Vitiligo
What is Vitiligo?
Vitiligo and similar conditions:
- Albinism: Albinism is a congenital (by birth) condition in which there is complete absence of melanin pigment in the skin, hair, and eyes.
- Leukoderma: Leukoderma is a combination of two words one is “leuko” means “white” and second is “derma” means “skin” any white patch of varied pathology, it could be infectious like in alopecia areta , Pityriasis alba , Granuloma annulare, Halonaevus, Post-inflamatory hypopigmentation, Idiopathic guttate hypomelanosis, Pityriasis, lichen planus, Mycosis fungoides, Leucoplakia ( is a precurssor to malignancy), Pityriasis versicolor, Pinta, Post kala azar, Lupus vulgaris, Hansens disease angular stomatitis.
What is its pathogenesis?
- Autoimmunity in which, though the immune system is normal but misdirected sensing pigment cells as foreign bodies and destructing them, a battle within the body.
- Neural hypothesis postulates a neurochemical mediator which is secreted from the nerve endings, destroys the melanocytes (pigment cells).
- Auto Cytotoxicity or melonocytes self destruction. The cell destruction hypotheses implicate an intermediate in melanin metabolism that causes melanocyte destruction.
How is it diagnosed?
- Clinical examination: most of the cases are diagnosed only by way of clinical examination
- Wood’s lamp examination
- Histopathology with special stains
What is its incidence and prevalence?
Incidence: 0.5-1% of global population. In India it is estimated to be 0.4% to 2.5%. Gujarat and Rajasthan states have the highest prevalence in terms of seeking treatment however disease prevails more in coastal areas of Kerala, Tamil nadu, Andhra Pradesh, West Bengal and Gujarat.
The incidence of Vitiligo is around 1 percent of the total population in USA, 1.64 percent in Japan, 0.14 percent in USSR, 0.24 percent in London, 0.39 percent in Switzerland and 1 percent in Egypt.
According to the various studies in different cities of India can be anything between 2.9% in Goa to 8.8 percent in Delhi and 1.2% in Hyderabad. However, most authors say that its incidence is around 4% which is definitely more as compared to the world’s population of 1 percent.
Prevalence: The prevalence among the dermatology outdoor patients is estimated to be between 3-4 percent.
It affects both the genders equally regardless of social and racial background.
What are the types of vitiligo?
- Segmental/ Dermatomal Vitiligo – It affects the area supplied by a nerve, occurs in a unilateral asymmetric distribution spreading over one or more Derma tomes.
- Acrofacial Vitiligo – Vitiligenous lesions of the Acral or Distal parts of limbs (i.e. Fingers, palms, toes, feet and also affects the joints in later stage and natural orifices, (mostly on lips) the latter in a circumferential pattern.
- Lip-tip vitiligo – refers to the type where lesions are restricted only to the lips and distal parts of fingers and toes.
- Focal Vitiligo – describes one or two closely set depigmented lesions localized to a single area.
- Non Dermatomal Vitiligo – The most common presentation with bilateral a symmetrical or bilaterally symmetrical lesions, sometimes may exhibit mirror image symmetry which covers the extensive surface of the body.
- Vitiligo Vulgaris or Universal Vitiligo – in some cases there is loss of pigment over the entire body surface except a few small islands of pigmented skin.
- Combination Vitiligo – very rarely vitiligo vulgaris and segmental vitiligo are seen in the same patient.
- Mucosal Vitiligo – it affects only the areas with mucous membrane. Most common areas are lips, ano-genital areas, etc.
- Chemical Contact Vitiligo – this is the most common and fastest emerging type of vitiligo which results due to chemical contact (Drugs/chemicals: hydroquinone, Phenolic compounds, detergents, antiseptics, adhesives), use of recycled plastic wear, poor-quality cosmetics (commonly bindis, lipstick), use of condoms are a few to start with.
- V1 Active Vitiligo
- V2 Quietient Vitiligo
- V3 Repigmenting vitiligo
Facts about Vitiligo
- Histologically vitiligo is characterized by loss of melanocytes with diminished or absent activity of melanocyte tyrosinase on the melanin pigment precursor dihydroxy phenyl alanine (DOPA)
- World wide disease prevalence of 0.5–1.0%
- 1 in 136 or 0.74% or 2 millions people in USA
- Female : male ratio of 1:1
- Age at onset. No age is exempted, 50% develops their full clinical picture before attaining their early adult life and 70% before their three decades of life
- A disorder consisting of areas of macular depigmentation, commonly on extensor aspects of extremities, on the face or neck, and in skin folds involving unilateral, bilateral asymmetrical or sometimes symmetrical distribution
- Emotional distress, discrimination are usually associated
Classification
Localized
- Segmental
- Mucosal
Generalized
- Acrofacial
- Non-dermatomal
- Vulgaris
Thrust Areas
Specific, safe and potent drug development in relation to galloping phase (autoimmune phase) where aggravation of lesions indicates the active vitiligo.
There is an ample need to develop Immunomodulators both systemic and topical immunosuppressant.
Vitiligo being a stubborn disease requires prolong treatment, generally during the course of treatment patient acquires resistance to the treatment .
Hence there is an ample need for specific drugs to overcome the resistant phase.
Melanogenic drugs to induce and accelerate the rate of re-pigmentation.
Before & After
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