Vitiligo

30% of cases have a hereditary component

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Diagnosis and Treatment for Vitiligo at the Clínica

Vitiligo lesions are caused by a lack of melanocytes, which are the cells responsible for pigmenting the skin.

In the majority of cases, the diagnosis is made after a medical examination of the patient's skin.

Occasionally, a slit-lamp or Wood's lamp can be used. These lamps give off an ultraviolet light that makes the areas lacking melanocytes appear as a bright white colour.

Sometimes a cutaneous biopsy must be carried out to rule out any other autoimmune diseases, as well as a blood analysis to determine the levels of thyroid hormones and vitamin B12.

The skin of a patient suffering from vitiligo doesn't have any functioning melanocytes (the cells responsible for pigmenting the skin) in the affected areas, and so it is important for them to wear sun cream, given that they will burn much more easily.

Do you want to learn more about Department of Dermatology?

The department, along with the Area of Cell Therapy, prepares and implements the amniotic membranes with cultured epidermal cells.

The best method is to treat select zones which are in a stable condition and have not responded to conventional medical treatments, rather than large areas.”

Powerful corticosteroids can be used on limited areas of the skin, but it's important to avoid persistent and continual application.

When dealing with more extensive cases of vitiligo, oral photo chemotherapy is usually carried out. This treatment consists in orally administering a drug (psoralen) along with the exposure to UVA rays (PUVA). This treatment manages to repigment the skin in 50% of vitiligo sufferers.

Another treatment used for moderate cases of vitiligo is to apply Kellina cream onto the skin along with sun exposure. Administering amino acids such as phenylalanine either orally or onto the skin, accompanied by sun exposure, is another therapeutic treatment for vitiligo.

Additionally, using calcipotriol on the skin has also achieved good results. This is a drug used for psoriasis that contains calcineurin inhibitors.

Recently, there have been more and more publications about surgical treatment for vitiligo, using autologous skin grafts or the selective cultivation of melanocytes.

This new technique involves transplanting the patient ́s own epidermal cells (skin cells) from a pigmented area to specific unpigmented areas. 

Generally, this cell therapy procedure is applied in areas where it is thought it will be successful, like the face, which is also usually the area that most interests affected people. 

There are other areas on the body where repigmentation does not work as well, for example on the hands where vitiligo also commonly appears.

It is best to carry out this treatment on selected zones of the skin and not on large areas which remain stable after having not responded to conventional medical treatments.

It's important to remember that surgical treatment using sheets of epidermal cells would never be the first choice treatment for vitiligo and should never be used on active vitiligo.

Finally, some patients whose patches affected by vitiligo are bigger than the areas of normally pigmented skin can be treated by depigmenting their healthy skin using hydroquinone in high concentrations.

Treating vitiligo using this new technique begins with the cultivation of epidermal cells, mixed with keratinocytes and melanocytes, to be used after a selection has been cultivated, which will form a single layer to support the amniotic membrane.

The procedure was developed by a team of specialists at the Clínica, and begins by taking a biopsy (a small area of the skin) from a hidden area, it could be the lower back or the buttock if they're still

Next, the skin sample is processed by the Cell Therapy Department. Using enzymes, they separate the epidermis from the dermis to collect the necessary cells from the separated epidermis for cultivation.

The cellular groups collected are cultivated afterwards on an amniotic membrane and grow into millions of more cells.

The quantity of epidermal cells collected in cultivation will be processed until there is a sufficient amount on the cell surface in order to cover the affected area. If the surface being treated is very large, it's necessary to increase the number of weeks that the epidermal cells must be left to cultivate. In this way, enough cell plates can be gathered as required by the affected zone.

Applying the amniotic membranes, with epidermal cells, onto the patient is carried out in the operating theatre:

  • Firstly, the white patches are treated with a CO2 laser. It is necessary to use this laser very lightly to succeed in eliminating the epidermis.
  • The amniotic membrane is then placed onto this epidermis with epidermal cells.
  • Once transplanted, the layers of melanocytes must be covered during an occlusive dressing stage which lasts 3 or 4 days.
  • Next, the patient must be exposed to solar or UV rays, depending on the time of the year. 

The surgical technique is an outpatient procedure and is carried out with local anaesthetic.

Generally, this cell therapy procedure is applied in areas where it is thought it will be successful, like the face, which is also usually the area that most interests affected people. 

There are other areas on the body where repigmentation does not work as well, for example on the hands where vitiligo also commonly appears.

Learn more about vitiligo

It's a skin condition with an unknown origin that is characterised by white patches on the skin due to a lack of pigmentation. 

Vitiligo is a disease which affects 1% of people worldwide and is more common in races that have a higher quantity of pigmentation in their skin.

It's believed that the condition is more prevalent in women and the general age at which it appears is between 10 and 30 years old, although it can arise at any point in life.

In specific cases, surgery has a 90% efficiency rating and is recommended as an alternative treatment.

Know what is vitiligo. [Infography only available in Spanish]
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The cause of the disappearance of melanocytes or ceasing to produce melanin is unknown.

Different theories have been created to suggest that this disease is of an autoimmune origin.

It ́s also been noted that situations like stress or trauma can cause the appearance of these lesions in predisposed patients.

Sometimes, vitiligo is connected to other types of diseases such as diabetes, pernicious anaemia, Addison's disease or thyroid diseases.

  • Focal vitiligo: the appearance of isolated white patches of reduced size and number in a certain area. 
  • Segmental vitiligo: characterised by unilateral patches that usually follow a specific distribution pattern. It ́s generally the most common type of vitiligo and patients will have multiple symmetrical hypopigmented patches spread out all over the skin ́s surface. 
  • Acrofacial vitiligo: affects distal parts of the body (hands, lower legs, feet) and the face, though generally very few areas of the body are affected.

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