VITILIGO

What is vitiligo?

Vitiligo is a skin disorder that 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.

Vitiligo can be focal, segmental (Figure 1) or generalised (Figure 2). Common sites affected in vitiligo include:

Figure 1: Segmental Vitiligo

Figure 2: Vitilig​o vulgaris

Bony surfaces - back of hands and fingers, elbows and knees

Around body orifices - around the eyes, mouth and nose

Body folds - armpits and groins

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

What causes vitiligo?

The cause of vitiligo remains unknown. However, people with vitiligo may have a genetic predisposition or associated autoimmune disease including thyroid disease, pernicious anaemia and diabetes mellitus.

Can vitiligo be treated?

Yes. Several forms of treatment are available but the response to treatment varies with each person and site affected.

How can vitiligo be treated?

1. Corticosteroid Creams

Corticosteroid creams are effective in many patients, however regular monitoring by your doctor is necessary to prevent side effects.

2. Topical tacrolimus or pimecrolimus

These are creams known as topical immunodulators. They work by modulating the immune attack against melanocytes in the skin and by stimulating the function of melanocytes. They may be combined with other treatment modalities. There is a “Black Box” warning on the use of these creams which will be addressed by your doctor.

3. Ultra Violet Light Treatments

a) Narrowband UVB (NBUVB)

    Phototherapy

NBUVB phototherapy is administered 2-3 times per week. Each session involves exposure of large surfaces of the skin to ultraviolet B light, with the purpose of inducing repigmentation of affected skin. It may take 1 year of treatment to achieve satisfactory repigmentation.

b) Excimer Light

This is a form of targeted phototherapy and utilises a specific UVB wavelength. It is indicated for the treatment of small localised areas of vitiligo. Treatment is administered 2-3 times per week.

4. Oral corticosteroids

Oral corticosteroids are prescribed only for patients with active disease. Side effects will be addressed by your doctor.

5. Surgical Options

Surgical transplants are meant for patients with stable vitiligo that fail to respond to topical treatment or phototherapies. Stable vitiligo means no new lesions or progression of lesions over 6 to 12 months. These options work best for patients with segmental or focal vitiligo. The surgical techniques include tissue and cellular grafting.

Approximately 90% of our patients with segmental vitiligo who have undergone cellular grafting, have good to complete recovery.

6. Camouflage cosmetics

Cover-up cosmetics provide good colour match and camouflage of vitiligo lesions. They are particularly useful for white patches on the face and back of the hands.

7. Sunscreens

Areas affected by vitiligo are very prone to sunburn as they lack protective pigments. It is advisable for patients to use broad-spectrum sunscreens with high protection factor on the affected areas.