Vitiligo (Safed Daag) is a Skin disease manifested by Depigmentation (loss of colour) of skin. Skin colour mainly depends on pigments present in the skin, among them, the most important pigment is Melanin, which is synthesized by Melanocytes, apart from the presence of several Chromophores. Melanocytes are present in the basal layer of epidermis. They contain discrete organelles called Melanosomes, which actually synthesize Melanin. Apart from pigments of skin, even blood flow in the skin also determines its colour.
Vitiligo is an Autoimmune Hypopigmentary disorder, which manifests lack or destruction of Colour producing cells (melanocytes). The cause of Vitiligo is not exactly known, and there are different patterns of Vitiligo which may have different etiology. Defect in Vitiligo is usually Melanocytopenia. As it is an autoimmune disease, no exact cause can be identified, yet different theories have been introduced which can be the cause of Vitiligo. These include- Genetic Factors- which means Vitiligo patients may have a Positive Family history (20-30%), which means it can run in Families.
Immune Hypothesis states that there is evidence which points towards autoimmunity, which means our own Immune cells destroy Melanocytes resulting in destruction of melanocytes. Neural Hypothesis states that there may be certain toxic neurotransmitters that destroy melanocytes. Even Free Radical Hypothesis mentions that there may be presence of oxidative stress which can interact with the intermediates in melanin synthesis, again resulting in destruction of Melanocytes. Clearly suggesting that there is no pinpoint cause of Vitiligo, which can be prevented.
Vitiligo is increasing at a high rate in the world, affecting about 1% of the people throughout the world. The incidence of Vitiligo in India is also quite high, varying in the range of 3%-4%, and as high as 8.8%. (as per IJDVL). There is no certain age group or gender for Vitiligo, it can affect all ages and races, and however peak incidence is between 10 and 30 years. Vitiligo can affect any part of the body, however areas subjected to repeated friction and trauma are more frequently affected (like upper side of hands and feet, elbows, knees), characterized by Depigmented Macules, chalky white in appearance, having concave or scalloped borders. Hairs on those patches may sometimes lose their colour which is known as Leukotrichia, which is associated with poorer prognosis. We should note that the hairy areas of the skin show good results to the treatment, while non-hairy areas are difficult to treat.
Vitiligo presents with different patterns, it can be Segmental- which commonly occurs in children, and is not associated with an Autoimmune disease, segmental vitiligo is characterized by white patches along a particular segment or dermatome, usually having a stable course. Another pattern is called Non-Segmental which can be Localised (include Focal and Mucosal) and Generalized.
Generalized pattern includes
Vitiligo Vulgaris: It is the most common type of vitiligo. It may be slowly or rapidly progressive. Bilateral symmetrical patches are present, which means that white patches are present on both sides of the body at the same places.
Acrofacial Vitiligo: It involves areas like periungual area, palms, soles, tip of fingers, lips, around eyes. Also known as Lip-Tip Vitiligo. This form is usually very difficult to treat.
Vitiligo Universalis: It is a widespread Vitiligo involving more than 80% of Body surface area.
Vitiligo can be associated with other disorders- like Hashimoto’s Thyroiditis, Hypothyroidism, Diabetes Mellitus, Pernicious Anemia. Long Standing disease, associated with other Autoimmune disease, Leukotrichia, Acrofacial patches , patches on Resistant areas like bony prominences, non hairy areas like elbows,lips, finger tips etc. , all these are associated with poor prognosis. Although there is no particular treatment to cure the disease, the main management of doctors is to prevent its progression.
Though vitiligo is a painless disease, the disease is highly concerned with psychological stress for the patient. There is more of a social stigma attached to it. Vitiligo is bringing great psychological tension to the patient; Patient feels embarrassment in society which shouldn’t be. Anyone having Vitiligo, should embrace themselves, they should not lose self-esteem. General people should accept the Vitiligo patient wholeheartedly, Please remember Vitiligo is not a Contagious Disease, It cannot spread through any means.
Every patient of Vitiligo, you shouldn’t need to feel alone, you shouldn’t be depressed, you shouldn’t lose your confidence, It’s just a disease which can affect anyone in the world, It can’t describe your Character. It can be treated, you should not lose hope, you should never feel ashamed or rejected. The Social Stigma should be stopped, and there should be no difference between vitiligo patients or normal people.
Present treatments have shown very effective results. Topical medications like Calcineurin Inhibitors (Tacrolimus, Pimecrolimus), Topical Psoralens. Systemic Medications are used like corticosteroids (Prednisolone etc), cyclophosphamide, Methotrexate, Immunomodulators( Levamisole). Currently one of the most effective therapy is present, which is known as Excimer Laser(308 nm Xenon), which is one of the best treatments, and most effective. Besides other photo therapies like Narrow Band UV B, PUVA are also present.
Surgery can be done only if vitiligo is stable means when white patches are not progressive for almost 2 years. Surgery includes Grafting, Melanocyte Transfer. FDA has announced the approval of Opzelura(RUXOLITINIB) cream for treatment of Non Segmental Vitiligo. It is the first FDA approved pharmacological treatment for repigmentation in vitiligo patients. At the end of the 24-week treatment period, 30% of Opzelura patients had at least 75% improvement in the facial Vitiligo Area Scoring Index, compared with 10% of placebo patients.
We should never ignore any white patch on our body, whether small or large. Any of the small or slightly white patches can be a warning sign. We should take note of every white patch if present on our body and consult a Dermatologist as soon as possible. The disease can be treated better at initial stages, so never delay the consultation with your doctor.
Stop Social Stigma..!
Keep Spreading knowledge, Stay Healthy.
(Author is 5th year Medical Student: Email- [email protected])
