vitiligo pattern all doctors would love to hate.
Here patches develop on fingers ,lips, and feet including the toes, and the chances of curing this with medicine is very poor and with Melanocyte transplant it remains a challenge till date ,for some reasons i have seen a all or none phenomenon with this pattern which means some do very well and some do not get any color at all.
Hence we proceed with caution.
5.Lips : A whole lot of patients come with patches on the lips alone, either upper ,lower or both, and the response to Melanocyte transplant surgery has been good, chances of curing this with medicine alone is poor most of the times.
What causes Vitiligo?
This is like a scientist explaining rocket science to me which i would not understand, to an ordinary citizen who land up with vitiligo, explaining causes of it is complicated, genes, auto immune diseases, and nerves releasing poisons that kill Melanocytes are some of the reasons ,that can kill Melanocytes and produce white patches on skin.
Chemicals have also been implicated to destroy melanocytes the stuff we find in sticker bindis, watch straps, slippers, and even condoms, however here the patches are usually restricted to the areas of contact the chemicals have with the body.
How genes and immune diseases kill Melanocytes are beyond the scope of discussion here and futile as most would fail to understand the mechanisms and is best left unexplained.
What these factors do is to destroy the Melanocyte and this in turn causes white patches to appear, is a simple explanation, the more we try to explain in detail the more confusing this gets, and for the more inquisitive ones the internet provides more detailed and vast information on the causes.
Diagnosis of white patches is always been visual or through woods lamp if in doubt.
This is how patches appear under woods lamp, and this can also help us to differentiate it from other diseases that cause skin to turn white.
When Melanocytes in skin die we get white patches on skin, when Melanocytes in hair follicles in the skin where white patches have developed die we get white skin with white hairs.
Why is this important in treatment is due to the fact that in hairy areas of the body it is the Melanocytes in hair follicles which when medically stimulated migrate to the skin to provide color to skin, hence when you have white patches with white hairs medical treatment can fail to provide color to skin as there is no reservoir of Melanocytes available which can migrate to skin to provide skin color, and surgery becomes the principal treatment to provide skin color once the patches have turned stable.
In this photo of segmental vitiligo one sees white patches and white hairs as well, these do not do well with medical treatment and Melanocyte transplant is a good option.
Another example of white skin with white hairs. this is a case of focal vitiligo.
Progression of the disease.
Once patches appear on one or different areas of the body ,they spread for a variable period of time, then they stop also for a variable period of time depending upon the cause of the disease, hence in a life time it is possible you have a single episode of white patches appearing on the body in which case if cured it become a permanent cure for vitiligo, or there may be a possibility of new patches appearing later on in life which can be treated and cured again if possible, in these patients it becomes a semi permanent cure.
so clinically we have two types of patches
1.Unstable Vitiligo-disease is new ,patches are appearing, spreading, new patches can appear in near future, and any injuries in this period can turn white in color.
2.Stable Vitiligo-here the disease has stopped spreading, new patches do not appear, and any injuries heal with normal skin color.
Why is stability important is because surgery as a cure is available for stable patches only and is not offered when the patches are unstable.
Can the appearance of new white patches be stopped.
A simple answer is no, an analogy would be is it possible to cure fever, -no , can one take a paracetamol tablet daily to prevent fever forever -no because there is no fever to treat and one would get fever whether you try to prevent it or not and one would probably suffer liver damage from prolonged consumption of paracetamol tablet.
The same holds true for vitiligo -once patches have stopped spreading it means the disease though inside your body is silent and not causing further damage to the Melanocytes, once the disease stops killing Melanocyte cure from medical and surgical options becomes a lot easier, once you are cured of your existing patches it means to us you are a normal person not a patient any more,
Will the disease reactivate in all-no in some yes, and if does is there a time limit to this-no ,there are cases where new white patches can appear after 10 or 20 years later,
Does it make sense when you are not suffering from vitiligo disease to stuff yourself with drugs which are not going to remove the disease permanently, all drugs whether allopathic ayurveda or homeopathy can have side effects, some of the ayurvedic preparations which we have got analyzed had higher levels of lead in them ,this was not added to the medicine but came in plants through environmental pollution, lead is known to cause organ damage in humans, so long term medication in an attempt to stop a non existing illness is not worth the risks of causing long term damage to your body, and there is no guarantee that taking medicines for all these years will actually prevent the appearance of new patches in future.
The reason why I explain this is because this is the most commonest question I face in my practice every day.