Vitiligo is an acquired iddiopathic depigmentary condition, which though worldwide in distribution, is most common in India, Egypt and other tropical countries. It is a source of great social embarrassment to dark-skinned people. It affects all age groups with no predilection to either sex. Many cases start at the age of five, fifteen and at menopause. Its incidence is markedly on the increase.
Vitiligo is a skin disorder characterized by patches of lighter skin. In vitiligo, parts of the skin stop producing melanin. The cause of vitiligo is not known. However, it is believed to be caused by an autoimmune disorder that destroys the melanocytes (melanin producing cells). This skin condition requires treatment by a dermatologist.
Vitiligo is a common disorder of depigmentation which probably has an autoimmune aetiology. Sufferers often have relatives with other organ-specific autoimmune disorders. It presents in childhood or early adult life with well-demarcated macules of complete pigment loss. There is no history of preceding inflammation. However, repigmentation is rare if a lesion has persisted for more than 1 year or if the hair is depigmented. The psychological consequences of vitiligo can be devastating especially in Asian or black African people.
Patients are very susceptible to sunburn. Lesions are often symmetrical and frequently involve the face, hands and genitalia. The hair can also depigment. Trauma may induce new lesions. Spontaneous repigmentation can occur and often starts around hair follicles giving a speckled appearance.
A defect in enzymes tyrosinase is held responsible for vitiligo. According to some, melatonin, a substance secreted at nerve ending inhibits tyrosinase, thus interfering in pigment formation, DOPA staining shows that melanocytes are deficient. In active cases, mononuclear hugging at the junction of the lesion and normal skin is a prominent feature.
Treatment is very unsatisfactory and has no impact on the long-term outcome. Sunblocks should be used to prevent burning. Potent topical steroids or PUVA therapy may help some individuals. If vitiligo is almost universal, depigmentation may be considered as a treatment. Finally, referral to a specialist camouflage clinic can be useful.
Psoralens are the mainstay of treatment. These are nothing but purified form of babchi - the age old remedy.
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