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Vitiligo:

The modern world gives ample importance to the aspects of beauty. It reflects a sense of well being and self confidence. The skin is the largest and the most visible organ of the human body. Hence any imperfection of the skin apparently affects self-confidence and self-esteem.

Vitiligo is not a fierce ailment. This does not cause any major physical harm to the body. Its societal value is dominant than medical importance. Even though we are unaware of what causes Vitiligo/leucoderma, society evidently shows the equivalent psychological neglect towards Vitiligo patients as lepers since the beginning. Vitiligo was quoted as "Sweta Kustha" denoting "White leprosy". Vitiligo is mutilating in all races but predominantly highlighted in dark skinned populace because of hefty contrast. The most recent decade has witnessed a rising awareness in emotional effects of skin disease Vitiligo and quality of being in individuals torment from these diseases.
Vitiligo is a genetic-autoimmune acquired skin depigmentation disorder. Many doctors and researchers believe that vitiligo is an autoimmune-related disorder. Vitiligo skin is characterized by circumscribed white spots on skin with sudden loss of the inherited skin colour. The white patches may be on the hands, feet, arms, face, legs and lips. However, not all white spots of skin are Vitiligo.

Vitiligo has been considered NEITHER A CONDITION NOR A SYMPTOM. Though a harmless skin-disease, Vitiligo can cause immense stress in the affected, especially in those with dark skin. People of all ages and ethnic backgrounds can develop the disease, but infrequently evident in infancy or old age. Almost all cases of vitiligo are acquired pretty early in life. A female predominance has been reported for people affected with vitiligo, but it is statistically insignificant and inconsistency has been accredited to the reporting of more figures of female patients due to the cosmetic concerns. Vitiligo is typically observable as a patch of white depigmented skin. Melanocytes, the cells that construct skin pigment are damaged by the disease Vitiligo. The white skin patches can gradually extend to quite a lot of locations of the body. There are established therapeutic and investigational surgical treatments for vitiligo. People initially develop white patches (depigmentation of skin) on their skin. It may commence as a small pale dot which subsequently manifests as white or hypopigmented macules or patches owing to absolute loss of melanin pigmentation over affected areas.

The lesions are generally well demarcated, in circles, elliptical, or linear in profile. The margins may be convex. Lesions propagate centrifugally over a period at an erratic tempo. The most prominent symptom of vitiligo is depigmentation of skin that occurs on the extremities that are exposed to the sun, like hands, forearms, feet, and face. Patches can also emerge on the mucous membranes of orifices (inner walls of the mouth and nose), the retina, genitalia and umbilicus. Some lesions have hyperpigmentation around the edges.

Vitiligo can cause premature hair greying. Scalp involvement is typically seen as localized patch of white or gray hair but total loss of colour may also occur. Body hair (leukotrichia) may also get depigmented. Eyebrows, pubic hair, and axillary hair, may also get infected. Spontaneous transformation of depigmented to re pigmented will not occur in most of the cases.

Although patches are small at the onset, they often widen and alter shape. Lesions range from millimetres to centimetres in size. In several patients it may start as a solitary spot and may not spread for years or for all over the life. In contrast some patients spreading may be hasty, as fast as from one spot to many, in a few months period. Swiftness of spread is unpredictable. Also, some patients may show discontinuous spread. It is also noted that individuals affected on areas such as finger tips, are at a high threat of having an aggressive spread; even though it is not a rule.

The exact rationale behind the defective development or the destruction of Melanocytes is still elusive to the researchers in the medical field. There are some reasonable theories which are well thought-out which points to the processes in Vitiligo. In concise, genetic and immunological, neural or stress factors cause Vitiligo. Causes for Vitiligo fall under either of the following,
  1. Destruction of the pigment cell, Melanin, owing to loss of colour on skin
  2. Malfunctioning of the melanin synthesis, thus, skin colour development is arrested.

The causes of Vitiligo:

Genetic factors play an important role in the skin-disorder Vitiligo. Incomplete penetrance, multiple susceptibility loci, and genetic heterogeneity are observed in Vitiligo. The genes associated with the biosynthesis of melanin, a response to oxidative stress and regulation of auto-immunity are considered to be highly susceptible to Vitiligo. Auto-immunity is considered as one of the basic and important causes of Vitiligo, according to Ayurveda as well as Allopathic system of treatment. The body's own cells are knocked down by its own immune system, leading to demolition of melanin cells. The most credible confirmation of an auto-immune pathogenesis is the occurrence of circulating antibodies in the blood of Vitiligo patients. Intrinsic deformities in Melanocytes including atypical rough endoplasmic reticulum, ineffectual synthesis and processing or receptor dysregulation or early apoptosis may owe to the death of Melanocytes or decreased survival rate of Melanocyte and cause Vitiligo. Disturbance in oxidant-antioxidant systems, hormonal connections, trauma or stress can also be one of the causes for Vitiligo. Abrupt emotional trauma, prolonged stresses are also reported to be involved in the vitiligo disease. Skin injury or psychological stress cause the release of some neuropeptides that may harm melanin, still signifying the involvement of multiple causal factors. In a few cases Psoriasis or Lichen Planus may be a source of pigment loss. Both may be seen to be coupled with vitiligo, on the same site. Other factors include; Regular interaction with certain rubber hand gloves, continuous practice of tight clothes, and prolonged use of certain medication may initiate the disorder. But this cannot be the cause of vitiligo in children.

Types of Vitiligo:

Segmental Vitiligo or Unilateral Vitiligo:

It tends to affect areas of skin that are associated with dorsal roots from the spine and is most often unilateral. Often seen on a leg, face or arm, about half of the affected lose some hair colour, such as on the head, an eyelash or an eyebrow. It generally has an early onset, often advances for a year or so and then stops.

Non-segmental vitiligo Or Bilateral Vitiligo or Vitiligo vulgaris or Generalized Vitiligo:

It is the most common type of vitiligo reported ever. It has bilateral origin, such as both hands and knees. Usually begins on the hands, fingertips, wrists, around the eyes or mouth, or on the feet. Individuals experience rapid loss of skin colour in the beginning, which then stops after a while, eventually leading to repeated colour loss. This start-and-stop cycle usually continues all through a person's lifetime. Colour loss tends to propagate, covering larger vicinity, thus increasing visibility.

Universal: This is rare. This is complete or nearly complete depigmentation of the skin. It is often associated with multiple endocrinopathy syndrome.

Vitiligo treatment is getting more and more importance not because of the physical effect the disease is causing but because of the social and psychological impact on the individual. Vitiligo clinic provides modern treatments for Vitiligo. Vitiligo Support International is the largest vitiligo organization in the world. It provide extensive public awareness/enlightenment, absolute support and policy changes for vitiligo, altered images, skin health. The information on vitiligo treatments, vitiligo support, vitiligo cure updates, and connecting to other people with vitiligo is offered by vitiligo cover.

The traditional vitiligo treatments include sunscreens; masking; restoration of normal skin colour; and bleaching of normal skin with topical creams to remove normal skin pigment to make an even colour.

Sunscreens: Sunscreen lotions protect the normal skin from burning caused by the sun. It should protect the depigmented skin from burn and reduce the tanning caused to the normal skin. The sun protective factor present in the lotions prevents redness of skin and also believed to affect the DNA of skin cells. For that SPF should be more than 30.

Masking: Use of cosmetics to make the white patches on face less visible is another choice used by individuals. Normal skin colour restoration methods include spot treatments or whole body treatment are also used as cures for vitiligo.

Bleaching: Bleaching causes irreversible loss of pigmentation. Here the normal skin part is depigmented by the use of chemicals in order to make the skin colour uniform and not contrasting from the affected areas.

Anti-Vitiligo Oil: Anti Vitiligo is an herbal medicine used as a natural vitiligo treatment. It believes to induce re-pigmentation of skin.

Unconventional treatment: Even though there is no solid evidence from studies, some vitamins, minerals, amino acids and enzymes are seen to restore skin colour in people.

Surgery: There are different types of surgical treatments.
  1. Tissue Grafting: Punch grafting, Split skin grafting, Suction blister grafting
  2. Micropigmentation of tattooing: The outcome of the tissue grafting and tattooing are not very successful and only small repigmentation happens.
  3. Cellular Grafting: Melanocyte transplantation (misnomer): Melanocyte cells from the donor area are transplanted to the recipient area. The basic idea of transplantation has important value in the treatment of Vitiligo. The method uses a special media for Melanocyte maintenance.
Laser treatment for vitiligo: A series of excimer laser treatment can often lead to dramatic re-pigmentation of the skin. Laser treatment is the latest, effective and the quickest treatment currently available. Many methods of cure are available for vitiligo but people have found laser treatment as the best option for vitiligo treatment than the others. This treatment offers a promise of excellent results by stimulating the melanocytes.
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