Autoimmunity: this occurs when the bodies immune system attacks its own cells.
Autioimmune disorders such as diabetes mellitus and thyroid disorders are often found in patients
with vitiligo or their immediate relatives. As such, it is postulated that vitiligo arises when
circulating autoantibodies target the melanocytes resulting in loss of function.
Autocytotoxicity: a defect in free radical defence results in increased sensitivity
of the cell to oxidative stresses, leading to melanocyte death.
Neurogenicity: it is thought that nerve endings in the skin may produce
neurochemicals which are toxic to the melanocytes.
There are no proven measures to prevent vitiligo. However we know that vitiligo can appear in areas
of the body that have been injured by cuts, abrasions of burns. As such, those who have vitiligo
should attempt to avoid any kind of repeated trauma to the mselves especially the extensor area of
their limbs. There are many treatments available to those with vitiligo. Topical steroid creams are
effective in up to 50 percent of patients. Results are usually seen in the first three months of
treatment. However,as these creams can cause side effects such as thinning of
the skin, patients should be regularly monitored by a skin doctor. Immunomodulator creams such as
tacrolimus and pimecrolimus work by reversing the immune attack on the pigment cell. As they do not
contain steroids, they can be used for longer periods. Lastly, creams containing Vit D compounds
have also been found to be effective in some patients.
Those with moderate to severe vitiligo can be treated with ultraviolet light. Patients are exposed
to narrow band UVB rays in a light box two to three times a week. This treatment is safe for
children and pregnant women, as no oral medication is involved. Alternatively, there is PUVA,
whereby a chemical (psoralen) is administered topically or orally to render the skin temporarily
sensitive to UVA light. As this treatment involves potential side effects and requires sun
protection precautions, it may not be suitable for all patients. Excimer lasers can also be used to
treat patients with vitiligo. Their advantage is that one can treat single patches, thus sparing the
non- affected skin. The laser is administered twice a week. Significant repigmentation of up to 75
percent has been reported in about half of patients treated, with areas on the face responding best.
Surgical options, in the form of tissue or cell grafts, can be considered when topical and light
therapies have failed. Only stable cases,where there are no new lesions or progression of existing
lesions for 12 to 24 months are suitable for grafting.
The last resort when treating vitiligo is depigmentation. It involves the application of monobenzyl
ether of hydroquinone daily for a period of nine to twelve months until the skin is evenly bleached.
The results are irreversible so this treatment should only be embarked upon after extensive
counselling and consideration.
