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Vitiligo is a skin disorder that leads to the development of patches of lighter than usual skin. The exact cause is unknown, but it is thought to be an autoimmune-related condition, meaning our body’s defense system starts attacking healthy cells too, leading to loss of pigment and hence patches appearing. Vitiligo develops in people of all ages, and it’s thought around 1% of the world’s population suffers from it, so chances are you know someone who has been affected by this, or you will at some stage in your life! In terms of treatment, there are lots on offer in terms of treatment, from light therapy to turn back the clock with laser technology. I have tried to summarize what works well, why these treatments work, and which one suits certain people the best. So let’s get started!
What is vitiligo?
Vitiligo is a skin disorder that leads to the development of patches of lighter than usual skin. The exact cause is unknown, but it is thought to be an autoimmune-related condition, meaning our body’s defence system starts attacking healthy cells too, leading to loss of pigment and hence patches appearing. Vitiligo develops in people of all ages, and it’s thought around 1% of the world’s population suffers from it, so chances are you know someone who has been affected by this, or you will at some stage in your life! In terms of treatment, there are lots on offer in terms of treatment, from light therapy to turn back the clock with laser technology. I have tried to summarize what works well, why these treatments work, and which one suits certain people the best. So let’s get started!
How can vitiligo be classified?
Classification for Vitiligo is based upon the extent and location of pigment loss:
* Vitiligo affecting less than 10 percent of total body surface area (TBSA) is considered localized. Localized vitiligo may affect part or all of one limb or may affect areas like the face, neck, or scalp.
* Vitiligo affecting 10 to 30 percent of TBSA is considered segmental. Segmental vitiligo can cause depigmentation in patches that resemble the patterns on a Dalmatian’s coat. It most commonly occurs on an arm or leg and rarely affects more than a few adjacent body regions.
* Vitiligo affecting over 30 percent of TBSA is considered generalized. Generalized vitiligo typically causes widespread pigment loss throughout many body parts involving many different types of skin cells called melanocytes. There are also some rarer variations of vitiligo, such as focal, mucosal, and trichrome forms.
How is vitiligo diagnosed?
Diagnosis of vitiligo can be made by appearance alone. Still, a skin biopsy (removal of the affected skin area and examination under a microscope) can also be performed to confirm the loss of pigment. Sometimes, this is requested if atypical features on physical exam or disease progression suggest an alternate diagnosis. It can be essential to rule out conditions such as amelanotic melanoma (a type of skin cancer arising from cells that produce melanin), tinea versicolor (skin infection with fungus), sarcoidosis, or lupus erythematosus. Once these conditions have been ruled out, your doctor will diagnose your condition as vitiligo.
Symptoms of Vitiligo?
Vitiligo commonly leads to one or more depigmented patches on the skin, where the pigment is lost. The affected area of skin may be lighter or darker than normal skin color, and in some cases, may have a contrasting border between normal-appearing skin around it. Sometimes parts of the body exposed to the sun (such as the hands, forearms, feet, and face) will appear slightly darker than surrounding areas with vitiligo. People with dark skin tones might notice that their condition stays about the same color as their natural skin tone, rather than getting lighter with time, like Caucasians who tend to get whiter over time. As you can see, vitiligo causes these patches to appear on the skin, so even if you have small patches, they are still considered diagnosable as having Vitiligo.
How does vitiligo spread?
Vitiligo spreads by extending locally at a rate of about 1 centimeter per month. It can affect larger areas over time. One theory is that melanocytes carrying the gene for vitiligo die or cannot function properly, rather than having their pigment-producing ability wholly destroyed. The decrease in melanin production may be due to cumulative damage resulting from free radicals produced when cells use oxygen. These free radicals can interfere with the synthesis and distribution of melanin pigment within the affected. Other theories include infections or autoimmune processes that may trigger the destruction of melanocytes.
Vitiligo does not spread to other parts of the body or other people, nor is it contagious in any way. It is not life-threatening and has no bearing on one’s intelligence or overall health. Some suggest that vitiligo is brought about by emotional distress, but this view has been discredited by numerous studies showing no correlation between emotional state and the spread of vitiligo.
Now comes the treatment various options treat part vitiligo we will discuss in detail about every vitiligo treatment option:
- Topical treatment
Topical corticosteroid cream is one of the mainstay treatments for widespread vitiligo. Corticosteroids are drugs that suppress the immune system, but they have little effect on melanocytes once they have lost their ability to produce pigment. They can be combined with phototherapy or psoralen+ ultraviolet A (PUVA) therapy as an effective treatment for depigmented patches of vitiligo. It is important to start this treatment early before there is any significant loss of skin color because by the time a lesion has become pale, it may be too late to reverse complete depigmentation. The most commonly used agents include prednisolone acetate 1% cream applied twice daily, and fluocinonide 0.05% ointment applied once daily. Your doctor may prescribe a more potent corticosteroid cream if the lesions are extensive, but they should be used sparingly to minimize side effects.
Topical steroids are safe to use during pregnancy and lactation. However, you must talk with your doctor for proper guidance before applying them to any part of your body, as this will help reduce any further spread of vitiligo.
- PUVA therapy
PUVA (psoralen+ultraviolet A) therapy is very effective in treating widespread vitiligo. It involves ingestion of psoralen, a drug that makes the skin more sensitive to light, followed by exposure to ultraviolet A (UVA) radiation from a particular light source. This type of phototherapy is better suited for widespread lesions that are not responsive to topical corticosteroids or a significant risk of scarring after repigmentation surgery. It has been reported as being successful in more than 95% of patients. Still, the results may take several months before you see any changes in your skin, so it can be a bit discouraging for people who want immediate results.
- Laser therapy
Laser therapy uses unique lamps or lasers which emit highly-concentrated beams of light energy that target and destroy melanocytes responsible for pigmentation on specific areas of the skin, thus allowing surrounding normal skin to show through. The most commonly used laser devices include fractional CO2 lasers, Q-switched alexandrite lasers, Q-switched ruby lasers, and flash lamp pumped pulsed dye lasers. They are usually more influential on smaller areas of vitiligo -especially when they are on parts of the body that are exposed to the sun or on regions with a thick skin such as palms and soles. Although laser therapy is generally safe, some people may experience side effects such as pain, burning sensations, changes in skin pigmentation, and scarring.
Phototherapy involves exposing affected areas of the skin to ultraviolet B (UVB) radiation from artificial lamps or sunlight for short periods each day. It can be combined with PUVA treatment if psoralen takes too long before you see any results. It is usually the first choice of treatment for vitiligo on the face, and it is capable of depigmenting up to 85% of lesions. Still, some people may require long-term maintenance therapy (at least three sessions per week) to prevent repigmentation from reversing.
- Repigmentation surgery
If there are small areas of depigmented patches in your skin, surgical techniques such as punch grafting and melanocyte transfer can be used to restore color to them. Punch grafting removes a circular plug of healthy skin that contains melanocytes and transfers them into the lesion. In contrast, melanocyte transfer involves moving cells that produce pigment from under the fingernails or inside the mouth to the vitiligo patches. The success rate of these therapies can range from 30 – 70 percent for punch grafting and 50-100 percent for melanocyte transfer, but they will also be more expensive compared to other treatment options.
- Topical immunomodulators
Topical immunomodulators such as pimecrolimus cream and tacrolimus ointment work by inhibiting molecules called cytokines responsible for causing inflammation associated with autoimmune skin diseases such as vitiligo. They are effective in depigmenting small depigmented patches that do not respond to other treatments. Some studies suggest that they may result in a longer duration of action than corticosteroid creams.
- Topical corticosteroids
Topical corticosteroids are the most commonly used treatment for vitiligo because they are cheap, easy to use, and safe, but they only work well on small areas of depigmentation. They can cause your skin to become thin and fragile, so you must speak to your doctor about the correct dosage to make sure you do not expose yourself to any unnecessary risks. You should not be using topical corticosteroid creams long term as this may lead to side effects such as skin atrophy, telangiectasia (formation of tiny red lines just under the surface of your skin), striae (purplish stretch marks), acneiform eruptions (acne-like rash), perioral dermatitis (inflammation of the skin surrounding mouth), hypertrichosis (growth of fine soft hair on your body) and hypopigmentation.
- Ultraviolet light therapy
Ultraviolet light therapy involves exposing the skin to ultraviolet A rays from natural sunlight or UVA lamps for short periods each day. It is usually used as a supplementary treatment along with other therapies for treating larger areas of vitiligo. Still, it may be sufficient by itself to repigment small patches of vitiligo. People who can tolerate phototherapy are more likely to respond well than those who cannot, which means that patients with different types of vitiligo will react differently to this treatment option. The side effects of phototherapy include nausea, headache, fatigue, and dizziness. Occasionally, photosensitivity (sensitivity to the light) can occur due to phototherapy, so you should avoid direct exposure to sunlight, and you should inform your doctor if you develop symptoms such as nausea or vomiting.
- Corticosteroid injections
Corticosteroid injections are usually used for treating vitiligo on the hands and feet because topical therapies may be less effective at treating these areas where the skin is thicker than elsewhere on the body. They work by suppressing melanocyte activity in the affected skin, allowing repigmentation to occur over time. However, this treatment option has limitations because it only works well for small patches of depigmentation. The success rate of corticosteroid injections is around 20 percent in patients with widespread vitiligo.
Surgery is not usually the first option for treating vitiligo, but it may be used to treat areas of depigmentation that are resistant to other forms of treatment. The most common surgical procedures include punch grafting, autologous skin grafts, and melanocyte transfer. Surgery can be expensive, painful and it only provides a temporary benefit in some cases.
- Homeopathic treatment
Homeopathic treatment for vitiligo is another way of getting rid of vitiligo. Most of the conventional treatments have side effects, and they do not cure vitiligo permanently. Some of these treatments lead to the pigment coming back without any help from doctors.
Vitiligo is a chronic skin disorder; several treatment options can be used to repigment your depigmented patches, and depending on the type and extent of your condition, you may respond better to one treatment option compared to another. In case if you are looking for one effective treatment for vitiligo, you can book an appointment through OHO Homeopathy and meet a renowned and experienced Homeopathic doctor for further online consultation. They will guide you on what treatment would suit your condition best and provide you with the necessary remedies that may help control vitiligo and treat it permanently. The homeopathic medicines come without any side effects, so if you are looking for a safe way of treating vitiligo, book an appointment right away!