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VITILIGO / LEUCODERMA (January, 2003)

VITILIGO / LEUCODERMA.

An acquired disease of skin, in about 1% of population, wherein "milky white patches" occur on the skin. Often more than one member in a family may suffer. It may follow a serious illness, acute mental stress, some minor or repeated injury or excessive exposure to sunlight. White patches often occur in burn scars too.

Why, How, When & Where?
Why? Several ingenious theories have been postulated, but none conclusively proved. Usually starts before 20 years of age, in sun exposed parts like face, back of hands etc. "Milky white" patches appear, gradually increase over several years and then stabilize. Even minor injuries in such a person may cause additional patches. Hairs in affected areas may be black or may turn white too. There is no pain, itching or other symptoms; it is purely a cosmetic problem. It is NOT A CONTAGIOUS disease; but such people are often looked down upon in society. It is often mistaken for and confused with the more dreaded Leprosy.

Vitiligo on face
A patient with vitiligo on Face

What to do ?
Reassure the patient, all family members AND THE PUBLIC AT LARGE, that it is an absolutely harmless and non contagious disease. In up to 20%, spontaneous regression and cure may occur. Small patches respond well to topical steroid applications alone. Larger patches or spreading lesions need to be treated more aggressively by one of 2 methods :

Oral PUVA: Taking psoralen tablets orally & exposing patches to sunlight after 2 hours.

Topical PUVA : Application of topical psoralen and exposing the area to sunlight for 5 minutes. When the white patches are rapidly spreading, oral steroids can be given to arrest the spread of the disease. In very extensive lesions, bleaching creams are applied over normal pigmented skin. Treatment needs to be continued for several years.

Two months post punch
grafting
Two months post graft
skin still growing

Surgery for Non-responders or quicker relief :
Any dermato surgery or cosmetic surgery for vitiligo should only be done when the patches have been stabilised for about 2 years.

Following are the techniques available :

  • Cosmetic tattoing : This involves implantation of minute pigment granules manually or using a electrically driven tattooing machine. It produces long lasting, often permanent relief.
  • Skin Grafting : This is done in one or more sittings, usually under local anaesthesia, by one of several techniques available. Thiersch's skin graft is a very thin skin graft applied over abraded vitiligo patch. Small areas of thin skin may be harvested by "suction blister technique" Miniature "punch grafting" is yet another method.
  • Regional dermabrasion using manual or electrical abraders are suitable in some instances.
  • Skin culture techniques are now possible. These grafts containing keratinocytes and/or melanocytes can be used for implantation.
  • Needling &
  • Spot chemical wounding are two other simple multistaged out patient procedures available.
  • Keratinocytes grafting using very thin skin graft, sliced and mashed is applied over an abraded patch.
  • Excision and plastic surgical reconstruction using an adjacent flap or split skin graft is suitable in some cases.

Conclusion:
Vitiligo or Leucoderma is a harmless non contagious skin disease. Upto 20% lesions regress spontaneously. In others, treatment is advised purely for cosmetic reasons. Prolonged medical treatment is effective in quite a few patients. In others, several cosmetic procedures are available with fairly good results in many of them.

Dr. Anuradha Rao, MBBS,DNB(Dermatology),

Consultant Dermatologist & Cosmetologist, Bangalore.
E-mail: anu.sanjay@gmail.com


 


 

 

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Updated on 01.01.2003.
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