Vitiligo is a common, acquired primary, progressive, chronic depigmenting (skin colour loss) disorder of obscure causes, manifesting clinically as colourless patches. The hair on these areas may also be colourless.

In some cases the margins are of the patches are darker in colour. In others, margins may be inflamed. In some cases the lesion may be surrounded by a lightly coloured zone which in turn is separated from normal skin by a darker coloured margin.

• In 50% of the cases no cause is observable.

• A few of the probable factors could be friction, itching, trauma, pregnancy, parturition, surgery, gastrointestinal disturbances and psychological trauma

• People of any age or sex or race can have this problem.

• Patches can appear anywhere on the skin surface.

• Most patients initially experience depigmentation on sun-exposed areas followed by body folds then lips or genitalia.

• Sites of covered areas initially affected include chest wall, lower back or areola.

• The size, shape, number and distribution of individual macules vary widely. The bilateral lesions are usually symmetrical.

The onset of this condition is subtle. Progresses often unpredictably.

Signs of repigmentation and development of new lesions may occur simultaneously. There may be a quiet phase when no new patches appear. Then there may be a rapid extension of disease over the following years.

There are three broad classification of vitiligo categorised according to the extent of involvement and distribution on depigmentation.

A.    Types depending on the distribution pattern and area wise involvement :

1. Vitiligo Vulgaris: The most common type with bilaterally symmetrical lesions, predominantly distributed over face, neck, torso, fingers, toes, palms, soles and facial orifices.

2. Segmental Vitiligo: Here the patches are unilateral and asymmetric in distribution.

3. Lip-tip Vitiligo: These are restricted to the lips and distal part of fingers and toes.

4. Focal Vitiligo: Focal Vitiligo localized to a single area.

5. Universal Vitiligo: There is loss of pigment over the entire body surface except a few small islands of pigmented skin.

6. Combination Vitiligo: A Combination of Vitiligo Vulgaris and segmental Vitiligo are seen in the same patient.

B.   Types depending on the activity of the disease process :

1. Active
2. Quiescent
3. Improving

C.   Types Depending on the cause:

1. Immune
2. Neural
3. Chemical

Diagnosis of Vitiligo involves:

• Personal examination by dermatologist
• Wood’s Lamp examination
• Special Staining procedures.

Medical Management
Surgical Management
Depigmenting
Cosmetic Camouflage

Medical Management

There are a number of therapies available for the management of these conditions, the suitability of which will depend on the age of the patient, extent of disease, type of disease and stability of the condition. The first choice is always medical using a class III or IV topical corticosteroid with ultraviolet a light (UVA) or Psoralens with UVA. Psoralen, the active principle of the seeds of psoralea corylifolia, is used for the re-pigmentation of vitiligo. Photochemotherapy is one of the standard therapies for vitiligo and is widely employed. When this line of treatment fails, the patient may be subjected to various surgical procedures that are available.

Surgical Modalities Available

Criteria for surgical procedures

1. No signs of activity. Stable Vitiligo
   1. Size of the macule or patch should be stationary for more than 2 years.
   2. No recent development of new lesions.
2. Mini-grafting test is negative for activity
3. Lesions are unresponsive to medical treatment
4. Skin over the lesion should not be thickened/ lichenified
5. Inactive lesions requiring urgent correction.

1. Melanocyte culture
2. Keratinocyte-melanocyte separation, and transplantation
3. Transplantation of blister tops
4. Split thickness skin grafting
5. Spot/Regional dermabrasion.
6. Single hair grafting
7. Needling
8. Chemical Peeling
9. Excision and Closure
10. Liquid nitrogen cryotherapy
11. Cosmetic tattooing.

Depigmenting Therapy for Extensive Vitiligo

Some patients with extensive vitiligo who do not respond to repigmentation therapies, may desire bleaching or removing the remaining islands of pigments to achieve an uniform appearance.

Cosmetic Camouflage

Temporary and cosmetic methods for covering or hiding disfiguring vitiliginous lesions on the exposed skin may be followed when such lesions are not amenable to therapy. Cosmetics of many shades in the form of make up and topical dyes to match different skin colours are available commercially. Some of these areare Dermablend, Covermark, Blenderm, Clinique, cover sticks and opaque cover cosmetics. Shades are chosen according to the patients’ complexion. They can be easily smeared on the vitiliginous areas and can remain for 6- 12 hours

Source: Dr. B.Narasimha Rao, M.D.(Derm & Lep)F.D.S(LON) M.A.M.S.(Vienna) M.I.S.T.D (USA) F.I.C.C., M.I.L.A.(USA) F.I.M.A.S., F.I.A.M.S., M.A.A.A.(USA) Ph.D is the Chairman and Medical Director of BNR Skin Hospitals. He is a renowned consultant in vitiligo treatment and surgery, including hair transplants. He has more than 37 years of experience in dermatology and dermato surgery. He claims to have conducted more than 1500 free skin camps throughout India. He has many awards to his credit. He has held several academic positions and has served as Medical Officer, Govt. Leprosy Control Unit at Tanuku and Eluru in West Godavari Dist. (1968-71). He has presented many research papers. BNR Skin hospitals has eight branches in India. For details view www.drbnrskinhospitals.com.