Vitiligo is a long term usually very distressing illness that results in depigmentation of the skin. Often as irregular patches, but it can be symmetrical. It is caused by death of melanocytes, the cells that give skin its pigment or suntan.
We do not know the cause of vitiligo, but it is suggested that it is linked with other autoimmune illnesses such as thyroid disease and diabetes. There is also a genetic bias.
The main symptoms of vitiligo are loss of pigment in patches.
These can be anywhere but are often on hands, face or feet. The patches get bigger with time or spread (unstable vitiligo) then stop spreading (stable vitiligo). Depression and stigma are common, especially in darker skinned individuals where visibility is most pronounced.
With non-segmental vitiligo there is usually symmetry in the location of patches. It can start at any age.
Types of non-segmental vitiligo (NSV):
- Generalized Vitiligo: This is the most common pattern.
- Universal Vitiligo: Here loss of pigment covers most of the body (sometimes referred to as vitiligo universalis).
- Mucosal Vitiligo: depigmentation of only the mucous membranes (eg mouth)
- Acrofacial Vitiligo: Affects fingers and anal areas.
- Focal Vitiligo: a few scattered patches spread around, often in children.
Segmental vitiligo (SV) is quite different to NSV.
The treatment is also very different to NSV.
- SV affects areas of skin that are associated with nerves from the spine.
- SV spreads much more rapidly than NSV.
- SV is much more stable once settled and amenable to topical treatment. It also tends not to be associated with autoimmune illnesses.
There is unfortunately no cure for vitiligo.
However there are a number of treatments that improve the appearance of the condition. In fair-skinned people, avoiding tanning of normal skin can make patches of vitiligo less noticeable there are 4 main methods of treatment.
Zenith has launched Recell Therapy for Vitiligo
This method takes all the cells from the skin and transplants them on to the stable vitiligo. Recell was developed for treating 2nd degree burns and is used in the NHS in special burns centres. There are good reasons to suggest that the effects of Recell on vitiligo may last longer than melanocyte grafting per se.
PROTOCOL FOR RECELL THERAPY FOR VITILIGO
3 basic requirements for us to consider Recell Therapy are:
1) Failure of topical therapy such as Steroids and immunomodulators such as protopic
2) Failure of conventional phototherapy
3) Vitiligo must be stable for 1 year.
Success rates appear to be significant in these most resistant patients
Sun-block (SPF 30 or above) is applied to areas of vitiligo to prevent burning.
In some cases where the individual has a few vitiligo patches and a slightly pigmented skin, they can be hidden with makeup or camouflage solutions.
The traditional treatment used by dermatologists is the application of potent topical corticosteroid creams.
A biopsy is taken, the melanocytes are removed, grown and put back on to the depigmented skin. Good results have been documented on stable vitiligo, with the transplanted melanocytes lasting several years.
UVA treatments have been used and are giving way to narrow band UVB treatment combined with immunomodulators. Obviously over exposure is dangerous but this is calculated and a maximum dose is delivered over the course of a year, perhaps 1 or 2 treatments per week much in the same way as treatment for severe psoriasis.
In cases of vitiligo universalis the tempting option is to de-pigment the unaffected skin with topical drugs such as hydroquinone (these are sadly no longer available in the UK).
The removal of all the skin pigment with chemicals is permanent and protection must be used for life to avoid malignant melanomas.
Depigmentation takes about a year. Q-switched tattoo lasers have also been used with varying success to remove small areas of remaining pigmented skin.
It is critical to assess the mental health of those with vitiligo. As with severe acne there is an increased rate of suicide, especially in late teens or in women of Asian origin.