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                                   Overview of Vitiligo 

What is Vitiligo?                                              

Vitiligo is an acquired skin pigmentation disorder, characterized by milky-white or discolored patches, single or multiple on any part of the body. The reason behind this pigmentation is due to the progressive destruction of color-producing cells of the skin called melanocytes.

Vitiligo is also known as ‘white spot’ or ‘leucoderma’ in India, 

Vitiligo is neither life-threatening nor contagious and not a medical disorder. 

What are the Myths and Facts?

However, due to misconception or lack of awareness, a social stigma surrounds the disease; owing to society’s standards of beauty, and the patients often have to bear the brunt of society’s judgment and ridicule. Its high impact on one’s life, patient feel embarrassed and develops low self-esteem and very low confidence levels as well. Let us clarify and bust a few myths about the disease:

It is not a curse of god or genetic, it is familial.

 It is not leprosy or not contagious and it is definitely not leprosy.

It is not due to the wrong combination of food

It does not affect any internal organs, it purely affects the skin 

It is not untreatable, treatable to great extend, and in stable cases, surgery can cure.

Vitiligo is classified into two major forms: 

1. Segmental Vitiligo-appear as unilateral patches in a segmental or band-shaped distribution.

2. Non-segmental Vitiligo- appear as bilateral symmetrical patches, often distributed in an acrofacial pattern involving mostly the exposed area of skin such as face, neck, and hands or scattered symmetrically all over the body. It is the most common type of vitiligo, found in 90% of cases.

Non-segmental vitiligo can further be classified into the following types:

Generalized Vitiligo: This is the most common type of non-segmental vitiligo, is not confined to a certain specific area. 

Acrofacial Vitiligo: This involves the face and acral areas such as fingers or toes…

Mucosal Vitiligo: This appears mostly around the mucous membranes and lips.

Universal Vitiligo: This occurs extremely rare, and the depigmented patches cover most of the body.

Focal Vitiligo: One or a few scattered discrete patches of white patches develop and are mostly found in young children.

Who gets vitiligo?

Vitiligo can begin at any age, the majority of cases between 20 to 30 years; and the prevalence is the same in both sexes. The incidence ranges from 1% to 2% in most populations, but only with the exception of areas such as India and South America it is 8 to 9%, could be due to the impact of genetic and environmental factors. It is observed that 30% of the higher chance of developing vitiligo with the history of the sufferers in first and second-degree relatives.

However, it is commonly found in people who are affected by other autoimmune diseases such as thyroid disease, diabetes, alopecia areata, morphea, myasthenia gravis, pernicious anemia, etc.,

What Causes Vitiligo?

Vitiligo is due to the progressive destruction of color-producing cells of the skin called melanocytes. The reason behind the destruction of melanocytes is not completely understood. It is understood that immunological factors play an important role due to its high association with other autoimmune diseases. The autoimmune disease in which the body’s immune system attacks and destroys the skin cells melanocytes. Other factors such as genes and neurological or combination of all these three, may play a role in causing vitiligo.

In fact, some say that any kind of trauma (physical, mechanical, chemical, emotional) can trigger this de-pigmentation process.

What are the Treatments of Vitiligo?

Vitiligo is a harmless condition, due to social stigma the patient feels embarrassed and develops low self-esteem and very low confidence. Most of the patients due to social pressure adopt treatment.

There are various modalities of treatment. The choice of treatment depends on your age, how much skin is involved, the disease is progressing, and affecting your life.

Many treatments for vitiligo are available – medication, phototherapy, surgical treatments, etc. In the past, the treatment options were few, with the intensive research we can clear vitiligo from 20% to 100% depending upon the disease stability and early treatment invention. The treatment available helps to restore skin color and in some, it ends up making the skin color look more even. As the treatments can have various untoward side effects, they need expert monitoring.

Medical treatment helps to achieve the repigmentation of skin color and arrest the spread of the depigmentation process. In the majority of cases phototherapy is helpful to restore the pigment; and in limited stable vitiligo, not responding to conventional treatment, repigmentation can be achieved by308 excimer and or with surgery.

Herewith we at Clear Skin Centre, before suggesting you with treatment, we will undertake you through a whole counseling process as to what your actual problem is, why are we suggesting this treatment and how is it feasible for you, etc., and regarding the best possible treatment to restore our color. 

Conventional treatment includes topical and systemic medication.

Topical medication: such as topical corticosteroid and most recently used topical calcineurin inhibitors (tacrolimus, pimecrolimus) are most commonly used to achieve repigmentation. 

Systemic Medication: to be added if topical therapy fails to respond or in whom the condition is progressing rapidly. Immunosuppressive drugs such as oral corticosteroid or methotrexate or azathioprine or psoralens and sunlight exposure may be useful.

If Conservative treatment fails, we may need interventional treatment such as phototherapy or surgery to restore the color.

Interventional Therapy: 

Phototherapy: are further divided depending upon the area of exposure and the band of light used.

Conventional Phototherapy:

In this phototherapy process, we expose the patient to the whole body or specific areas such as hand & foot to artificial Ultraviolet A & Ultraviolet B rays. This treatment process may take about 4 to 6 months.

Narrow Band UVB: Here the light is emitted in a narrow band portion of the UVB light range, and has been shown to stop or slow the progression of active vitiligo. It might be more effective when used with corticosteroids or calcineurin inhibitors.

Psoralen +UVA called photochemotherapy: This treatment combines a plant-derived substance called psoralen with UVA light therapy to re-pigment the color. After you take psoralen by mouth or apply it to the affected skin, you’re exposed to ultraviolet A (UVA) light. Psoralen is known to increase the skin’s sensitivity to UV light, including sunlight. 

Targeted phototherapy: Targeted phototherapy is an exciting new technology that seeks to overcome some of the disadvantages with conventional phototherapy. This modality involves the application of light energy directly focused on or targeted at the lesion through special delivery mechanisms. The main advantages are safety, ease of administration, and suitability for difficult to treat areas and in children.

The two most used commonly in the field of dermatology across the globe are:

Daavlin Lumera: The world’s most advanced treatment with specific ultraviolet wavelength targeting the only affected skin without involving surrounding skin. It is most effective, quick, and needs only a few treatment sessions once in four or seven days.

308 Excimer system is a handheld system that uses a 308nm wavelength for intense monochromatic UVB therapy, treating autoimmune diseases of the skin such as vitiligo and psoriasis. The system enables you to apply high, therapeutically-effective doses of monochromatic UVB light while leaving healthy skin unexposed and protected. UVB radiation has an immune-modeling effect which can normalize pathologically altered cellular activities.

2) Surgery:

If phototherapy and medications haven’t worked, some patients with the stable and limited disease may be best suitable for surgery. The following techniques used are:                                                                                                                            

Skin grafting: In this procedure, very small sections of your healthy pigmented skin, transfers to areas that have lost pigment. Possible risks include infection, scarring, a cobblestone appearance, spotty color, and failure of the area to recolor. There are different techniques of skin grafting mentioned below such as:

Miniature Punch Grafting (MPG):

Taking of thin, miniature split thickness of sizes 1.5, 2, or 2.5 mm with skin biopsy punch from normal/pigmented skin usually external part of thighs or gluteus area grafting them in the appropriately punch out chambers at recipient vitiligo site. Basically, this is a kind of skin implant.

Suction Blister Grafting (SBG):

In this procedure, the blisters are created on a donor or pigmented skin; usually with suction, and then the roof of the blisters is carefully removed and placed or transplant on the dermabraded or laser-ablated vitiligeneous site. The pigmented cells from the implant begin to move into the vitiligo area within a week. This re-pigmentation may take about two to three months to complete.

Ultrathin Grafting:

Ultrathin split-thickness skin graft containing the epidermis and the uppermost part of the dermis, grafting them to the dermabraded or laser-ablated vitiligeneous site.

non-cultured melanocyte transplant or Cellular suspension transplant. This is a simple, outpatient procedure, in which some tissue from pigmented skin is taken, put into a solution to separate the cells, to get a rich yield of melanocyte, and then transplanted to the affected area. The repigmentation start showing up within four weeks of the procedure.

Micropigmentation: Micropigmentation is a technique in which rapid instantaneous insertion of minute, metabolically inert pigment granules are implanted below the epidermis for cosmetic and/or corrective enhancement. The process can be performed in vitiligo involving lips, areola, in less than two hours.

All of these procedures are usually completed in one sitting, though large areas may take several sittings. These are outpatient procedures and there is no sort of hospitalization required.

Depigmentation treatment: in those patients with extensive vitiligo with leftover few patches of pigmentation. The skin bleaching with depigmenting cream or cryotherapy or with laser therapy with Q-switched may be used.

As the latest equipment or technology and advanced treatment are the demands of the time. We at Clear Skin Centre bring to you these all at one place, the most advanced, up-to-the-date world’s best technology, and enabling to treat the vitiligo problem under one roof. In fact, if you go on comparing, you will find that we have some of the most popular equipment that is widely used in most of the well-advanced countries.

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