Vitiligo is an autoimmune disorder characterized by destruction or abnormal function of melanocytes (pigment-producing cells).
- It is known to affect 1-2% of the total world’s population.
- It presents as white spots on skin and mucosa and silvery grey hair on the scalp. Vitiligo can be either stable (not spreading or increasing) or progressive.
- Vitiligo is known to affect the quality of life and causes immense psychological stress in patients.
Clinically Vitiligo can be of classified as:
1. Segmental type – which can affect one or multiple segments of the body.
2. Non-segmental type – which can be acrofacial (affecting face, head, perioral, hands, and feet), mucosal (genital and oral mucosa involvement), generalized (any part of the body), universal (>80-90% body involvement), mixed (involvement of segmental and non-segmental type).
3. Unclassified or indeterminate – can be focal (isolated spots are seen without segmental distribution) or mucosal (where only one mucosa is involved).
The exact etiopathogenesis of Vitiligo is still unknown, but several theories have been proposed:
1. Autoimmune theory
2. Adhesion Defect theory
3. Neural defect
4. Vitiligo’s biochemical theory
5. Intrinsic theory
6. Viral theory
7. Integrated theory
A better understanding of the main pathways involved in vitiligo onset will help in the formation of the optimal treatment plan which would stabilize melanocytes, suppress autoimmune response and increase regeneration of melanocytes and stimulate their migration from surrounding skin and adnexa.
Management of Vitiligo can be:
1.Pharmacological – which includes the use of medicated creams and systemic agents.
2.Physical therapy – Use of UV radiation.
3.PUVA light therapy – should be done under supervision. It Involves the use of UVA and the photosensitizing drug, psoralen.
4. NBUVB therapy – use of narrowband UVB (311 nm) to restore skin color, no need for oral psoralens, safe, minimum side effects.
5.Excimer LASER – use of coherent and monochromatic light, 308 nm to restore color.
Surgical modalities – they are used when the vitiligo is stable. Methods used are Split-thickness skin grafting and Melanocyte transfer