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LEUKODERMA - VITILIGO

What is Leukoderma ?

Vitiligo is a disorder in which the body destroys its own pigment cells (melanocytes) in various parts of the skin. In affected areas, the pigment gradually disappears. Small or larger areas of skin then become white with sharp margins where they adjoin unaffected parts of skin. If hairs are involved in this area, they too also grow white rather than pigmented. The condition is most noticeable in summer, when normal skin darkens. Because of the lack of protective pigment, the affected areas are also likely to burn and blister in the sun.

How does Leukoderma occur ?

In vitiligo, white blood cells attack and destroy pigment cells in discrete areas of the skin. It is called an auto-immune disorder, because the pigment cells become regarded by the body as "foreign" and are therefore rejected. You may have another auto-immune skin disease called alopecia areata (where small areas of hair are lost). You may also have pernicious anaemia, various types of auto-immune thyroid disorder, Addison's disease (an adrenal gland problem) or other auto-immune disorders. If the affected areas of skin are examined under the microscope, white blood cells called lymphocytes can be seen clustering around the pigment cells. These are eventually destroyed and the skin loses its pigment.

Why does Leukoderma occur ?

In 25% of patients with vitiligo there is a family history, either of vitiligo itself or another auto-immune disorder. In these patients it appears to be inherited as a dominant trait. This means that it affects half the offspring of an affected parent and half the brothers and sisters of the patient. Vitiligo may also occur at sites of injury to the skin and therefore may at first show itself in scars or burns. Current evidence suggests that the cause of the problem is the development of an antibody to an enzyme in the pigment cell. It is this antibody and the lymphocytes which together result in destruction of the pigment cells.

Treatment Involved for Leukoderma

Vitiligo is mainly a cosmetic problem. However, treatment can help some patients. The treatment of choice is corticosteroid (cortisone-like) ointment or cream. The appropriate strength will be used, depending on the site involved. A mild steroid would be used on the face and a stronger steroid for the trunk and limbs. If you find that you have dark hair growing from the area of vitiligo, the outlook is better, since the vitiligo is likely to be affecting only the upper layers of the skin. This means that pigment cells that are still present in and around the hair roots can migrate upwards to the surface. The skin will then re-darken at a later date. About 50% of patients with vitiligo will respond to a corticosteroid. In those who do not respond, a specialized form of light treatment may be of value. This treatment is called PUVA and involves applying a paint, made out of a plant extract, called psoralen to the affected areas of skin and then exposing the skin to long wave ultraviolet A light. The psoralen can also be given by mouth 2 hours before the PUVA treatment. The oral route is used if the vitiligo affects a larger number of areas of the skin. This treatment tends to only be available in hospital. The success rate of PUVA treatment is about 50%. Recently some doctors have been using vitamin D-like cream in vitiligo with good effect. Clinical trials are needed to properly evaluate these creams but results so far look promising. In patients who do not want active treatment or in patients who fail treatment with both corticosteroids and PUVA therapy, cosmetic camouflage can be used in areas that are exposed. The British Red Cross run a Camouflage Clinic in many dermatology departments and will match up to your normal skin colour.

During Treatment for Leukoderma

As vitiligo responds to treatment, a darkening halo appears around the affected area, with spotty pigmentation within the area. The spotty pigmentation is due to movement of healthy pigment cells from the hair roots to the surface of the skin. As the pigment spots become larger, they eventually join together. The lesion then gets smaller as additional pigment cells move in from the perimeter of each affected area. If you are taking the psoralen orally, it will be absorbed throughout the body including the eyes. The eyes must then be carefully protected with dark glasses for the following 12 hours.

After Treatment for Leukoderma

New areas of vitiligo can develop, and previously treated areas may require further courses of treatment.

If Leukoderma is Left Untreated

Vitiligo tends to be a persistent chronic condition and will generally become more extensive if not treated. There is, however, no way of predicting how extensive the disease will become. There is no way of stopping the condition from affecting other areas of skin. In some individuals, however, it may remain restricted to very small areas of the body throughout life or even spontaneously get better.

Effects on Family of Leukoderma

Vitiligo can be an inherited condition. If other members of your family are known to be affected, then there is a stronger likelihood of you passing it on to your children. Vitiligo is also an extremely embarrassing condition and may cause a profound psychological upset to sufferers. Family and friends therefore need to be very supportive of those affected. There is no way of preventing the condition.