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Vitiligo Treatment and Surgery

Vitiligo Treatment and Surgery


We Offer the Best Cost & Advanced Vitiligo Treatment in Delhi/Vitiligo Surgery in Delhi

Care Well Medical Center offers the best cost for Vitiligo Treatment in Delhi or Vitiligo Surgery in Delhi, India and in fact offers the latest treatment with best and proven results. Vitiligo treatment is performed by an experienced Cosmetic Surgeon Dr. Sandeep Bhasin.

Regain Flawless Skin and Confidence Back with Latest Advancements in Treatment  of Vitiligo.

Don’t Despair, we are Here to Offer an Empathetic and Professional Support.

Hi, I am Dr Sandeep Bhasin a Cosmetic Surgeon trained in Vitiligo Surgeries. I have been treating Vitiligo for last 10 years. I will speak my heart out to share common question that my Clients have regarding Vitiligo.  These are based on my practical years of experience.

So lets start.

What are common Myths about Vitiligo?

First My Dear Friend if you or any of your dear one is suffering from Vitiligo be assured that Vitiligo is not life threatening in any way. That’s my first message to all of you. It is more of Social Stigma and Cosmetic Nuisance rather than Morbid Disease.

Vitiligo

Second Important message is Vitiligo Does Not Spread By Close Contact i.e. it is not contagious or communicable disease. So please don’t discriminate anyone with Vitiligo on this pretext.

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Third Vitiligo has nothing to do with eating Fish, Curd, white things, Sour things. I have not come across a single scientific paper which shows any correlation with Vitiligo and diet. So, no known dietary link is found with Vitiligo as of present. Enjoy and relish the food of your choice and don’t curtail it out of fear and wrong messages.

Fourth Vitiligo cannot stop you from succeeding in life. Here is a list of famous celebrities from all over world who had Vitiligo:

 

Michael Jackson, Winnie Harlow the American Super Model, Dean Edwards Chef in BBC cookery Show, Graham Norton an Irish Actor, Thomas Lennon director and producer of Star of Reno etc. You can have look for further details at – http://uniteforvitiligo.com/community/famous-vitiligans-celebrities-with-vitiligo/

 

Fifth Vitiligo is treatable to a great extent though it may not be curable.

 

What is Vitiligo?

Dear Friends Vitiligo / Leucoderma / White Patch is a condition when a area of body skin becomes depigmented and appears as a white patch in contrast with surrounding Skin. This condition is acquired with age and may start at any age. Even children as young as 1year may have these white patches and is usually hereditary in children.

 

People who suffer from Vitiligo no longer have to worry because at Care Well Medical Centre we perform various combination of procedures to treat vitiligo*.  Vitiligo is a skin condition which usually spreads on to our hands, face and torso & before we talk about Vitiligo Treatment we should know about, what exactly Vitiligo is.

 

Melanocyte Transplant Treatment for Vitiligo

Melanocyte Transplant Surgery is the most advanced treatment available in India to treat Stable Vitiligo*. Results can be seen in just 2-3 months*. Completely natural treatment.Treatment also available for Unstable Vitiligo.

                         Know More about Melanocyte Transplantation

 

Which are the areas commonly involved with Vitiligo?

Vitiligo or White patches can involve any area of body though sun exposed areas are more common to develop these patches. The patches may typically start on hands, elbow, knees, legs or face and  then either spread for some time then stagnate or rapidly spread. Sometimes Mucosal area as Lips, rectum and vagina may also be involved. Vitiligo can affect eyes, retina and cause eye discoloration also.

 

More about Vitiligo

Vitiligo is result of destruction of special pigmented cells in skin called Melanin.  We know that the skin color is because of Melanin pigment. By what ever method if this pigment is destroyed then patient may develop Vitiligo. So there are many theories about the cause of destruction of Melanin pigment:

  • Auto Immune Disorder
  • Self Destruction of Melanin Pigment
  • Stress Induced
  • Chemical Induced
  • Neurological cause
  • Some Nevi from birth

 

Vitiligo contusions are signalized as follows:

  • White patches in oval, round, or linear in shape
  • Depigmented macules
  • Generally well delineate
  • Borders may be curved outwards
  • Patch size may vary from millimeters to centimeters
  • Expand divergently over time at an unforeseeable rate
  • These patches don’t pain or cause Itching

 

The contusions in the beginning take place most often on the forearms, feet, hands and face, favoring a periocular and perioral and scattering.

Some Excellent Results (Before & After)

vitiligo-before-after

Clinical variants

  • Segmental
  • Non Segmental
  • Acral
  • Mucosal
  • Generalised or Vulgaris
  • Koebner phenomenon: Occurrence and advancement of vitiligo at areas of particular trauma, such as a burn, incision, lesion or abrasion.

                                

Who is affected by Vitiligo?

 

  • Can affect anyone
  • More common associated with Autoimmune diseases as Hypothyroidism, Diabetes type 1, Psoriasis.
  • Family History of Vitiligo present
  • Stress and Emotional Trauma
  • Hair turning gray at very early age before 35 yers,
  • Exposure to Chemicals
  • Severe Sunburn or any Thermal Burns

 

Diagnosis of Vitiligo

  • Eye examination by Physician.
  • Skin biopsy where a small portion of skin is withdrawn for sample testing
  • Dermatoscopy

Microscopic assessment of concerned skin characterizes a complete lacking of melanocytes in association with a complete loss of epidermal pigmentation.

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Treatment of Vitiligo

Vitiligo Treatment

People having vitiligo need not to panic as there are handful of therapies, both surgical and non-surgical in the clinical cosmos, that can help you be free from vitiligo or at least minimize the appearance. All you need is to keep the positive attitude alive and rest assured that these medical procedures will definitely help.

 

Vitiligo Treatment

For the treatment purpose we need to check whether Vitiligo is stable or not.

Stable Vitiligo means:

  • The patches are not increasing in size for last one year or more
  • No new patch in last one year
  • Any injury or wound heals with normal pigmentation.

Unstable Vitiligo means:

  • New patches coming up.
  • The patches are increasing in size
  • Any injury or wound heals with whitish discoloration.

 

The management of Vitiligo will depend on the status whether the Vitiligo is stable or not

  • For Stable Vitiligo the treatment is Surgical Management.
  • For Unstable Vitiligo Medical Management is advisable.

 

For Stable Vitiligo, we do one of the Following Surgical Options.

  1. Non Cultured Melanocyte Transplant
  2. Punch Grafting
  3. Skin Grafting Split thickness ultra thin graft
  4. Blister Grafting

 

For those with Unstable Vitiligo we advise following Medical  treatments

  • Oral Immune suppressants as steroids, Azathioprim,
  • Topical Ointments as steroids, Calcineurin
  • Ointments to promote pigmentation as Methoxpsoralen
  • Multi vitamins orally and injectable
  • Ozone therapy as Major Auto Haemo therapy and Minor Auto haemotherapy
  • Narrow Band Ultra Band UV B .

 

For those patients where the Vitiligo patches are covering more than 40 % of body area we advise

  • Depigmentation of reaming skin by using Monobenzone
  • Micropigmentation or Tattooing of skin patches
  • Camouflage with Derma Colours.

 

Let me give you details of Surgical Methods

Surgical Methods for Vitiligo

As discussed Surgical methods are useful only if Vitiligo is Stable and not increasing in size, for last 1 year

Surgical Treatments for Vitiligo

Basis of Surgical treatment is that we take either a potion of normal skin with melanin pigment or the Melanin Pigment itself and transplant these to the White Patch area.

  1. Skin grafting: A Ultra Thin Patch of skin from normal Donor area is taken and grafted to White patch area after making the affected patch raw by Dermabrasion..Problems with skin grafting are-  The cosmetic results are not as good as with Melanocyte Transplantation and we need large donor area.
  2. Blister grafting: Here we induce a blister by mechanical or chemical method on normal skin. The Blister has very thin thickness so the cosmetic results of Blister grafting are  .much better than Skin Grafting method. But this is slow process  and suitable for large areas.
  3. Punch Grafting: Here small punches 1-1.5 mm punches from normal skin are taken and implanted on donor area. This technique is good in areas as Scrotum, Lips etc. But disadvantage is Uneven skin or Koberization .
  4. Non Cultured Melanocyte transplantation: This is latest and most advanced method in treatment of stable Vitiligo.

 

Advantages of Melanocyte Transplantation

  • Best Cosmetic Results as compared to all above methods. For areas as Face, lips, around eyes etc. this is recommended treatment.
  • We can cover big areas as large as 400-600 sq cm area in one sitting
  • We do not need a large donor area. Only one fifth of White patch area is sufficient for this procedure
  • If correctly done then there are not much scars on donor area.
  • It is safe and effective treatment for stable Vitiligo.

 

What is Melanocyte Transplantation?

Melanocyte Transplantation is one of latest Surgical method for management of Stable Vitiligo. In this we take a normal colored thin skin graft from thigh called Donor area . It is important that the graft of skin should be ultra thin. This will improve our results and decrease the scarring. The Skin graft is chemically treated and Melanin Pigment is separated from the skin.The Melanin Pigment is transplanted to the white patch after making the Vitiligo patch raw with Dermabrasion.

Melanocyte Transplantation

 

How is Melanocyte Transplantation different from Skin Grafting?

In Melanocyte transplantation we separate the Melanin pigment from skin graft and transfer this pigment only to the dermabraded Raw Patch whereas in Skin Grafting the entire skin graft is transplanted to the white patch.

 

What are Advantages of Melanocyte Transplantation over Skin Grafting ?

Cosmetic Results  Of Melanocyte Transplantation are much better than Skin grafting. In results are so good that in many cases one cannot even tell whether any procedure has been done

Very Natural Results no discrimination with surrounding skin. In skin grafting often the grafted patch appears as a separate area.

Minimal scarring on donor area after Melanocyte Transplantation, as we take Ultra thin graft

 

How much skin graft do we need for Melanocyte Transplantation?

In Melanocyte Transplantation we need skin graft equivalent of 20% -30% of the Vitiligo area. In Skin grafting we need area 100 % or more than white patch area.

 

How is Melanocyte Transplantation Done?

 The steps of Melanocyte Transplantation are as follows:

  • An ultra thin Skin graft from Donor area is taken. Most preferred area is thighs, from graft is extracted. Graft is taken under Local or General Anesthesia
  • The skin graft is treated with a chemical called Trypsin and incubated at 37 degree for 1 hour
  • Then the skin graft is manually teased to separate Dermis and Epidermis. The whitish Dermis is discarded. At this point Trypsin is neutralized with solutions as Phosphate Buffered Saline and Dulbecos Medium
  • The solution obtained is centrifuged at 1500 rpm for 10 minutes to get a Pearl of Melanin Pigment
  • The White patch or Leukoderma area is made raw with Dermabrasion
  • The Melanin pigment pearl is mixed with Serum of patient and transferred to these white patches which have been dermabraded
  • Dressing is done with Collagen Sheets and Tegaderm

 

What are precautions after Melanocyte Transplantation?

  • There should not be any movement for 5 days in the area where Melanocyte Transplantation has bees done. So strict bed rest is must
  • The dressing should be changed on 5th post operative day
  • Antibiotics and pain killers may be needed for 5-7 days
  • Follow up for 1-2 months should be done and few treatments as Narrow Band UVB Phototherapy and few medications topical and oral are often prescribed for 2-3 months after Melanocyte Transplantation

 

What is success rate of Melanocyte Transplantation?

  • The success rate of Melanocyte Transplantation will depend of type of Vitiligo.
  • In Segmental Vitiligo success rate is 80-90 %
  • In Acral Vitiligo success rate is 50-60 %
  • In Non Segmental Vitiligo Success rate is 60-65%.

 

How many sessions of Melanocyte Transplantation are needed?

Depending on type of Vitiligo one or more sessions after interval of 5- 6 months may be needed.

 

What is treatment advised after Melanocyte transplantation?

In our protocol we advise following treatment for 4-5 months after Melanocyte Transplantation

  • Oral Immuno suppressant’s as Mini Pulse Therapy
  • Oral Multivitamins and Amino acids as Phenylalanine which can improvise regimentation
  • Topical Steroids and Calcineurin Inhibitors
  • Topical Methoxpsoralens
  • Dermarollers and Tacrolimus Occlusion dressing
  • Narrow Band UV B Phototherapy
  • Ozone Major Auto Haemotherapy
  • Multi Vitamin Drips as Meyers Protocol.

 

How long does it take for the results of Melanocyte Transplantation to come?

It normally takes 3-4 months for results to come. Sometimes results may come after 6 months or more. More than one session may be needed in some cases.

 

What  is Ozone Therapy and how it is useful in treatment of Vitiligo?

Ozone therapy is an upcoming Complimentary therapy very popular in Russia and Cuba. Ozone is a gas derived from Oxygen . It is administered in patients body either by dissolving in saline or the patients own blood. We take 200 cc of patients blood add anticoagulants as Heparin into it and then bubble 200 cc  of Ozone gas through the blood.

This blood is then transfused back to patient. This procedure is called Major Auto Haemotherapy.Ozone therapy helps in Immune Balancing and correcting Auto immune disorders. Vitiligo is an auto immune disorder. So we find Ozone Major Auto Haemotherapy useful in Unstable and stable Vitiligo.

Preferred Approach Considerations for treatment of  Unstable Vitiligo

treatment of Unstable Vitiligo

Our common protocols for Vitiligo management are as follows:

  1. Oral Minipulse therapy with Corticosteroids. We give Oral Betamethasone twice a week in mini pulse dose to reduce side effects. Usually this stabilizes the Vitiligo in 3- 4 months.
  2. We often add another Immunosuppressant as Azothiaprim to above, A strict monitoring of LFT and other parameters is must
  3. We give oral antioxidants, Multivitamins, PolypodiumLeucotomas,Phenyl Alanine etc. as adjuvant therapies
  4. Ozone Major AutoHaemotherapy where we mix ozone gas in 200 cc of Patients blood and trabsfuse it back. This is helpful in immune balancing.
  5. Regular Use of Narrow Band UVB Chambers thrice a week.. This helps to stabilize Vitiligo and helps in faster repigimentation of patches. This also reduces the dose of Steroids.
  6. Topical Steroids, Calcineurininhibitors,Pesudocatalase inhibitors and Methox psoralen. All these help in faster repigmentation.
  7. Meyers Protocol where we give intravenous drips of Multi vitamins to accelerate pigmentation.

 

With our exhaustive protocol we find that our success rate goes much higher than using standard protocols which don’t focus on immune balancing, nutrition and other aspects of treatment which we focus upon.

 

During therapy, pigment cells surface up and escalate from the pilosebaceous unit, relieve epidermal melanocytes,and the outline of lesions or contusions, and migrate up to 2-4 mm from the edge.

 

Tattooing in Vitiligo

Tattooing is often used in unstable vitiligo as a camouflage treatment. But in our opinion it is not very good choice. We have seen following problems with Tattooing

Tattooing in Vitiligo

  1. The colour match is often not exact and it looks artificial
  2. With time the color of tattoo changes i.e. the  shade of pigment would change and start looking odd men
  3. Tattooing can cause allergies , flare up auto immune disorders and cancers.
  4. It is not easy to remove Tattoo if you decide so. Lasers are painfully slow and even do not give full results.

So kindly use tattooing disparingly as a last resort.

 

There are 2 types of vitiligo:

  • Segmental
  • Non-segmental

 

Segmental vitiligo

Segmental kind of vitiligo becomes extensive and scatters over more quickly. It is recognized as more uniform and consistent and less irregular than the non-segmental type. This kind of vitiligo is non-symetrical but is not very prevalent and is found in merely about 10 percent of people with vitiligo. This generally affects areas of skin linked to nerves arising in the dorsal roots of the spine. It responds quite positively to topical treatments.

People of early age groups are likely to be more affected by segmental type, affecting about 30 % of children diagnosed with vitiligo.

 

Non-segmental vitiligo

Non-segmental type of vitiligo is the most common form, contributing for up to 90 % of cases. There are frequent occurrences of equivalent patches on both sides of the body, with some amount of symmetry. Segmental vitiligo and an age of inception younger than 14 years have been connected to more refractory disease.Most commonly they make appearance on skin that is usually left uncovered to the sun, such as the face, neck, and arms or hands.

Most common areas likely to have non-segmental Vitiligo include:

  • Arms
  • Armpit
  • Backs of the hands
  • Eyes
  • Elbows
  • Feet
  • Knees
  • Mouth
  • Groin
  • Nose
  • Navel
  • Genitals
  • Rectal area

 

Apart from above mentioned areas, patches can also appear at various other sites which include:

Non-segmental Vitiligo is further fragmented into sub-divisions:

  • Generalized: There is no particular part or size of patches. This is actually the most prevalent type of non-segmental that affects the larger part of people with Vitiligo
  • Universal: Depigmentation covers larger part of the body. This is not very common.
  • Acrofacial: This category takes place commonly on the toes or fingers.
  • Focal: One, or a few, distributed white patches occur in an unattached area. It is most common in young children.
  • Mucosal: This occurs most often around the lips and mucous membranes.

 

Potential future treatments

In near future there would be no surprise to see the most effective medical practices that can completely cure Vitiligo and other skin disorders.

Treatments being studied include:

  • A drug that reverses color loss in skin:An oral drug called Tofacitinib Citrate, mainly used to treat rheumatoid arthritis, has presented some potential as a treatment for vitiligo. It blocks an enzyme called Janus kinase that seems to be suspicious in the cytology of vitiligo.
  • A drug that recovers color loss in skin:Called as Pseudocatalase,this new compound seems to provide an effective cure for the loss of skin color associated with vitiligo. Medical researchers made an announcement in 2013 on findings of this drug in which some participantswere treated with a modified pseudocatalase (PC-KUS). PC-KUS was found to recover the pigmentation in their skin and eyelashes. Not only this, but the substance delivered surprising results in restoring the natural hair color among people with gray hair.
  • A drug to provoke color-producing cells (melanocytes):Known as afamelanotide, a synthetic compound that mimics alpha-MSH, this potential treatment is embedded beneath the skin to stimulate the growth of melanocytes. In some cases of vitiligo, low melanin levels might be due to lower levels of α-melanocyte-stimulating hormone (alpha-MSH). Afamelanotide In combination with UVB treatment is also perceived to be effective.
  • A drug that helps control melanoctyes:Called as Prostaglandin E2, the drug is being tested as a means to restore skin color in people with localized vitiligo that is not spreading. It is applied on the skin in form of a gel.

Medical experts are exploring and testing potential new treatments, interventions and tests as a way to detect, prevent and treat this disease.

 

Home remedies and lifestyle tips to manage Vitiligo

The following self-care strategies may help to cope up with Vitiligo by reducing its appearance and also improving your skin:

  • Protect your skin from direct sun and artificial sources of UV light: If you have Vitiligo, especially when you have light skin too, use a broad-spectrum, water-resistant sunscreen with a minimum of SPF30. Apply sunscreen more often if you are travelling, sweating or swimming.
  • Stay away from sunbath:Strictly avoid sunlamps, halogen bulbs or tanning beds as it causes worsening of skin condition. You can however relax in dorms or shelters and wear clothes that can protect against sun
  • Refrain from tattoo making:Avoid tattooing like that caused by a tattoo, may promote a new patch to appear after about 2 weeks. This is called Koebner phenomenon.
  • Cover depigmented skin:Concealing and certain makeup products may enhance the appearance of the skin and help reducing its appearance, particularly if your vitiligo patches are on uncovered skin area. There are various makeup brands and self-tanners available in the market, you need to find the one that blends the best with your normal skin tone.You must use water-proof products, self-tanner or dye as these tend to last longer than makeup. If you seek to cover up white spots, Dyes work the best.  The coloring of self-tanning products does not washout, but it slowly fades over a couple of days. In case you use a self-tanner, choose the one that contains dihydroxyacetone, as it is approved by FDA.

 

Coping Tactics

There are a few people who inculcate low dignity and lose pride in oneself, but trust us this should be strictly aborted. If you are refraining yourself to hang out with people, it must no longer be carried on. Some people can also develop serious depression.

People may get Vitiligo for life, so it is crucial to create coping tactics. A coping tactic that is known to help a lot of people is to simply obtain fruitful information about Vitiligo. Another worthwhile approach is to keep in touch with people who have Vitiligo.

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