Vitiligo is a common skin disorder, characterized by de-pigmented milky white patches on the skin. It is an acquired disorder, which leads to a chronic and progressive loss of melanocytes from the epidermis and follicular reservoir.

The term Vitiligo was used for first time by a Roman Physician Celsus in the 2nd century AD. The Atharvaveda mentioned leukoderma as a variety of Leprosy (Shwetakushtha) along with a prescription of several herbal remedies. This book dates back to 1400 B.C.

While the current incidence of Vitiligo is not accurate, it is conservatively estimated that it afflicts about 0.5-2% of the global population. That means anywhere between 35 and 140 million people. Vitiligo equally affects both genders and all races. It is also assumed that prevalence is similar throughout the world and in all ethnic groups. However, there is less data to support the frequency of the disease.

Is it Contagious?

It is not! Vitiligo disease is a cosmetic disability and does not spread by touching. However, the patients may often find themselves victims of discrimination and are driven to the depths of despair.

Pathogenesis

An exact cause of the disorder is still unknown. A combination of factors including genetic predisposition, disturbance in the immune system, environmental triggers and other known and unknown exogenous precipitating factors, are thought to be responsible for the development of Vitiligo.

Autoimmunity:

Antibodies in the form of white blood cells (lymphocytes) are formed in the body, which destroys melanocytes (pigment cells). The reason for this is still under cover. Vitiligo is also associated with other autoimmune disorders such as Psoriasis, Thyroid disease, Alopecia Areata, etc.

Neurogenic:

Some observers feel that there is an unknown chemical substance released at nerve-endings, which destroy pigment cells. But, causes still need to be unveiled.

Types & Appearances:

Segmental Vitiligo (SV):

Occurs on one side of the body in a specific pattern. It usually starts early in life, stabilizes quickly and then remains unchanged for the rest of the life or for several years.

Non-Segment Vitiligo (NSV):

Generalized: Patches distributed on both sides of the body symmetrically.

Acrofacial: Affects face and extremities (Lip-Tip variant: patches on the fingertips and lips)

Universal: Affects almost the entire body, with a few spots/islands of pigment.

Focal: A few spots of depigmentation on one anatomic area without any specific pattern.

Mucosal: Involving only the mucosa (mouth and genitals)

Mixed Vitiligo – Segment & Non-segmental:

This is uncommon and a recently recognized variant. This includes an amalgam of any of the above two patterns.

Complete re-pigmentation is unlikely with medical therapies. Surgical treatment gives the optimum results. Recurrence and spread in the same segment are possible but rare.

Why a Vitiligo Clinic?

In a general Dermatology Clinic, it gets difficult to allocate sufficient time for a specific condition such as Vitiligo which requires keen attention. In our endeavour to guide all Vitiligo cases, it is essential to have a super speciality clinic which can do justice to the patients.

To give the best and most reliable information (evidence-based) about Vitiligo/Leukoderma.

To advise the most suitable line of treatment for Vitiligo/Leukoderma

To keep track of latest advancement in the field and encourage patients accordingly.

To answer all questions and doubts of patients and to free them of all the misnomers.

NON-VITILIGO

There are several disorders, other than Vitiligo, which leads to loss of pigment. Some of these disorders are as follows:

A burn is a common accidental injury seen in medical practice. It results in scarring and fairly frequently, hypo or de-pigmentation. Normal pigmentation returns in many patients without any treatment, within about 6 months after complete healing.

Some patients, however, experience permanent hypo/de-pigmented patches similar to that of Vitiligo. This is mainly due to mechanical destruction of melanocytes. To address post-burn Leukoderma, surgical transplantation methods are a perfect option. Any other medical treatment including photo-therapy is likely to be unsuccessful.

This is a hereditary disorder characterized by milky white patches of variable size and shape. These patches are present since birth and remain unchanged throughout life and are located on the front portion of the body (ventral part of the body).

This is a genetic disorder with a complete absence of melanocytes. This disease does not respond to any medical therapy.

Transplantation of melanocytes generally gives excellent outcomes with very good re-pigmentation. On the whole, the surgical method results in excellent results. Lastly, in some cases, non-cultured epidermal cell transplantation also counts as the good option to treat large patches of piebaldism.

This is a localized hypo-pigmented non-progressive lesion, which remains unchanged throughout life. It appears at birth or within a few months of birth. The exact cause of Nevus is not known. Medical treatment, including phototherapy, is not effective. Transplantation methods have been tried to treat this disease with variable results.

This disease can lead to scarred and de-pigmented patches on the face and upper chest. Usually, these lesions fail to respond to medical treatments. There are only two reports in the literature, which show good results with surgical treatment. However, more studies with long-term follow up will be helpful to assess/prove the efficacy of surgical therapies.

Lasers have been increasingly used in dermatology to treat vascular disorders, hair removal, hyper-pigmented disorders, tattoo removal etc. These treatments sometimes lead to white spots. Melanocyte Keratinocyte Transplantation (MKTP) may be used to treat these white patches with excellent results.

Certain chemicals like quinone and hydroquinone results in pigment cell destruction that leads to white spots. These chemicals are present in industry and cosmetics. Occasionally phenol or tricholracetic peeling also lead to white patches. MKTP can be considered to treat such lesions.

Halo nevus consists of a pigmented mole surrounded by a sharply outlined area of de-pigmentation. Although it is often associated with Vitiligo, as a whole, it is a separate entity. Usually, the pigmented mole disappears spontaneously and the de-pigmented area pigments spontaneously. Using transplantation, these nevi can be treated successfully, provided they should be stable.

Medical Treatments

It includes the creams, phototherapy and, on rare occasions, oral tablets. All medical therapies are under medical supervision.

All medical therapies are effective on hairy areas with pigmented hairs. On non-hairy areas such as wrists, feet, ankles and in presence of grey hair, they have very little or no effect...... Read More

Surgical Treatments

Always trust professional dermatologist for surgical treatments.

Melanocyte transplantation is also known as Non-cultured Melanocyte-Keratinocyte Transplantation Procedure (MKTP) is the latest modification in the surgical management of Vitiligo/Leukoderma.... Read More

Skin Grafting: Thin skin samples are obtained with skin grafting knives, and transferred to affected areas after removing epidermis superficially. It uses the equal size of skin, very efficient, but associated with a color mismatch, graft rejection, graft shrinkage, etc.

Epidermal Grafting: Blisters are produced by suction at the donor site. The roof of the blister is cut and grafted onto the affected area after scrubbing the superficial skin. The procedure does not cause any scarring but is more time consuming; blistering may be painful, and only small areas can be treated using this method..... Read More

Mini grafting/Punch grafting: Small punch grafts are implanted 3mm to 4mm apart within minute holes in the Vitiligo/Leukoderma area. This is the simplest procedure, effective, but has the highest proportion of adverse effects, cobblestone effect being most common.

Important Note: It is important to note that since no cause is known, there is no permanent cure for Vitiligo/Leukoderma. The disease can be treated to achieve re-pigmentation of Vitiligo patches, but on the whole, there is no cure from the root.

Depigmentation Treatment

The primary goal of Vitiligo/Leukoderma therapy is to re-pigment the affected skin. However, it is not always possible. All the treatment modalities available for re-pigmentation may fail to achieve it. In this situation, de-pigmentation therapy can be considered.... Read More

Phototherapy

We have a full body chamber unit at our facility. However, you may not always need the full chamber. Depending on the Physician’s advice, you can be treated either using Full Body Chamber or Home Units..... Read More