Can vitiligo be treated?

Here are the causes and treatment options for vitiligo

Vitiligo is a common skin disorder which is also referred to as 'white leprosy' or 'leucoderma.' Because of a limited understanding about vitiligo, people suffering from it often have a low self-esteem and experience social isolation to some extent. Plus, there are a lot of misconceptions associated with vitiligo, like it is contagious and nothing can be done about it.

If you are suffering from vitiligo, you should realize that:

• Vitiligo is not a life-threatening condition but it can be a life-changing event.
• It is not transmitted in any form, but it can gradually spread to other parts of your body.
• There is no cure for vitiligo but the spread of white patches can be controlled and skin color can be restored to some extent using medicines, alternative therapies and surgeries. (Read: Vitiligo Awareness Day 2013:Vitiligo myths busted)

What causes vitiligo?

Vitiligo is a skin disorder in which the cells (melanocytes) that make the skin pigment called melanin are damaged. Melanin is a pigment responsible to give the skin its normal, brown color. Lack of melanin gives rise to white patches on the skin. In the initial stages, white patches (depigmentation) appear on specific areas such as the hands, feet, face and around the lips. Later, they appear in the armpits and around the eyes, nostrils, navel and rectum.

The exact reason for destruction of melanocytes is not known. But, researchers suggest that it has something to do with the immune system. Evidence suggests that a combination of factors such as autoimmunity, in which immune system acts against the body's own tissues, genetic aspects and environmental aspects may cause vitiligo.

Research has shown that people suffering from vitiligo have a group of 3 genes that increase their susceptibility to destruction of melanin. It has also been found that cells of the immune system produce certain chemicals (cytokines) that alter the pigment-producing cells causing their death. Studies also suggest that melanocytes under certain conditions may destroy themselves. (Read: Delhi doc cures Kenyan man's vitiligo)

What is the best treatment option for Vitiligo?

The main intention of any treatment option for vitiligo is to improve its appearance. And, the recommended treatment depends on the amount and type of white patches, their size and location, and the extent to which they are spread. But, ultimately it also depends on what works best for you and what you prefer because every patient with vitiligo may respond to the treatment differently.

Currently, options for vitiligo treatment include drug therapy, surgery, alternative therapies like homeopathy and ayurvedic therapy.

Read more about causes, symptoms, diagnosis and treatment of vitiligo.

Medical Treatment:

• Topical creams: There are various creams and gels containing corticosteroids, such as acetonide, that can be helpful in restoring the skin color, especially if used in initial stages. But these creams can cause side effects like shriveling of skin and appearance of streaks on the surface of skin.

• Depigmentation or Bleaching: 'In extensive vitiligo with scattered pigmented islands of skin and without any hope of recovery, removal of the remaining pigment to give the skin a uniformly white appearance may be cosmetically desirable,' says Dr Jaishree Sharad, Medical Director & Cosmetic Dermatologist at Skinfiniti Aesthetic Skin & Laser Clinic, Mumbai and Vice President of The Cosmetic Dermatology Society of India (CSI). 'Depigmentation may be achieved by using monobenzyl ether of hydroquinone (monobenzone),' she adds further.

• Psoralen photochemotherapy: This is an effective treatment in which white patches are repigmented using psoralen, a drug containing substances that react with UV light to darken the skin tone. The drug is either taken orally or can be applied topically.

Surgical treatment

Surgical techniques may be recommended when medical treatment is ineffective. These include:

• Skin grafting: In this procedure, the skin having pigmentation from one part of the body is removed and attached to a part which has white patches. Another type of grafting is done using blisters wherein the doctor subjects a part of normal skin to heat, pressure or cold temperatures for developing blisters. Then the blisters are excised and grafted on the depigmented area. This treatment is called as suction blister grafting.

• Tattooing (Micropigmentation): In this treatment, pigment is delivered into areas of skin having white patches using a surgical tool. It shows good results for lips, especially for people with dark skin tone. But, the pigment may fade with time. Also, there is risk of outbreak of blisters.

• Melanocyte transplants: Here melanocytes and keratinocytes (skin cells) are obtained surgically from the patient and then grown in a culture in the lab. Once grown, the cells are placed on the patient's vitiligo patches.

Dr Sharad says, 'Most cases of localised vitiligo can be reversed with the above mentioned treatments. In case of extensive vitiligo even though the repigmentation is not 100% but with treatment the cosmetic appearance of the patient can be greatly improved.'

Dr Rohit Batra, dermatologist and vitiligo expert at Sir Ganga Ram Hosptial says 'The results of surgical treatment in vitiligo patients are encouraging and patients must not lose hope.' The cost of surgical treatment of a white patch of about 100 sq cm on a patient's hand would cost anywhere between Rs.20,000 and Rs.40,000 in India.

Alternative therapies:

Homeopathy: There are several homeopathic medicines that are believed to enhance the production of skin pigment. The treatment given will be based on understanding of the patient's history and way of living. Although homeopathy holds that vitiligo can be cured completely, it may not work for everyone. (Read: Homeopathy treats white patches safely)

Ayurveda: In ayurveda, the focus is mainly on correcting diet and introducing lifestyle changes. Several home remedies that involve ginger juice, turmeric, mustard oil etc for external application are recommended in ayurveda. However, it may take time to show results.

Other adjunctive treatments:

Other treatments such as light therapy or laser treatment can be used to improve the appearance temporarily. Additionally, there are several things you can do to protect as well as improve the appearance of your skin.

Using sunscreens and reducing exposure to sun prevents tanning. This will help you to reduce the contrast between pigmented skin and white patches. You could use cosmetics to mask a few facial white patches. Self tanning products that contain dihydroxyacetone (DHA) can also be used to camouflage white patches.

References:

• Davinder Parsad, Sunil Dogra, and Amrinder Jit Kanwar. Quality of life in patients with vitiligo
• Jimi Yoon, Young-Woo Sun and Tae-Heung Kim. Complementary and Alternative Medicine for Vitiligo
• National Institute of Arthritis and Musculoskeletal and Skin Disease (http://www.niams.nih.gov)

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