Introduction
Leukoderma or Vitiligo is a long-term problem in which growing patches of skin lose their colour. It can affect people of any age, gender, or ethnic group. The patches appear when melanocytes within the skin die off. Melanocytes are the cells responsible for producing the skin pigment, melanin, which gives skin its colour and protects it from the sun’s UV rays. The total area of skin that can be affected by vitiligo varies between individuals. It can also affect the eyes, the inside of mouth, and the hair. In most cases, the affected areas remain discoloured for the rest of the person’s life.
The condition is photosensitive. This means that the areas that are affected will be more sensitive to sunlight than those that are not. The spread might take weeks, or the patches might remain stable for months or years. The lighter patches tend to be more visible in people with dark or tanned skin. Globally, it appears to affect between 0.5-2% of people.
Signs & symptoms
The only symptom of vitiligo is the appearance of flat white spots or patches on the skin. The first white spot that becomes noticeable is often in an area that tends to be exposed to the sun.
It starts as a single spot, a little paler than the rest of the skin, but as time passes, this spot becomes paler until it turns white.
The patches are irregular in shape. Normally, it does not cause any discomfort, irritation, soreness, or dryness in the skin.
The effects of vitiligo vary between people. Some people may have only a handful of white dots that develop no further, while others develop larger white patches that join together and affect larger areas of skin.
Types
There are two types of vitiligo, non-segmental and segmental.
Non-segmental vitiligo
Vitiligo often appears in a semi-symmetrical pattern.
If the first white patches are symmetrical, this suggests a type of vitiligo known as non-segmental vitiligo. The development will be slower than if the patches are in only one area of the body.
Non-segmental vitiligo is the most common type, accounting for up to 90 percent of cases.
The patches often appear equally on both sides of the body, with some measure of symmetry. They often appear on skin that is commonly exposed to the sun, such as the face, neck, and hands.
Common areas include:
- backs of the hands
- arms
- eyes
- knees
- elbows
- feet
- mouth
- armpit and groin
- nose
- navel
- genitals and rectal area
Non-segmental vitiligo is further broken down into sub-categories:
- Generalized: There is no specific area or size of patches. This is the most common type.
- Acrofacial: This occurs mostly on the fingers or toes.
- Mucosal: This appears mostly around the mucous membranes and lips.
- Universal: Depigmentation covers most of the body. This is very rare.
- Focal: One, or a few, scattered white patches develop in a discrete area. It most often occurs in young children.
Segmental vitiligo
Segmental vitiligo spreads more rapidly but is considered more constant and stable and less erratic than the non-segmental type. It is much less common and affects only about 10 percent of people with vitiligo. It is non-symmetrical.
It is more noticeable in early age groups, affecting about 30 percent of children diagnosed with vitiligo.
Segmental vitiligo usually affects areas of skin attached to nerves arising in the dorsal roots of the spine. It responds well to topical treatments.
Causes
The exact cause is unknown, but it may be due to an autoimmune disorder or a virus.
Autoimmune conditions
Non-segmental vitiligo (the most common type) is thought to be an autoimmune condition.
In autoimmune conditions, the immune system does not work properly. Instead of attacking foreign cells, such as viruses, your immune system attacks your body’s healthy cells and tissue.
In non-segmental vitiligo, the immune system destroys the melanocyte skin cells that make melanin.
Vitiligo is also associated with other autoimmune conditions, such as hyperthyroidism (an overactive thyroid gland), but not everyone with vitiligo will develop these conditions.
Risk factors are;
- Family history
- Family history of other autoimmune conditions
- History of skin cancer or non-Hodgkin lymphoma (cancer of the an autoimmune condition that affects the stomach)
- History of any autoimmune disease
- History of melanoma
Neurochemicals
Segmental vitiligo (the less common type) is thought to be caused by chemicals released from the nerve endings in your skin. These chemicals are poisonous to the melanocyte skin cells.
Triggers
It’s possible that vitiligo may be triggered by particular events, such as:
- Stressful events like childbirth
- skin damage, such as severe sunburn or cuts (Koebner response)
- exposure to certain chemicals
Pathophysiology
Vitiligo is caused by the lack of a pigment called melanin in the skin. Melanin is produced by skin cells called melanocytes, and it gives the skin its normal colour. In vitiligo, there are not enough working melanocytes to produce enough melanin in your skin. This causes white patches to develop on your skin or hair. It’s not clear exactly why the melanocytes disappear from the affected areas of skin.
Diagnosis
Case history and physical examination
Wood’s lamp
Other autoimmune conditions
As non-segmental vitiligo is closely associated with other autoimmune conditions, you may be assessed to see whether you have any symptoms that could suggest an autoimmune condition, such as:
- being tired and lacking energy, which may be a sign of Addison’s disease.
- being thirsty and needing to urinate often, which may be a sign of diabetes.
A blood test may also be needed to check how well your thyroid gland is working.
Treatments
There is no cure, and it is usually a lifelong condition.
Using sunscreen
Phototherapy with Ultraviolet B light
Phototherapy with UVA light
Skin camouflage
Depigmenting
Topical corticosteroids
Calcipotriene (Dovonex)
Drugs affecting the immune system – like ointments containing tacrolimus or pimecrolimus, drugs known as calcineurin inhibitors, can help with smaller patches of vitiligo.
Psoralen
Skin grafts
Tattooing
Prognosis
For most people with vitiligo, this condition slowly worsens without treatment or needs continued treatment.
Complications
Vitiligo does not develop into other diseases, but people with the condition are more likely to experience:
- painful sunburn
- hearing loss
- changes to vision and tear production
A person with vitiligo is more likely to have another autoimmune disorder, such as thyroid problems, Addison’s disease, Hashimoto’s thyroiditis, type 1 diabetes, or pernicious anaemia.
Anxiety
Depression
Disease & Ayurveda
Switra
Nidana
Unwholesome diet with opposite potency
Improper routine and behaviour
Teasing and humiliating other good people
Theft
Bad deeds which cause emotional stress factors like repentance/fear/anxiety
Purvaaroopa
Not mentioned
Samprapti
Due to the causative factors,all the three vitiated doshas vitiate rasadhatu first and then gets lodged in deeper dhatus(Rakta, Mamsa and Medas) causing depigmentation of skin. The disease gets manifested as whitish patches on skin.
Lakshana
1)Vaata- In raktadhatu
Rooksha-dry
Aruna – depigmented as dark colour
2)Pitta-In maamsadhatu
Tamram like Kamalapatra – Coppery hue like lotus petal
Sadaaham – with burning sensation
Romavidhwamsi – Hairs fall off from the area
3)Kapha-In medodhatu
Swetam – whitish
Ghanam Guru- heavy
Divisions
- Vaatika
- Paittika
- Kaphaja
Prognosis
Mostly Asadhya especially if:
- Developed on genitals, extrenities, and lips
Sadhya if:
- The hair colour is intact,
- Not continuous & spreading to one another,
- New,
- Not developed on the spot of a burn
Chikithsa
Samana
Lepana with theekshnadravya
Aatapaseva
Sodhana
Teekshnavirechana repeatedly
Vamana
Commonly used medicines
Gojalaasavam
Markavarasayanam
Bakuchichoornam
Brands available
Keraleeya Ayurveda samajam
AVS Kottakal
Patanjali ayurveda
Home remedies
No home remedies are proven to cure leukoderma
Diet
- To be avoided
Red meat, fried non-veg items, and sea foods
Heavy meals and difficult to digest foods – cause indigestion.
Junk foods and spicy food- cause disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening agni (digestive fire)
Curd – causes vidaaha and thereby many other diseases
- To be added
Light meals and easily digestible foods
Green gram, soups, buttermilk boiled with turmeric, ginger and curry leaves
Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc
Behaviour:
Avoid sedentary lifestyle. Be active.
Better to avoid exposure to excessive sunlight wind rain or dust.
Maintain a regular food and sleep schedule.
Avoid forcing or holding of natural urges like urine, faeces, vomiting, hiccups etc.
Avoid Stress and emotional imbalance as much as possible.
Yoga
Ardha mathsyentra asanam
Halasanam
Vakrasanam
Dhanurasanam
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
Research articles
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3764764/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5362109/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5017284/
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