Skip to main content
Medical Research

Vitiligo explained

By 18 March 2014August 24th, 20202 Comments

In this column, specialist dermatologist, Dr Rakesh Newaj explains the skin condition vitiligo and available treatment options.

During the past decade, the prevalence of skin diseases has increased tremendously. Global warming, stress, bad habits and pollution have all played a role. It is very difficult to measure the direct impact of these factors; however, one should never ignore them. Several diseases have been described that can alter the colour of our skin, and vitiligo is one of the most common. This disease presents as a loss of colour of the skin, which can affect up to 1% of the population.

While being barely visible in Caucasians, it can lead to severe psychosocial consequences in darker races. Melanocytes are cells in our skin that produce melanin, thereby defining our skin colour. In vitiligo, the body produces certain antibodies that identify the melanocytes as being foreign and destroys them. There are many theories as to why this occurs, and various antibodies have been identified. There is also an association with certain autoimmune diseases such as thyroiditis, diabetes mellitus, pernicious anaemia, alopecia areata, primary biliary cirrhosis and adrenal insufficiency. Although it has a genetic component, lifestyle may also play a role. Table 1 lists some of the most plausible theories for the development of the disease.

Vitiligo occurs at any age and can affect any part of the skin or mucous membranes (lips, mouth, genitals). This disease tends to start as a loss of colour in a small area, which soon becomes completely white. The patches increase in number, and often appear on both sides of the body in a symmetrical fashion. However, there are rarer variations of the disease that affect only a small part of the skin, following a certain nerve distribution. Areas around the eyes, lips, fingers and genitals are most commonly affected. With time, the disease can affect most of the skin surface, and even the hairs can turn white.

Vitiligo is chronic and difficult to treat. Certain areas of the body tend to respond better to treatment than others. In general, the best response to treatment occurs on the face and neck, and the worst areas to treat are the non-hairy ones. Early diagnosis and aggressive treatment can halt the disease, and can lead to re-pigmentation in many patients.

The main goal of treating vitiligo is to stop the disease and induce re-pigmentation. This is achieved by various treatment options, including the use of creams, pills, light therapy and surgical procedures. International guidelines still advocate the use of potent corticosteroid creams as the first line of treatment for small areas. Other creams that are also effective are vitamin-D analogue, tacrolimus and khellin. The addition of light therapy, such as narrowband UVB or excimer laser, can improve the success rate tremendously. Excimer lasers can only treat small surfaces and can be very costly, while UVB light therapy is safe, affordable, can be administered to the whole body and yields good results.

In my clinic, a combination of UVB, corticosteroids and khellin cream achieves the best results. Surgical procedures can also be used in a selected few. These are performed on patients only where the disease is stable, with a small area of involvement.

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 melanocytes.

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 is 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 regenerate 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. The 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 colour pigment cells are harvested, treated and cultured, then injected into the vitiligo area. This method should be repeated a few times to achieve the best result. But this is a very expensive procedure, due to the advanced equipment and good laboratory staff needed.

The surgical procedures are combined with light therapy to stimulate the proliferation of melanocytes to normalise colour. In some people with progressive vitiligo, the use of steroid tablets in low doses for 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 tattoos, to look close to the original skin colour.

However, in a few cases, the disease is so extensive that the only solution is to bleach the remaining areas to match the majority of the body surface. Doctors should not ignore the psychological impact that this disease can have and should refer their patients for psychological help.

 

Dr Rakesh Newaj discusses vitiligo

Dr Rakesh Newaj

Dr Rakesh Newaj MBBCh (Wits) FC Derm (SA) is a specialist dermatologist based at Arwyp Hospital, Kempton Park, South Africa.

 

mm

Guest Writer

This post has been curated by a Longevity Live editor for the website.

The content in this editorial is for general information only and is not intended to provide medical or other professional advice. For more information on your medical condition and treatment options, speak to your healthcare professional.

2 Comments

  • Kamalini Jeena says:

    So beneficial reading what u have explained.my vitiligo started about 3 years ago.is on most of my body now.so sensitive to certain clothing and the sun.had laser treatment done ,but chose to discontinue….cos…did get burnt too with excessive time duration.hope to gain new knowledge and a new perspective of this condition.

    • mm Gisèle Wertheim Aymes says:

      Dear Kamalini, we can provide you with Dr Newaj’s email address and telephone number as he is the expert who provided the information in this article and you would need to consult him further. His emails address is rnewaj@gmail.com and his Telephone is +27 012 751 4001 Regards,