Don’t worry about those white patches anymore!

A prominent white patch on your skin may discourage you from leading a normal life. You may feel like you’re the centre of attraction; that people seem to be distancing themselves from you. The stigma revolving around vitiligo is such that people continue to think that it is a contagious health condition. But in reality, it is not. 

“Our body comprise of melanocytes (pigment cells) – a highly differentiated cell that produces melanin inside melanosomes,” explained Dr. Saman Gunasekara, Consultant Dermatologist at the Colombo South Teaching Hospital. “Vitiligo is a condition in which the skin loses these pigment cells. As a result, white patches emerge on your skin and change your skin and hair colour. This condition is seen in people with dark skin tones. As a result it is cosmetically disabling and has a psychological effect on people who experience these symptoms. Therefore people become reluctant to socialise, apply for jobs, they fear marriage and even to make children. Apart from that there’s a social stigma attached to this condition as well. Vitiligo affects 1% of the world population but in India this number is around 8%.”

“Around 21% of people have a family history and males and females are equally affected by this condition. People with health conditions such as thyroid, diabetes, anaemia, arthritis have increased risks of being diagnosed with vitiligo. It can affect any part of the body including eyes, fingertips and genitalia and could emerge in sites of trauma such as in places where cuts and burns have occurred. It could also occur on hands and feet and on birthmarks. Sometimes, hair turns white in places where patches emerge. This is known as leukotrichia.”

“When a patient comes to a clinic, an experienced dermatologist can do a clinical diagnosis. A dermascopy can be conducted using a special instrument used to examine the inside of a skin. Skin biopsies are rarely done and this is followed by a blood test to determine if any other system is affected by diabetes, anemia, thyroid conditions etc. Once the diagnosis is done we assess the patient to check the progress of the disease and if the patient has been psychologically affected we have treatments for them as well,” he said.

Even though there is no cure for vitiligo, it could be treated successfully. “We aim to retard disease progress and induce pigmentation on white patches,” Dr. Gunasekara added. “But certain sites are difficult to treat. These include fingertips, palms and soles and we cannot use strong treatments on areas such as genitals. If someone has a mild disease we recommend steroid or Tacrolimus creams. But these should be used under supervision or it could lead to side effects. Phototherapy is another treatment method available at all major hospitals. Here light therapy is given to patients who have excessive vitiligo. It is given to the whole body or the required part. This is also a safe treatment to be done during pregnancy as well. People with rapidly progressing vitiligo are prescribed with oral drugs such as steroids, Methotrexate and newer drugs depending on the history of the patient. If all these treatments fail we do vitiligo surgery. We take a small piece of skin from an area that has not been affected and implant it on the damaged area.”

Dr Gunasekara said that there could be a little bit of color mismatch or unevenness at these sites. “The graft should be kept for two weeks and only two areas could be grafted at a time,” he added. 

People are advised to minimise injuries if they have experienced signs of vitiligo. “Don’t delay treatments. If you treat early the success rate is good. Therefore people are advised to come for treatments early. Some other conditions such as leprosy, versicolor (Aluham) could mimic vitiligo. In very resistant patients we can do a cosmetic camouflage. Here we use a cream that is exactly your skin colour. But it’s important to have sun protection. If you get sun burnt, vitiligo can get worse. As such it’s important to get sun cream. We can also assess patients who have been affected psychologically. They become less confident, less social and ultimately become depressed. Therefore support from family and friends is also important.”

Vitiligo is a skin disease and it is not contagious. “It can be treated or controlled successfully. People with vitiligo can lead a normal life. They don’t need to worry about this condition. People’s attitudes should also change. They don’t respect people with vitiligo. There are certain myths that are woven around this condition. Some say that it’s caused by rats but there’s no scientific basis for such myths. Even though treatments are expensive there’s always a hope,” Dr. Gunasekara said in conclusion.