Leukoderma or Vitiligo

Dr. KS Prasanna, Director, Institute of Applied Dermatology, Kasaragod, Kerala

Vitiligo is a  highly stigmatic, skin disorder that occurs after birth, where the skin colour in some areas of the body becomes white due to progressive loss of melanocytes, which are responsible for the colour of the skin. It affects 1-2% of the population and is more obvious in the Indian skin, whereas in western skin it is not stigmatic. The darker-skinned a person is, the more their vitiligo stands out, because of the contrast between the affected and unaffected skin.

Vitiligo occurs due to the destruction of melanocytes (the aforementioned melanin pigment-producing cells) due to genetic or autoimmune, where a person's immune system reacts against the body`s organ or tissue. Various factors control the progression of this disease, mainly the psychological factor and the diet. Sometimes it is genetic which runs in families.

This disease can affect people of any age, sex, and race and it can affect any part of the body. It starts as a small white patch and slowly it progresses to a bigger patch, sometimes involving the whole body, or it may remain as a small patch for a long time, what we call stable vitiligo. Rarely, it is associated with itching. These white patches could be localized (limited to one area) or generalized or segmental (one segment of the body). Some of the chemicals in the footwear, wallet, bindi, etc. can cause white patches, in the areas of its contact, what we call Leukoderma. Continuous friction in one particular area like tying a saree skirt very tightly can also cause a white patch. I would like to stress here that Vitiligo is not contagious.

The major issue in Vitiligo is its psychological impact on most of the patients and their families rather than the disease per se, mainly because of the stigma and misconceptions attached to this disease. It can lead to embarrassment, a sense of humiliation, loss of self-esteem, negative effects on marital life sometimes ending in divorce, and job discrimination leading to impairment in the quality of life. It can affect a person's emotional and psychological well-being and may create difficulty in professional and social situations. They express emotional stress, especially if the vitiligo patches are on the visible areas of the body, such as the face, hands, arm, leg, and lips. Adolescents who are particularly concerned about their appearance can be devastated by widespread disease. Vitiligo has become a marked social stigma in our country where the marriage of the affected individual is difficult even today. In children, sometimes it severely affects their self-esteem by getting teased in the school, so much so that the child gets depressed, refuses to go to school, and even gets suicidal thoughts!.

Vitiligo is diagnosed by clinical examination, coupled with a test called wood`s lamp examination. Sometimes a skin biopsy is necessary to differentiate it from other white patches. Occasionally, Vitiligo is associated with other autoimmune diseases like thyroid disease and diabetes Mellitus. So, a blood test is essential to find out these diseases.

The management of Vitiligo, even though there is no complete cure, is very crucial. The doctor should be empathetic and should be a good listener. He/ she should be able to provide emotional support to the patient and the family. So, counseling becomes a very important step to overcome the initial storm. There are various modes of treatment depending upon the age of the patient. Topical therapy, PUVASOL (exposure to sunlight after 2 hours of taking the tablet), phototherapy, surgical treatments, and lasers in addition to diet correction.  In the case of stable Vitiligo, split-thickness skin grafting can be of help. This procedure has the advantage of providing uniform pigmentation over a short period of time. Cosmetic camouflage is very important to conceal the visible patches. Skin camouflage is a specially formulated product, which is used to conceal the color or contour defects of the skin. To camouflage vitiligo, opaque creams in the shades of brown matching the patient's skin color are being used. If the disease increases after taking the treatment either in biomedicine or alternative medicine, we need to find out the causative medicine which is responsible for it.

There are several patient support groups for Vitiligo, providing a common platform for patients to meet and discuss their problems, both online and face to face. Hearing real-life experiences of other vitiligo patients can itself boost confidence, which in turn help the treatment response. Many of these groups provide job and matrimonial opportunities. Patients can log into such groups, e.g., Vitiligo support international, Vitiligo friends, Shwetha association, and the Vitiligo Society.