Vitiligo: Types, Symptoms and Treatment

Vitiligo is an autoimmune progressive acquired disorder due to a defect in melanocytes, leading to a decreased number of myocytes. It is associated with other autoimmune disorders Such as diabetes, thyroid, pernicious anemia, alopecia areata, and Down syndrome. Its most common association is with Hashimoto thyroiditis. 20 to 30% are associated with a family history of vitiligo.

Pathogenesis

There are various hypotheses regarding the pathogenesis of vitiligo. It Includes.

• Genetic factors: Catalase gene
• Immune hypothesis
• Neural hypothesis: Certain neurotransmitters are released and destroy the melanocytes along with a particular which is responsible for segmental vitiligo.
• Toxic self-destructive or radical hypothesis.

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Clinical Presentation

• Totally depigmented asymptomatic macules and patches which are chalky, and white in color. They are progressive and present anywhere on the body and have convex or scalloping margins. 
• There is patchy white hair on the vitiligo site or if they are a separate entity they are called leucotrichia.

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Multiple Colors of Vitiligo Patches

1. Trichrome vitiligo- There are 3 zones-
   • The Center zone is of depigmentation
   • Surrounding the center zone is the zone of hypopigmentation
   • Surrounding the hypopigmented zone is the zone of hyperpigmentation and 2It is of 3 colors.
2. Quadrichrome vitiligo-There is perifollicular pigmentation and it is of 4 colors.

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Types of Vitiligo

Segmental Vitiligo

along a segment/dermatome

• It is not present at birth and usually develops after birth during childhood. 
• The depigmented macules are present in particular dermatomes and are unilateral with midline demarcation.
• The course is relatively stable and there is the absence of Koebner’s phenomenon.

Non-Segmental Vitiligo

This type is not present along this segment, it can be focal that is limited to one area. There can be one or two lesions present on the mucosal surfaces.

Generalized Vitiligo

It consists of

• Vitiligo vulgaris- It is a bilateral and symmetrical lesion skin disease.
• Acrofacial vitiligo- it is present in the acral and face areas. It is also known as lip tip vitiligo. This kind of vitiligo can also be seen in genital areas. As there are no hair follicles in the areas where acrofacial vitiligo is present therefore it is very resistant to treatment because of the inability to get pigmentation.
• Vitiligo universalis- In this kind, more than 90% of the body surface area is depigmented.

Signs of Poor Prognosis

• Acrofacial vitiligo
• Vitiligo universalis
• Luekotrichia
• Other immune diseases
• Progressive vitiligo

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Treatment of Vitiligo

Patient should be advised to avoid traumas because trauma leads to Koebner’s phenomenon which in turn aggravates vitiligo.

Medical Treatment

• Topical corticosteroids
• Topical calcineurin inhibitors like tacrolimus which can be used on the face and genitalia.
• Systemic drugs like betamethasone, Methylprednisolone, and azathioprine.
• Narrow-band UV B phototherapy can be done
• Targeted phototherapy or laser therapy can be used.

Surgical Treatment

• When vitiligo is stable for more than one or two years then surgical treatment can be done.
• Donor areas are selected based on the presence of good amount of pigmentation. A skin graft is taken from the donor area and put on the recipient area.
• Techniques like skin grafting and cellular techniques can be used.
• Bleaching techniques

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