Professor Dr. S.M. Bakhtiar Kamal

Vitiligo, also known as leucoderma, has existed as a common skin condition since prehistoric times. It is a long-term skin pigmentation disorder that begins with small, medium, or large white patches. Sometimes, it can spread to cover most parts of the body. The exact cause is still unknown, but it is identified as an autoimmune disease. The mechanism involves reduced or destroyed functionality of melanocytes in the body, leading to the appearance of this condition.

Although the exact cause is not known, certain factors can increase the likelihood of developing this condition. For instance, there is a possibility of inheriting it if someone in the previous generation had it. Additionally, diabetes, thyroid diseases, and even trauma or high sensitivity to sunlight can trigger the condition. However, an underlying autoimmune mechanism must be present within the body.

Endless research is ongoing to find a cure for this condition. Although 100% effective treatment is not yet available, the advancements in science may provide a solution in the near future. Currently, vitiligo is treated in four ways: medication, phototherapy, laser, and surgery.

Medication: Various oral and topical medications can initially treat this condition. In some cases, injections are also administered.

Phototherapy: Phototherapy or light therapy has been in existence for nearly four decades. PUVA, NB UVB, and Targeted Phototherapy are successfully administered in different centers in our country.

Laser: Excimer laser is used for this treatment, which is not yet available in Bangladesh.

Surgery: Punch grafting, skin grafting, and melanocyte transplantation are surgical treatments successfully practiced in Bangladesh.

Patients often have various questions, such as—

Is this condition curable?

• This condition is always treatable, and in many cases, it can be cured.

Can vitiligo recur after it has been cured?

• There is a possibility of relapse, but it depends on the area and type of the condition.

Are there any dietary restrictions?

• There is no scientific basis for dietary restrictions in vitiligo.

Are there any restrictions on using cosmetics or soaps?

• Generally, there are no restrictions, but it is better to avoid cosmetics containing alcohol as they can cause irritation.

What can cause the condition to worsen?

• Stress is the primary factor that can worsen this condition. Additionally, the presence of other autoimmune diseases can exacerbate vitiligo and reduce the chances of recovery.

Prognosis:

The progression of vitiligo depends on the patient and the age of the condition. For instance, early-stage treatment shows better results, and if the condition occurs in childhood, the chances of recovery are much higher compared to older adults.

Causes of Vitiligo:

• Genetic Factors: If parents have vitiligo, there is a chance their children may develop it.
• Autoimmune Diseases: The body’s immune system produces antibodies that destroy melanocytes, causing white patches on the skin.
• Segmental: A specific nerve in the body secretes toxic substances that destroy melanocytes. Segmental vitiligo presents as distinct white circular patches on one side of the body.

Treatment for Vitiligo:

Initially, the white patches of vitiligo may increase, after which they stabilize.

(1) Medical Treatment: For patients with increasing white patches.

(2) Surgical Treatment: For patients with stable patches for at least six months.

Medical Treatment:

For all new white patches, initial treatment includes—

a. PUVA: The patient can go out in the sun two hours after taking a psoralen tablet.

b. NB-UVB Therapy: This is the most advanced treatment for vitiligo, and no medication is needed during phototherapy sessions.

c. Medication: Steroids and immunomodulators help stop the spread of vitiligo patches. Medical treatment can result in complete or partial improvement. This treatment is time-consuming and can take several months to years.

Surgical Treatment:

For patients with long-standing stable patches. It is more beneficial compared to other treatments and results in quicker improvement. Generally, three types of surgery are performed:

a. Skin Grafting b. Punch Grafting c. Melanocyte Transplantation

a. Skin Grafting:

• This surgery is done for small vitiligo patches.
• It is not effective for large patches.
• A small amount of skin is taken from the upper thigh, and brown pigment is separated through a special process. This pigment is then applied to the white patches of vitiligo. The advantage is that a small amount of skin can treat a large area, and the pigment blends with the surrounding skin color.

b. Punch Grafting:

• Small pieces of healthy skin are transplanted to the white patches using a punch instrument.
• Post-surgery, NB-UV therapy is needed.
• After cosmetic surgery, white patches appear like small stones.
• This surgery is effective for small patches but not for large ones.

c. Melanocyte Transplantation:

The most advanced surgical treatment for vitiligo was first introduced at Uppsala University in Sweden. Currently, only a few doctors worldwide successfully perform melanocyte transplantation, and a few doctors in Bangladesh have also gained experience in this treatment.

Procedure for Melanocyte Transplantation:

A small amount of skin (5×2 cm) is taken from the upper thigh under local anesthesia. Melanocytes are separated from the skin and applied to the white patches in multiple sections using special instruments. The bandage is removed after 7-9 days.

Advantages:

1. No hospital admission is needed.
2. Only a small amount of skin is needed to treat 100 sq. cm of area.
3. Skin color starts to return within 3-6 weeks after surgery.
4. The success rate of this surgery is 82%.
5. It is more effective compared to skin grafting and punch grafting.
6. In some cases, a second surgery is needed for complete improvement.
7. After surgery, exposure to sunlight or phototherapy is beneficial as it accelerates the return of melanin in the skin.
8. Large white patches can be treated with a small amount of skin.

Common Questions about Vitiligo:

1. Will the condition be completely cured with treatment?
   • Treatment involves phototherapy and autologous melanocyte transplantation. Phototherapy is effective where melanocytes are minimally present or non-functional. It stimulates melanocytes to produce melanin, and in cases where vitiligo spreads, it halts the spread, resulting in 60-70% improvement. However, where melanocytes are completely destroyed, melanocyte transplantation is needed, followed by phototherapy for nearly complete recovery. The affected area must remain stable for at least 6 months to 1 year, and the patches must be small.

1. Will it recur after treatment?
   • There is a very low chance of recurrence.
2. Will it appear in other areas in the future?
   • During treatment, new patches will not appear. However, if treatment is not completed or not taken, it can appear in other areas.
3. Can lipstick be applied if there is vitiligo on the lips?
   • It is better not to apply lipstick as it can increase vitiligo due to chemical burns. Special cosmetics for vitiligo patients are available in the market.

1. Does eating sour food worsen vitiligo?
   • Research is ongoing, and most findings show no relation between sour foods and vitiligo.
2. Can beef, shrimp, eggplant, or eggs be eaten?
   • All foods can be eaten unless there is an allergy.
3. Can soaps or other cosmetics be used?
4. Soap can be used, but mild soap is preferable. Other cosmetics like scents, body sprays, lotions, and creams should be avoided. However, sunscreens specifically for vitiligo patients should be used when going outside.

1. What cosmetics can be used for vitiligo?
   • Not all cosmetics are suitable for vitiligo patients as they can cause allergies or itching, worsening the condition. Special cosmetics for vitiligo patients are available, like Derma Color Collagen Cream, Derma Color Camouflage Cream, Derma Color Body Cover, Fixing Powder, Fixing Spray, which can be used safely.
2. Is phototherapy necessary after melanocyte transplantation, and how many sessions are needed?
   • Phototherapy is given to restore normal skin color after melanocyte transplantation. Initially, 2-3 sessions with 350 mJ, gradually increasing to 500-600 mJ, are given.

Professor Dr. S.M. Bakhtiar Kamal
Specialist in Sex Allergy and Hair Diseases, Department Head
Chamber: Dr. Kamal Hair & Skin Center
144 BTI Centara Green Road, Farmgate, Dhaka