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Leucoderma

Leucoderma coupled with vitiligo is a common skin condition wherein one can see extensive white patches on the skin. Some people use these terms interchangeably but there is one critical difference between leucoderma and vitiligo i.e leucoderma will strictly occur after physical trauma. While vitiligo can occur due to severe emotional trauma, hormonal changes, recurrent jaundice or typhoid, prolonged anti-biotics or corticosteroid and even some auto-immune conditions. Dermatologists in Delhi point out that the etymology of the disease says it all as leuco stands for white, derma for skin giving leucoderma and people with darker skin are more prone to be affected by leucoderma. An estimated two percent of the global population has this problem of having white patches on the skin. Populated tropical countries like India, Mexico have four per cent of their population suffering from white patches on the skin.

Symptoms:

Both in leucoderma and vitiligo, skin loses the pigment that decides its colour, resulting in discolouration or white patches. You will see irregular pale or milky white patches on the skin. Melanocytes are cells containing melanin which die resulting in leucoderma or vitiligo causing colour less white patches on the skin. The onset of leucoderma is sudden and the patient sees white spots appearing randomly on the surface of the skin. These spots usually advance very rapidly up to a point where there are no further white spots. They can appear anywhere in the body and even the hair on these spots becomes white. Sensitivity to heat and touch remains but sensitivity to sunlight increases so the patient may try to remain indoors. In some cases, re-pigmentation happens on its own without any medical intervention by the dermatologist in Delhi.

It can be a source of huge stress for young men and women in the marriageable age or those who are in customer-facing roles and cannot afford to have white patches on the skin. Leucoderma strikes early and children are the most vulnerable group. Youngsters in the age group of 10-30 are most affected and those who are below 40 are most likely to get it.

Causes of white patches

Loss of melanin or defective formation of new melanocytes can be due to stress, environmental, auto-immune, genetic factors and the exact cause has not been completely understood by scientists. There are many lifestyle diseases also that cause leucoderma, vitiligo or in plain simple words white patches on skin and these include: hypothyroidism, hyperthyroidism, diabetes, psoriasis, pernicious anaemia, Addison’s disease, alopecia areata. Other factors include: sun burns, physical or emotional trauma, exposure to chemicals that trigger de-pigmentation known as phenolic/catecholic derivatives. Hereditary factors also lead to white patches and research has pointed out the NALP1 gene to be trigger that causes white patches.

  • Focal: patches that are limited to a specific area.
  • Segmental: patches affect only one side of the body
  • Symmetrical: patches affect both sides of the body
  • Over body prominences: skin near the joints is affected
  • Lip tip: those occurring on the lips and fingertips/toe-tips
  • Genital: patches occurring on the private parts of the body

Treatment:

Examination of the affected area, limbs needs to be done under wood’s lamp as there are certain white patches that are not visible to the naked eye. Biopsy of the affected area can confirm whether it is vitiligo or not. Further blood tests need to be done to determine whether the thyroid gland is over-working or under-working. Anaemia needs to be identified through blood tests and presence of anti-nuclear antibodies needs to be determined as that would point out to auto-immune disease. The following kinds of white patches have been observed in patients:

All treatment pedagogies to heal leucodema or vitiligo are directed towards re-pigmentation in affected areas or arresting pigment loss by slowing down the loss of pigmentation. Phototherapy under medical supervision is administered.

Psoralen is an important compound that is used in the treatment of white patches. High ultra-violet absorbent properties of psoralen make it the ideal compound to be applied on skin and then ultra-violet light is applied on these compounds to cure the white patches. Formulations like phenyl amine , dapsone and levamisole coupled with cortico steroids are also used to treat white patches with a high degree of success.