The vitiligo and the leucoderma (leukoderma) are the same thing. Vitiligo is the medical term for leukoderma, and there is no difference between vitiligo and leukoderma. Michael Jackson and Jon Hamm had vitiligo. This article will discuss in detail what vitiligo is, what its clinical features, symptoms, causes, and prognosis are, and also the course of treatment it requires.
Skin color is a result of a pigment called melanin produced in melanocytes. When melanocyte function deteriorates the skin loses its color. This is called vitiligo. Although the exact cause for vitiligo is a mystery, there are many theories explaining the pathophysiology. Some suggest that it is autoimmune, where the body’s immune system acts against melanocytes destroying them. Others suggest a genetic link. TYR gene, which helps destroy cancer cells in malignant melanoma, is also present in vitiligo patients. In vitiligo, TYR gene makes melanocytes more susceptible to immune mediated damage. Oxidative stress theory suggests that toxic oxygen metabolites formed in normal body mechanisms destroy melanocytes. Inflammation is a tissue reaction to injurious agents. Injury may be due to viruses, bacteria or chemicals. Exaggerated inflammatory reaction releases toxic substances that damage and destroy melanocytes. Some viruses are known to affect skin cells specifically. This may also play a role in vitiligo.
There are two types of vitiligo. Segmental vitiligo appears on one side only, especially in areas associated with dorsal root supply. The appearance, shape, color, and size changes from patient to patient. Segmental vitiligo spreads rapidly but responds well to treatment. It is not known to be associated with autoimmune illnesses. Non segmental vitiligo appears symmetrically. There are five different classes of non-segmental vitilgo. They are generalized, universal, acro-facial, mucosal and focal vitiligo. When only a small area of pigmented skin remains with extensive generalized vitiligo, it is called vitiligo universalis. Acro-facial vitiligo affects face, fingers and toes. Focal vitiligo is the localized form of the disease.
Ultra violet light exposure and steroid therapy are the commonest treatment methods. Ultra violet light exposure can be done as an office or home procedure. Treatment regimen may be a few weeks long. Longer the spots have been there, longer it takes for treatment to take effect. Research suggests that phototherapy is not reliable, and there is no way to re-pigment the skin. Psoralen may result in partial re-pigmentation when added to phototherapy. Vitamin B12 and folic acid also have shown satisfactory results in studies by re-pigmenting 50% of the cases. Steroids affect the inflammatory mechanisms of the body minimizing melanocyte damage. But prolonged treatment with steroids may cause skin thinning, hair loss, and Cushing like condition. Some studies have shown that Tacrolimus is effective against vitiligo. Cosmetic camouflage prevents unaffected skin getting tanned when exposed to sunlight. De-pigmenting unaffected areas in case of vitiligo universalis is a last ditch option and basic sun safety should be adhered to afterwards. Melanocyte transplantation is another less commonly used method.