By Dr R Newaj
Vitiligo affects one to two percent of the population, affecting both sexes, all ages and races equally; however, it is more noticeable in people with dark skin. This disease starts without any warning, as loss of colour on parts of the skin or mucous membranes (lips, inside of the mouth, nose and genitals). It then progressively turns the skin and the hair that grows on these parts completely white. In most people the white patches become symmetrical, affecting similar areas on the right and left side of the body. However, there are some types of vitiligo that can also affect only localised areas of the skin.
Vitiligo is a pigmentation disorder in which melanocytes (cells that produce our skin colour) are recognised as being foreign and are thus destroyed by certain antibodies that our bodies produces. There is no definite known cause for the disease as there are many theories as to why this occurs and a number of antibodies have been identified. There is also an association with certain autoimmune diseases like thyroiditis, diabetes, mellitus, pernicious anaemia, alopecia areata, primary biliary cirrhosis and adrenal insufficiency, where a person’s immune system reacts against the body’s own organs or tissues. Vitiligo is not associated with food, lifestyle or witchcraft but may have a generic component.
The treatment entails the use of certain medications as well light therapies such as phototherapy with narrowband UVB and excimer laser.
Surgical procedures are gaining popularity in the treatment of localised, resistant yet stable vitiligo. These treatments are only possible for small areas of vitiligo. Some of the treatments are discussed below and are combined with light therapy to stimulate the proliferation of melanocytes.
- Punch grafting is a safe, simple and widely used technique. Its main purpose is to transfer small punches of normal skin to the depigmented area. Approximately 30% of the affected area is grafted, then NUVB is used to stimulate proliferation of melanocytes.
- Suction blister grafting is a procedure where superficial layers of normal skin are transplanted onto the areas of vitiligo. The transplanted skin transfers its melanocytes within 72 hours and then the skin dies off. Thereafter the skin involved becomes depigmented again and over a period of three months; excimer laser is used to stimulate the melanocytes to produce colour again. The success rate is around 80% and this treatment is regularly offered in our clinic.
- Skin needling is a treatment that introduces a series of fine, sharp needles at the edges of the affected skin to create bruises. This damage encourages normal melanocytes to regenerate into the affected area.
- Smashed skin grafting is a novel, simple method of vitiligo surgery with fewer side effects and high patient satisfaction if the technique is mastered. The procedure involves removing the top layer of skin from a donor site, crushing it and grafting it onto the vitiligo patch.
- Autologous melanocyte grafting is performed in specialised centres only. The colour pigment cells are harvested, treated and cultured, which in turn is injected into the vitiligo area. This method should be repeated a few times to achieve best results. This procedure can also be performed in Mauritius, but it is very tedious and costly.
- Hair transplant. Hairs from the axillae of the pubic areas can be harvested and transplanted into the depigmented areas of vitiligo. These hairs transfer their melanocytes from their bulb section into the skin and over a period of three to four months the hairs fall off. The melanocytes are then stimulated by using excimer laser.
- Skin micropigmentation is used on areas that are resistant to treatment. A dye that closely matches the skin colour is tattooed onto the skin to cover the white patches. This treatment can only be done on stable vitiligo and 2–3 repeated treatments may be required. It works very well for the hands and feet.
The choice of therapy depends on the number, location and size of white patches and on patient preference. Early treatments can halt the progression of the disease, therefore patients are strongly advised to consult early. However, if more than 50% of the skin is already involved, bleaching the rest of the skin to achieve uniformity can be an option.