By Dr. Neena Khanna
Vitiligo is a condition characterized by the appearance of white patches on the skin. These patches develop without any previous disease or injury. Melanin, which is synthesised by cells called melanocytes, gives skin its normal colour. In vitiligo, melanocytes do not function properly, which leads to white patches. This malfunctioning of melanocytes can be reversed or improved on its own or with treatment.
There is usually no itching, redness, pain, or scaling, so if you have any of these symptoms before or after the white patches develop, then you probably do not have vitiligo. Loss of sensation is also not a feature of vitiligo. Always remember that there are many causes of white patches other than vitiligo.
Vitiligo can start at any age, sex, or race, and its course is hard to predict. The precise cause of vitiligo is not completely understood. It tends to be more noticeable in individuals with darker skin, although it does not necessarily mean it is more prevalent in this population. Generally, it tends to progress slowly, with periods of stability. However, in some cases, it may progress faster, while in others, it may remain static after a certain point. The hair over the affected patches may or may not turn white. Additionally, new patches may appear at sites of injury. It is worth noting that some patches may improve spontaneously. The process of repigmentation usually begins around the hair follicles initially, and pigment also comes from the surrounding normal skin. As a result, white patches on non-hair-bearing areas and over joints tend to repigment more slowly compared to other sites.
The diagnosis of vitiligo is primarily made through a clinical examination of the patient’s skin. In most cases, additional tests are not required to confirm the diagnosis. However, in certain situations, doctors may choose to examine the patches under a Wood’s lamp, which emits ultraviolet light, to aid in the diagnosis. The Wood’s lamp can help highlight the depigmented areas of the skin by making them appear more distinct. It is worth noting that the use of a Wood’s lamp is not always necessary for the diagnosis of vitiligo, but it can be a helpful tool in some cases.
Vitiligo is not a contagious condition, it cannot be transmitted through physical contact, communication, sharing sleeping spaces, sitting together, or eating with individuals who have the condition. It is not caused or aggravated by food or edible items. Patients do not have to follow dietary restrictions or avoid using milk or milk products, fish, meat, eggs, and sour fruits (orange, lemon).
Vitiligo is not primarily an inherited or genetic condition. While there may be some cases where a family history of vitiligo exists, the majority of patients with vitiligo do not have a family history of the condition. It is not typically transmitted to offspring in a predictable pattern. In fact, the chances of children not having vitiligo when one parent has the condition are generally higher than the chances of them developing vitiligo.
Vitiligo has no effect on the normal functioning of the body. However, some employers are hesitant to hire people with vitiligo, especially if the job involves public dealings. This is a social misconception that needs to be addressed.
Treatment options for vitiligo depend on the extent and progression of the disease. If the vitiligo is localised to a small area or a few patches, creams or ointments may be used as a treatment. When the disease is more widespread, oral therapy may be prescribed. Light treatment, such as narrowband ultraviolet B (NB-UVB) phototherapy or excimer laser, is another option. In cases of residual disease or stable vitiligo, surgery may be considered as a treatment approach.
Most people show a satisfactory response to medical treatments such as topical steroids, phototherapy, tacrolimus, pimecrolimus, etc., and some achieve complete repigmentation with skin colour matching their surroundings. However, it typically takes a few to several months of treatment before this occurs. Lesions on bony prominences and non-hair-bearing areas, like the fingertips and ankles, tend to repigment more slowly compared to other sites.
Surgical modalities can result in good repigmentation rates if performed properly, but they are only recommended for cases with stable disease (no new white patches for at least six months, preferably one year). Multiple treatment sessions may be required in some cases.
During treatment, new lesions may appear, and previously repigmented patches may lose their colour again. This should not cause alarm or imply that the treatment is ineffective. Changing doctors frequently does not provide any added benefit, as most dermatologists are trained to appropriately treat vitiligo.
Apart from medical or surgical treatment, patients should
- Keep your confidence high.
- Use cosmetic camouflage; many patients manage just fine with this.
- Try to ignore advice proffered by all and sundry; it often raises hope without results or causes desperation. Don’t get waylaid by this and try to lead a normal social life.
(The author is a Head, Dept of Dermatology, Amrita Hospital, Faridabad. The article is for informational purposes only. Please consult medical experts and health professionals before starting any therapy, medication and/or remedy. Views expressed are personal and do not reflect the official position or policy of the FinancialExpress.com.)
