There are many diseases that can alter the colour of our skin, of which Vitiligo is one of the most devastating. Vitiligo affects up to one percent of the population, affecting both sexes, all ages and races equally; however, it is more noticeable in people with dark skin. This disease tends to start as white patches in different parts of the body, or on mucous membranes (tissue that line the inside of the mouth and nose) and can progressively turn the skin and the hair that grows on these parts completely white. In most people, the white patches become symmetrical, affecting similar areas on the right and left side of the body. Notable case studies were one of Michael Jackson who announced in 1993 that he suffered from Vitiligo.

Vitiligo is a pigmentation disorder in which Melanocytes (cells that produce melanin or pigments which define skin color) are recognized as being foreign and are thus destroyed by certain antibodies which our body produces. There is no definite known cause for the disease as there are many theories as to why this occurs and a number of antibodies have been identified. There is also an association with certain autoimmune diseases like thyroiditis, diabetes, mellitus, pernicious, anaemia, alopecia areata, primary biliary cirrhosis and adrenal insufficiency where a person's immune system reacts against the body's own organs or tissues. Vitiligo is not associated with lifestyle but may have a generic component. Table One lists some of the most plausible theories for the development of the disease.

The main goal of treating Vitiligo is to improve the appearance. There are a number of treatments for this condition with the most frequent being light therapies UVB (NUVB) and excimer laser. Excimer Laser can only treat small surfaces and can be very costly while UVB light therapy is safe, affordable, can be administered to the whole body giving good results. In my clinic, a combination of UVB, corticosteroids and Khellin cream achieves best results.

Surgical Procedures are gaining popularity in the treatment of these kinds of resistant yet stable diseases. Most of which are discussed below are combined with light therapy to stimulate the proliferation of melanocytes.

  • Punch Grafting is a safe, simple and widely used technique. Its main purpose is to transfer small punches of normal skin to the depigmented area. Approximately 30% of the affected area is grafted then NUVB is used to stimulate proliferation of melanocyte.
  • Suction Blistering is a technique whereby the superficial layer of the skin is cleaved from the underlying layers producing a blister. The skin from the blisters are then transferred and grafted onto the abnormal Vitiligo area.
  • Skin Needling is a treatment that introduces a series of fine, sharp needles at the edges of the affected skin to create bruises. This damage encourages normal melanocytes to re-generate into the affected area.
  • Smashed Skin Grafting is a novel, simple method of Vitiligo surgery with fewer side effects and high patient satisfaction if the technique is mastered. Procedure involves removing the top layer of skin from a donor site, crushing it and grafting it onto the Vitiligo patch.
  • Autologous Melanocyte Grafting is performed in specialised centres only. The color pigment cells are harvested treated and cultured which in turn is injected into the Vitiligo area. This method should be repeated a few times to achieve best results. But this is a very expensive procedure, due to the advanced equipment and good laboratory staff needed.

In some cases of progressive disease, the use of oral steroids in low doses over a period of a few months can stop the condition. However it only stops the disease from getting worse, it does not help with the re-pigmentation of the already affected areas. The choice of therapy depends on the number, location and size of white patches and on patient preference. In some instances stable patches can be concealed with cosmetics or tattooing which can achieve near normal skin colour. However, in most cases a suitable option may be bleaching the rest of the skin to achieve uniformity

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