What is Vitiligo?
Leucoderma is an autoimmune disease where, for unknown reasons, the body's immune system deactivates or destroys melanocytes in certain areas of the skin. Although it's not contagious, unfortunately, leucoderma can be stigmatizing for some patients, especially those with darker skin, when it is extensive and in visible areas. Leucoderma is classified as localized and generalized.
In the first case, there are one or more lesions without a specific pattern. Conversely, in generalized leucoderma, there is a larger area affected, often with symmetry in the distribution of lesions. Generalized and symmetric leucoderma has a worse prognosis and is much more resistant to any treatment. There are also cases with an intermediate condition, where, for example, there are isolated lesions on the body or face and symmetric leucoderma on the hands. In such cases, we recommend focusing the treatment on the isolated lesions.
Causes of Vitiligo
Leucoderma is a multifactorial disease, and its causes have not yet been fully clarified. Genetic factors play a role in its pathogenesis, and there is a correlation with other autoimmune diseases such as thyroiditis. Other factors include biochemical ones, with the accumulation of free radicals causing oxidative damage to melanocytes. Additionally, deficiencies in the function of the melanocyte growth factor action system have been found in some cases. Certainly, the action of the body's cytotoxic T cells is crucial, making them a therapeutic target. Interestingly, there is also a theory about the existence of a disorder in nerve endings and the dysfunction of certain neurotransmitters. It's not coincidental that leucoderma may first appear or worsen after intense emotional stress in individuals who naturally have this sensitivity.
What are the first symptoms?
While generalized leucoderma is quite characteristic and easy to diagnose, the same does not apply to incipient leucoderma, where there may be only one or a few small lesions. Since leucoderma can be triggered by minor skin trauma (Koebner phenomenon), the areas around the elbows and hands are perhaps the most common sites of initial appearance. Other times, lesions with lighter skin may appear in areas that have been heavily exposed to the sun.
There are no symptoms such as itching or burning sensation and pain in leucoderma; the skin simply loses its color in the affected area. This makes the condition more prominent in summer than in winter due to the contrast with tanned skin.
There is also a reported association of leucoderma with the presence of moles surrounded by a white halo (halo nevus). Finally, there is a correlation between leucoderma and Hashimoto's thyroiditis, as well as with Vitiligo, with a slight increase in the likelihood of developing one autoimmune disease due to coexistence with another.
In some cases, it is necessary to exclude a fungal infection of the skin (pityriasis versicolor), which is a common condition and usually appears on the back. Also, in cases of sensitivity in the area, we must always rule out the now very rare diagnosis of leprosy, which can also cause white patches. Finally, hypochromic spots often appear on the legs more frequently in women of a certain age, especially if they have been exposed to the sun a lot in the past. This is not leucoderma but hypochromic spots.
Which areas of the face are affected?
Leucoderma on the face most commonly appears around the eyes, on the eyelids, and around the mouth. The positive aspect is that leucoderma on the face is treated more effectively than leucoderma on the body, for reasons essentially unknown.
What is the appropriate treatment?
There is treatment for leucoderma, but it takes time, and it is important to explain certain things. Firstly, the first stage of treatment is to stop the spread. Then, the goal is to 'close' the affected areas. The success of the second stage depends on the extent and type of leucoderma and the time of its appearance. Leucoderma with a small extent and recent onset has a much better prognosis. The position of the lesions is also important.
Leucoderma on the face is treated much better than leucoderma on the hands.
Even better is the prognosis of patients who come before leucoderma is fully established, when they are in a 'hypochromic' state. In this case, but also established leucoderma, it is necessary to perform some tests for other related autoimmune diseases, such as thyroiditis.
Progress has recently been made in pharmacology with the development of new drugs in the family of JAK inhibitors. These have been used with very encouraging results in Vitiligo, Atopic Dermatitis, and Leucoderma. Therefore, shortly in Greece, we hope for new and more effective drugs for leucoderma.
Vitiligo & TotalSkin
Leucoderma is also a condition that has interested us both in research and clinically, and we have 4 original works in internationally recognized journals.
http://www.ncbi.nlm.nih.gov/pubmed?term=kyriaki-aroni-vitiligo
We translate our research interest into therapeutic schemes by following the latest developments in the international literature. However, the most important thing to emphasize is that treatment is almost always time-consuming and mainly depends on the patient's compliance and care to follow it. Unfortunately, there is still no magic pill or machine to provide a solution in a short period.
Finally, in some cases, interventional or even microsurgical techniques are used in treatment, with the concomitant use of active substances such as 5-FU or autologous platelet-rich plasma (PRP). However, it is essential first to stabilize the clinical picture.
