People fear about the familial occurrence of the patches. Though there is some hereditary tendency, as it is one of the many factors causing the disease, it is not that important what our society thinks.There are many vitiligo patients having no other family member suffering from this problem. On the other hand, there are large number of patients whose sons and daughters are not having vitiligo. So heredity is NOT the only factor, the way our society thinks. ( We always give an example of using mobile while driving. Use of mobile while driving, though dangerous, not the only cause of accidents. There are many other factors like bad light, bad roads, rash driving, etc. As mobile is not the only cause, accident can still occur even if mobile is deliberately left at home. Similarly accident does not immediately happen at the same moment, when you start using mobile.)

The spread of vitiligo can be arrested by use of various immunosuppressive drugs (like corticosteroids, azathioprine, methotrexate) for prolonged periods. Exposing body to Ultraviolet B (UVB) light also helps in stabilising the disease. Corticosteroids as well as some drugs called as calcineurin inhibitors (mainly tacrolimus and pimecrolimus) can be used as creams and lotions.

The patches once formed need to be repigmented. A group of drug called as Psoralens are useful along with Ultraviolet A light. UV light can be from artificial source or from sunlight. UVB light mentioned above, can also be helpful in getting the colour back.

Three types of artificial sources of UVB are available:

Chamber UVB : This is available in Alok Clinic Panvel. It is useful when whole body is to be exposed and when patient needs to derobe and needs privacy.

308 Excimer Lamp : This is also available in Alok Clinic Panvel. It is a laser like monochromatic light which can be used to give exposure to individual spots in a targeted manner.

Hand and Foot UVB : This equipment is available in alok Clinic, New Panvel and is very useful to give exposure to hands and feet.

For those patients, who have patches which are stable but resistant to treatment, skin grafting surgery can be performed. We transfer the skin / melanocytes from places like thigh and implant them on the patches. There are various methods:

Punch Grafting : This is a very old method. But still useful if patches are very big. Small pieces of full thickness skin from thigh are removed and grafted on the white patches after creating “wells” on the patches. Relatively easy to perform but leaves cobblestone like marks after the pigmentation takes place.

Split skin grafting : A thin layer of skin removed from thigh and grafted on white patch. It is a very good method for small areas.

Suction Blister Grafting : Blisters are created on the donor area of thigh by using syringes. The roof of the blister is used for grafting. Very useful for lips or smaller cosmetically important area.

Melanocyte Keratinocyte Transfer (MKT) : It is an advanced method, in which skin removed from thigh is processed with the help of chemicals like trypsin in an incubator. At the end of processing, we obtain a suspension of skin cells suspended in a growth medium called as DMEM. After removing upper layer of skin of white patches, the suspension can be applied like a paste and dressing given. This method can help us treat large areas. It does not give any textural changes in the grafted skin. So after complete repigmentation, the grafted skin looks near normal. Alok Clinic has procured all the equipment and has a well equipped Operation Theatre for this advanced method in its New Panvel setup.

To avoid scarring on the thigh, we now have even advanced method of removing few hair (process similar to hair transplantation) and process them to make melanocyte suspension. Due to this method, the scar on the thigh is avoided.

Vitiligo is autoimmune disease and require various immunosuppressive drugs to stop the spread. But these drugs, due to some of their side effects, require close monitoring and follow up. Sometimes, the spots keep one spreading at places in spite of these drugs.

Patch can get easily repigmented from the melanocytes (colour forming cells) in the hair follicle. Thus presence of pigmented hair on these white patch is very useful in getting the colour back. Patches where the hair have turned white, are difficult to treat. The patches on non-hairy area (like palms, soles, lips) are also resistant to treatment.

Sun exposure or ultraviolet exposure is very important for pigmenting the patches. Sun exposure is difficult for many patients who have patches at hidden sites and do not have access to a place where sunlight is available at their convenient time. Such patients can come Alok clinic and take UVB exposure, but it is possible only if patient is staying within reasonable distance from the clinic.Such patients are encouraged to purchase Personal UV lamps.

Vitiligo treatment goes on for prolonged period. We need continuous support, hand holding and counseling of patients to pursue such long courses.