VITILIGO
- What is vitiligo, broadly how is it treated ?
- Vitiligo is also known as 'leucoderma'. In India,
it is called 'safed kod' or 'safed dag' and is considered
as a social stigma. Vitiligo is appearance of single or multiple depigmented
patches on any part of the body.These patches
gradually increase in size & cause lot of
psychological stress in the patient. It is an auto-immune condition and may have a genetic
predisposition.
Treatment of vitiligo usually takes a long time. Medical treatment helps arrest
the spread of depigmentation and in some cases, may bring back the
pigmentation. In majority of the cases, medical therapy only achieves
stabilization of the vitiligo patch but fails to cause repigmentation.
However, repigmentation in cases of 'stable vitiligo' can be achieved by various
dermatosurgical techniques.
- What is is the role of puva in vitiligo ?
- PUVA therapy enhances skin re-pigmentation. An oral psoralen compound is
given to the patient. Two hours later , the de-pigmented patch on his body
is exposed to ultraviolet-A (UVA) rays, for a fixed time duration. This
should be supervised by a medical personnel. If UVA is not available then
the patch is exposed to sun rays. The latter is known as PUVA SOL
therapy.Treatment with UVB rays is another option. The most recent modality
is treatment with Excimer laser.
- When is the patient fit for surgery ?
- When the de-pigmented patch does not increase in size for a period of two
years, it is said to be stable. This is the right time to perform vitiligo
surgery.
If the patch is growing or is in an active phase, it needs treatment with
medicines and / or PUVA till it stops growing.
- What are the various surgical modalities available ?
- Method to be used depends on the the type and site of lesion.
Hence, selection of the appropriate surgical technique is
important for good cosmetic results.
- Miniature punch grafting.
- Ultra thin skin grafting.
- Suction blister grafting.
- Therapeutic spot or regional dermabrasion.
- Melanocyte culture and transplantation.
- Tattooing.
- What is miniature punch grafting ?
- Multiple thin grafts of 2 - 2.5 mm diameter are taken from the donor site
by special punches and grafted on to the diseased area. Once the grafts
are 'taken up' the patient is advised to take PUVA or PUVA SOL. Re
pigmentation occurs in 3 - 6 months and good cosmetic result is
obtained.
- What is ultra thin skin grafting ?
- A very thin skin graft (ultra thin) consisting of epidermis is grafted onto the dermabraded or laser ablated part of stable vitiligo. The graft
falls off by 8 -10 days but there takes place a cellular uptake of
melanocytes on to the abraded skin which gradually starts pigmenting, it takes 2 - 3 months for the
pigmentation to merge and match with
the surrounding skin color.
- What is suction blister grafting ?
- A prolonged suction (negative pressure) is applied to the donor site this
raises a large bleb and a thin graft containing only the epidermis is obtained. This is grafted
on to the dermabraded recipient surface. This technique is time consuming
but gives good cosmetic results.
- What is melanocyte transplantation ?
- Melanocytes are cultured in artificial culture media. The de pigmented
recipient site is dermabraded or laser ablated and the melanocyte suspension
is applied to it. The area is covered with a collagen dressing and
immobilized. Large areas can be covered with this method and excellent cosmetic
results obtained.
- What is tattooing ?
- Tattooing is injecting artificial pigment into the depigmented area. After
selecting the pigment shade which matches the surrounding skin color, the
pigment granules are implanted into the depigmented patch either with a
manual or electrically driven needles.
Though the patch resembles the surrounding normal skin, it may
permanently fade or acquire a bluish hue after 1 - 2 years which is
distinctly noticeable and may become unacceptable. Hence, tattooing is
usually not advised unless the patch is in an inoperable site.
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