By Dr. Devraj Dogra, Professor & Head Department Of Dermatology, GMC JAMMU : Vitiligo also called the ‘White spot disease of skin’ is known locally as safaiddagh, phulbahari ,Sveta kishta.The term vitiligo was derived from the Latin word “vitilium” meaning blemish. The Roman physician Celsus first used the term vitiligo in the 2nd century AD.Even the Rigveda mentions vitiligo as ‘kilasa’ meaning white spotted deer. Vitiligo is more common in Indian population affecting from about 0.5 to 9 percent people against the average world prevalence of 0.1 to 3 percent. Besides being more common vitiligo is a bigger concern due to darker skin tone of the Indian population as well as the social stigma and misconceptions prevailing regarding vitiligo in the Indian society.. Several generations of vitiligo patients have suffered discrimination because of unfounded beliefs about vitiligo which are prevalent for several centuries.
WORLD VITILIGO DAY
The world vitiligo day is observed on 25th of June every year aimed to build global awareness about vitiligo,a disfiguring skin disease that can have a significantly negative social and psychological impact on patient’s health. This day is also celebrated to make the people comfortable with the idea of living happily with the disease by decreasing their apprehensions about the disease.
What causes vitiligo?
While the exact cause remains unknown there are various hypotheses laid down to explain the causation like the role of genetic factors, autoimmune phenomenon,neurogenic etiology and role of toxins like phenol and quinones.There are certain other known causes of depigmentation of the skin collectively known as leukoderma which is more commonly the result of contact dermatitis to chemicals like bindi , footwear, burns and trauma.
Presentation of the disease:
Vitiligo is an acquired pigmentary disorder of the skin associated with loss of pigment forming cells known as melanocytes which presents as depigmented or hypo pigmented chalky white or milky white patches limited to skin without any internal organ involvement. It affects both the sexes equally but girls usually develop the disease early. The disease can present at any age but half of the patients have onset of disease before the age of 20 years. Children usually tend to have localized disease and respond well to treatment whereas onset of disease in later years tends to be more resistant to treatment. Any part of the body may be affected but the areas subjected to repeated friction and trauma like dorsal aspects of the hands and feet , elbows , knees and face are frequently affected. Also the disease occurs more in the hyper-pigmented areas of the body like face, axilla, groin, areola and genitalia .Besides skin the hair and mucosal surfaces may also be involved.
Vitiligo is broadly classified into segmental and non-segmental type. Segmental vitiligo follows an early and rapid course and later becomes static. On the other hand non segmental vitiligo occurs late and follows an unpredictable course.
Myths and facts:
There are certain myths regarding the disease which are prevalent in the society like
Vitiligo is a communicable disease while in reality it is neither infectious nor communicable.
Another common myth is that it occurs by intake of fish and milk together however the truth is that it has no relation with intake of milk, fish or both.
There is another misconception that vitiligo is an incurable disease which is not true, it is curable in majority of cases especially when diagnosed early.It has been seen that those patients who are treated early in the course of disease have better prognosis than those presenting late. Thus people should not waste time in going to the quacks and applying indigenous medicines which can actually hasten the disease course. Unbelievable as it may sound but up to seventy percent of cases can be treated successfully with the available treatment forms.
Another rampant belief is confusing vitiligo with leprosy. It should be understood that vitiligo is not leprosy and has no relation to it.These apprehensions of both patient as well as the family members often result in patient being discriminated and looked down upon. In the society. This often has a social and psychological bearing on the patient. Younggirls who have vitiligo commonly face problems like social segregation and marital discord.
Besides other myths one should be aware of the fact that it does not spread by contact and occurs because of destruction of pigment producing cells known as melanocytes mediated by an immunological phenomenon. Rarely, it may be associated with other disorders like thyroid abnormalities, pernicious anemia and diabetes.
Although all white patches are not vitiligo yet considering the nature of the disease it is highly recommended that any white patch should be examined by a dermatologist.
Treatment of vitiligo:
Treatment in vitiligo is based on certain factors like age of the patient, the progression of disease, psychosocial considerations and the affordability and availability of treatment forms. The goal of treatment is to stop the disease progression and to induce regimentation.
While phototherapy forms the backbone of the treatment medical therapy in the form of topical and systemic steroids and immuno-modulators are also used. Newer treatment options includes the use of basic fibroblast growth factor, piperine, PGE2, afamelanotide,capsaicin and lasers. Surgical treatment finds a role in patients not responding to medical treatment and in those with a stable course of disease. It includes taking tissue and cellular grafts from normally pigmented skin and replacing the depigmented areas with them.
In patients not eligible or unwilling for these treatment modalities camouflage may be used for cosmetic purposes by using tanning agents,stains, dyes etc.
Depigmentation therapy is used in cases with extensive vitiligo where small islands left of normal skin are depigmented to match the depigmented skin for a better cosmetic appearance. Avoidance of sun exposure and religious use of sunscreen lotions are extremely important in this group of patients to avoid long term sunlight induced damage and development of skin cancers as the skin is not protected from ultraviolet light due to loss of melanin pigment which has a protective effect against sunlight. (The author is a Skin Specialist, Professor and Head of Department, Govt. Medical College Jammu)