#vitiligo - an overview on diagnosis & treatment. Font: Globale Dermatologie

Vitiligo is a skin disorder which presents as white spots and patches on the skin. This is due to a progressive loss of the pigment, melanin, which gives us our skin colour. The loss of pigment occurs when pigment cells (melanocytes) are destroyed and melanin cannot be produced. Vitiligo is not contagious.

Common sites affected include:

1. Bony surfaces – back of hands and fingers, elbows and knees.
2. Around body orifices – around the eyes, mouth and nose.
3. Body folds – armpits and groins.
4. Others areas – legs, wrists, nipples and genitalia.

Vitiligo may also develop over an area of injury such as a cut or burn. Hair within the affected patch will be white too.

The causes of vitiligo remain unknown. However patients with vitiligo have a higher incidence of association with diabetes mellitus, thyroid diseases and other autoimmune diseases. Skin biopsy may be necessary for the right diagnosis. Some chemicals can destroy the skin pigment cells leading to vitiligo-like skin lesion. Avoiding the contact with such chemicals is important (like some bleaching creams).

Several forms of treatment are available but the response to treatment varies from one to another; it also depends on the affected site.

Treatment options:

• Corticosteroid creams: potent corticosteroid creams are effective in some patients, but regular monitoring by the doctor is necessary to prevent side effects.

• Topical immunomodulators, such as tacrolimus and pimecrolimus ointments, twice daily on the affected areas.

• Psoralen photochemotherapy(PUVA): 

This kind of treatment involves the use of a drug called Psoralen (P) and the exposure of the skin to UltraViolet light A (UVA) – hence the tern PUVA. Psoralen makes the skin temporarily more sensitive to UVA; it can either be used as lotions or as oral tablets. When the lotion is used with subsequent exposure to UVA, the treatment is known as topical PUVA. If the oral tablet is used, it is called oral PUVA. Generally, topical PUVA is used to treat vitiligo affecting limited skin areas.

Patients treated with PUVA must be prepared to undergo therapy for a year or longer for maximal results. Close medical supervision is necessary. The use of psoralen lotion followed by exposure to sunlight may be risky and unreliable as the amount of UVA in sunlight varies from day to day. Artificial sources of UVA used under proper supervision are preferred.

• Camouflage cosmetics: some cosmetics can provide very good colour camouflage and are particularly useful for white patches on the face and back of the hands. A special tanning chemical (dihydroxyacetone) which does not require sunlight, is also available to camouflage the patches of vitiligo.

• Sunscreens: areas affected by vitiligo are very prone to sunburn as they lack the protective pigment. Broad spectrum sunscreens must be used on affected areas which may be exposed to sunlight.