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
Vitiligo can be focal, segmental (Figure
1) or generalised (Figure 2). Common sites affected in vitiligo include:
Figure 1: Segmental Vitiligo
Figure 2: Vitiligo 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
Can vitiligo be treated?
Yes. Several forms of treatment are
available but the response to treatment varies with each person and site
How can vitiligo be treated?
Corticosteroid creams are effective in
many patients, however regular monitoring by your doctor is necessary to
prevent side effects.
2. Topical tacrolimus or
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)
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.
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.