Vitiligo Explained: The Science Behind White Patches and How to Manage Them

Vitiligo is a chronic skin disorder characterized by loss of melanocytes, leading to milky white macules (depigmented patches) on the skin.

Mnemonic: "V.I.T.I.L.I.G.O. = Very Irregular, Total, Idiopathic Loss of Individual's Generalized Opacity"


CAUSES & PATHOGENESIS OF VITILIGO

  • Autoimmune Theory (Destruction of Melanocytes by T-Cells).
  • Genetic Theory (Runs in Families – HLA Association).
  • Self-Destruction Theory (Toxic Melanin Precursors Kill Melanocytes).
  • Neural Theory (Nerve Dysfunction Affects Pigmentation).
  • Triggering Factors – Stress, Sunburn, Skin Trauma.

Mnemonic: "A.G.S.N.T." (Autoimmune, Genetic, Self-Destruction, Neural, Triggers)


TYPES OF VITILIGO

  1. Focal Vitiligo → One or few white patches in a limited area.
  2. Segmental Vitiligo → One side of the body (Dermatomal Pattern).
  3. Generalized Vitiligo → Most Common Type, Symmetrical, Wide Distribution.
  4. Acrofacial Vitiligo → Affects Lips, Tips of Fingers, Toes.
  5. Universal Vitiligo → Almost Complete Loss of Pigmentation.

Mnemonic: "F.S.G.A.U." (Focal, Segmental, Generalized, Acrofacial, Universal)


CLINICAL FEATURES OF VITILIGO

  • Milky White Macules (Round or Oval, Well Defined).
  • Common on Face, Hands, Knees, Elbows, Genitals.
  • Tri-Color & Quadri-Color Vitiligo (Different Shades of White & Brown).
  • Koebner’s Phenomenon (New Patches Appear on Trauma Sites).
  • Perifollicular Repigmentation (Brown Spots Around Hair Follicles).

- Mnemonic: "M.T.K.P." (Milky White, Tri-Color, Koebner’s, Perifollicular Repigmentation)


DIFFERENTIAL DIAGNOSIS OF VITILIGO

  • Pityriasis Versicolor (Superficial Fungal Infection, Scaly Patches).
  • Chemical Leukoderma (Due to Chemical Exposure – Irregular Borders).
  • Leprosy (Loss of Sensation in White Patches).
  • Albinism (Congenital – Since Birth, No Patchy Distribution).

Mnemonic: "P.C.L.A." (Pityriasis, Chemical, Leprosy, Albinism)


DIAGNOSIS OF VITILIGO

  • Clinical Examination (White Patches on Sun-Exposed Areas).
  • Wood’s Lamp Test (Lesions Glow Bright White Under UV Light).
  • Skin Biopsy (Absence of Melanocytes).
  • Blood Tests (Check for Autoimmune Diseases – Thyroid, Diabetes).

Mnemonic: "C.W.S.B." (Clinical, Wood’s Lamp, Skin Biopsy, Blood Tests)


TREATMENT OF VITILIGO

1. MEDICAL MANAGEMENT

  • Topical Steroids (Clobetasol – Reduces Inflammation, Aids Repigmentation).
  • Calcineurin Inhibitors (Tacrolimus – For Sensitive Areas Like Face).
  • Psoralens (PUVA Therapy – Psoralen + UV Light).
  • Narrow Band UVB (Gold Standard for Generalized Vitiligo).

Mnemonic: "S.C.P.U." (Steroids, Calcineurin, Psoralens, UVB Therapy)

2. SURGICAL MANAGEMENT (For Stable Vitiligo)

  • Skin Grafting (Transplanting Pigmented Skin to White Patches).
  • Melanocyte Transplant (Cultured or Non-Cultured).
  • Tattooing (For Small, Resistant Areas).

Mnemonic: "G.M.T." (Grafting, Melanocyte Transplant, Tattooing)


HOMOEOPATHIC MANAGEMENT OF VITILIGO

  • For Early-Stage Vitiligo:
  • Sepia, Silicea, Natrum Mur, Arsenicum Album.
  • For Autoimmune-Associated Vitiligo:
  • Thuja, Sulphur, Phosphorus, Calcarea Carb.
  • For Stress-Induced Vitiligo:
  • Ignatia, Natrum Carb, Staphysagria.

Mnemonic: "S.S.N.A." (Sepia, Silicea, Nat Mur, Arsenicum for Early Vitiligo)


FINAL REVISION WITH MNEMONICS

  • Definition = "V.I.T.I.L.I.G.O. = Very Irregular, Total, Idiopathic Loss of Individual's Generalized Opacity"
  • Causes = "A.G.S.N.T." (Autoimmune, Genetic, Self-Destruction, Neural, Triggers)
  • Types = "F.S.G.A.U." (Focal, Segmental, Generalized, Acrofacial, Universal)
  • Clinical Features = "M.T.K.P." (Milky White, Tri-Color, Koebner’s, Perifollicular Repigmentation)
  • Differential = "P.C.L.A." (Pityriasis, Chemical, Leprosy, Albinism)
  • Diagnosis = "C.W.S.B." (Clinical, Wood’s Lamp, Skin Biopsy, Blood Tests)
  • Treatment = "S.C.P.U." (Steroids, Calcineurin, Psoralens, UVB Therapy)
  • Surgery = "G.M.T." (Grafting, Melanocyte Transplant, Tattooing)
  • Homeopathy = "S.S.N.A." (Sepia, Silicea, Nat Mur, Arsenicum for Early Vitiligo)


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