Leucoderma, a chronic disorder of skin, which, is characterized by total loss of pigment in the skin, is found to be fully curable with a combination treatment involving existing medication with skin grafting. The combination treatment, which was introduced first in India by Dr. Sanjeev Mulekar, a well known dermatologist in India, involves melanocyte transplantation along with existing medical therapy using psoralen compounds, cortico steroids or azathioprine.
The disease, termed as Vitiligo by a Roman physician, Celsus, affects all races the world over. However, the highest incidence has been recorded in India and Mexico. It is roughly estimated between 3 to 4 per cent now in India. People belonging to different races, religion, and socioeconomic groups and with different dietary habits show similar incidence towards the disease.
Though the exact cause of vitiligo is still not known, recent studies have found that the factors like autoimmune, neurogenic and genetic transmission can be some of the major reasons for the disease. While the autoimmune caused when antibodies in the form of white blood cells (lymphocytes) are formed in the body which destroy melanocytes (pigment cells), the neurogenic factor is due to an unknown chemical substance released at nerve endings destroy pigment cells. The disease can also be transmitted to next generation. However, according to Dr Mulekar who has so far treated around 70 patients with this combo method in his clinics at Pune and Mumbai, only 20 to 30 per cent patients give positive family history.
Typical lesion is well-defined milk-white patch. It appears usually between the age of 10 and 20 years but can appear in any age. It can appear on any part of the body. Usually after initial spread of the disease (unstable stage) there are long periods of stability. During this period patches don't increase in size and no new patches appear on the body. However sometimes appearances of a new patch does not affect the stability of older patches. This stable phase lasts for many years, may be life long in some patients. About 20% of the patients experience spontaneous repigmentation of all or some of the patches. Small percentage of patients may experience reactivation of the disease. The exact cause of this recovery or deterioration is not known.
Currently, there are four types of Vitiligo found in the world. Of these, Segmental type, which is the most stable that does not respond to medical treatment completely and best results, can be expected with melanocyte transplantation surgery. The second type, Focal is localized to single part of the body, which responds well with surgery alone or in combination with medicines. However, the third category, generalized leucoderma, shows good response to medicines and surgery. Chances of relapse are more when compared with above to types. But acro-facial, the fourth type, in which patches are distributed at tips of toes and fingers and lips, is most difficult to treat as it does not respond to medical treatment and sometimes responds to surgical treatment.
Dr Mulekar says, "There are no laboratory investigations to determine the severity, the future course and activity of the disease. The activity of the disease is determined by clinical observation and by demarcating the patches." The spread of the disease, which is going to happen in the future, cannot be investigated by any other investigation as well, he adds.
The existing medical treatments are mainly with the psoralen compounds, corticosteroids and azathioprine. However the Ayurvedic practitioners have been using oily extracts of the seeds or the seeds of Psoralia coryfolla (Bavachee). These herbal products contain photosensitizing furocoumarin chemicals, which are capable of producing pigmentation.
At the same time the surgical treatment involves skin grafting, epidermal grafting and mini grafting. The skin grafting or the split thickness graft are performed in cases ranging from 6 to 100 sq.cm. area. The possibility of development of hyper tropic scar and undesirable cosmetic effect to the recipient and the donor site should be kept in mind.
Whereas, in the epidermal grafting, a blister is produced by suction at donor site. The roof of the blister is cut and grafted on the affected area after scrubbing the superficial skin. The procedure does not cause any scarring but is more time consuming, blistering may be painful and very small areas can be treated by this method, says Dr Mulekar.
Similarly, the mini grafting is performed by implanting small punch grafts 3 to 4 mm apart within minute holes into the leucoderma area. This procedure may give uneven pigmentation cobblestone appearance and scarring at the donor's site. All the above surgical methods give donor to recipient ratio 1:1 except mini punch grafting which gives the ratio of 1:3, Dr Mulekar informed.