Vitiligo

Vitiligo is a chronic, progressive and unpredictable pigmentation disorder that causes some areas of the skin to lose its colour, appearing to be depigmented patches due to the disappearance of functioning melanocytes in the epidermis. It can impact the patient cosmetically, and the affected skin can be more sensitive to sunburns. Common body sites including face, elbows, knees, hands and feet, it can affect any age and gender.




Clinically, vitiligo presents as milky-white, sharply demarcated depigmented macules and patches that are usually asymptomatic and have a normal skin texture without scaling. The most commonly affected areas include the hands, fingers, face (especially around the eyes and mouth), elbows, knees, genital areas and sites of repeated friction. Leukotrichia, or whitening of hair within the affected patches, may occur, and some patients develop premature greying of scalp hair. Mucosal involvement and halo naevi can also be seen. The condition is not contagious and does not cause physical harm, but it may have significant psychological and social impact, particularly when visible areas are involved. . Early in the disease, patients often notice a small pale spot that slowly becomes completely depigmented, sometimes becoming more apparent after sun exposure due to contrast with surrounding tanned skin.




Vitiligo treatment aims to suppress the autoimmune attack on melanocytes, stimulate repigmentation, and stabilise disease progression. Vitiligo is usually treated with creams and medications. When Vitiligo fails to improve with these treatments, further treatment such as surgical therapy will be considered for patients with stable vitiligo. Overall, treatment requires patience, as repigmentation is gradual and may take several months. Combination therapy is often more effective than monotherapy, and early intervention during active disease improves outcomes. Psychological support and camouflage techniques are also important components of holistic management.


Types of Vitiligo Surgical Therapy:




•   Janus kinase (JAK) inhibitors

  Topical JAK inhibitors is available for non-segmental vitiligo and has demonstrated improvement in repigmentation. It is a targeted therapy with good safety profile.

•  Repigmentation Surgery

  It is for patients with stable vitiligo and do not respond to medical treatments. Usually pigment starts to appear after several weeks, final results may take 3- 6 months. Risks may include colour mismatch.