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What Is The Cause And Treatment For Vitilago?

Posted on Sat, 3 May 2014

Question: Hi - I had been advised couple of days back by Dr XXXXXXX I have a follow up question if any of the experts can answer. I am 40 years old and have a spot of vitilago in my armpit. I have noticed this since 2 weeks and it is not anywhere else. I understand from consulting experts that there is no way to predict if this will stay localized. I got my extensive blood test done 3 weeks ago and have no issue reported with thyroid or any other issue. The question I have is has any expert treated a patient with similar situation like mine and what was the outcome of those patients. And today I noticed when I woke up that the patch had become red, maybe because it got scratched at night. but is this expected for this patch to become red ? I am attaching the photo as well. Want to know from experts if there could be a local cause for this patch to have come up and what are my chances of this staying localized as there is no thyroid or any other obvious immune issue noted in the blood work. Thanks-

Answered by Dr. Dr. Kakkar (24 minutes later)

Brief Answer: Vitiligo treatment Detailed Answer: Hello and welcome to healthcaremagic I am Dr. kakkar. I have gone through your concern and I have understood it. Vitiligo is a condition characterized by the autoimmune destruction of melanocytes, resulting in loss of pigmentation. In vitiligo, there is a partial or total destruction of melanocytes, initially only of the epidermis and later even of the hair follicle, which acts as a reservoir for providing melanocytes during repigmentation. Vitiligo can be of various types depending on the distribution of lesions: 3 types commonly seen are: -Focal Vitiligo -Segmental Vitiligo -Generalised Vitiligo Judging from the distribution of the lesions, you seem to be having a Focal type of vitiligo, where patches are far and few. Topical medical therapies are the primary treatment for focal vitiligo. To enumerate them. --Topical moderately potent steroids, --Topical immunomodulators like Tacrolimus, --Topical PUVA (Melanocyl lotion), Hand held NB-UVB Phototherapy --Topical basic fibroblast growth factor etc For Focal type of vitiligo, who present with a single or a few patches, I prefer to treat my patients with topical immunomodulators e.g tacrolimus ointment twice daily (to be rubbed in with fingers) as well as a moderately potent topical steroid e.g mometasone ointment once daily at night. Repigmentation usually becomes apparent in about 2 months times, in the form of perifollicular pigmentation or diffuse pigmentation. Focal vitiligo does'nt usually show up any abnormalities in blood work up and I usually don't even advice any of these test in my patients of focal vitiligo. Since the patch is of recent onset, we cannot predict with certainity the future course. However, if a patch of vitiligo is stable for some time, say for 1-2 years, without any progession, it is safe to conclude that it is going to remain the same way(stable vitiligo). regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Kakkar (41 minutes later)

Thank you Dr. Kakkar I have been having sleepless nights worrying this is going to come to my face and whole body. From your experience if this is a focal vitilago and it does spead a little what are my chances that this will come to my extremities in the near future. And chances my kids will get this. Again I understand sir that you are giving your professional assessment based on your experience. Thank you

Answered by Dr. Dr. Kakkar (19 minutes later)

Brief Answer: Vitiligo treatment Detailed Answer: Hi. Focal vitiligo generally has a good prognosis, if it remains focal. Since you noticed it just 2 weeks ago, so watching it for the next 3-6 months would most likely predict the way it behaves in future. If it remains so or spreads ever so slowly, then it is likely to remain focal. Vitiligo is not inherited. However, about one-fifth of people with this condition have at least one close relative who is also affected. regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Kakkar (30 minutes later)

Thanks you Dr. Even if focal vitilago spreads slowly does it change locations and can come up at different locations ? What are the percentage chances of this to spread to extremities for a person as mentioned before does not have any immune or thyroid issue. I am trying to assess my situation from dr experience to see what percentage chance I hold for this to remain focal and coming to my face. Sorry if I am asking same questions but answers from a experienced dr who have treated many patients with this does help in calming. All this I am asking from your experience treating patients. Also 4 months back I had started using Rogaine, I had a viral fever for 2 weeks where I took many flu medicines, I had back issue where I took muscle relaxers for a few days as well. Also I have been under lot of stress with work and personal for last year as well. Not sure if this might have had anything to do with this patch.

Answered by Dr. Dr. Kakkar (1 hour later)

Brief Answer: Vitiligo Detailed Answer: Hi. Focal vitiligo can be just a single patch of vitiligo or there may be a few patches which are asymmetric/here and there (e.g a patch on left arm and another patch on right leg and another one on trunk). New patches may form in focal vitiligo. Generalized vitiligo may start as focal patches and new patches appear on other body areas and are present symmetrically (i.e both upper limbs, both lower limbs) but in my experience, mostly the disease behaves the same way as it started. i.e focal remains focal and generalized is generalized from the start. Stress has no direct role in causation of vitiligo. Your medical history has no bearing on vitiligo regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Kakkar (52 minutes later)

Thank you. How long do you have to wait to know it is a focal vitilago and not generalized. Also I read that vitilago on the lips, eyelids, face and hands is different than on the groin, armpit. In case of a focal vitilago started in armpit have you seen it spread to face, neck or hands ?

Answered by Dr. Dr. Kakkar (19 hours later)

Brief Answer: Vitiligo treatment Detailed Answer: Hi. As I said before, watching it for the next 3-6 months would most likely predict the way it behaves in future. Though that is an arbitrary limit. A vitiligo may behave in a very unpredictable way and no one can really guarantee how it is going to behave in future. However, as i said before mostly the disease behaves the same way as it started. i.e focal remains focal and generalized is generalized from the start. Vitiligo on the lips, hands and feet is known as lip tip vitiligo/acral vitiligo. It is more resistant to treatment than vitiligo at other body sites. Armpits, groin lesions respond well to treatment. The goal is to treat according to the severity/extent of disease. While a single patch or just a few patches may require only topical treatment, slowly spreading vitiligo may require oral immunomodulators like levamisole to arrest the progression in addition to the topical treatment, whereas rapidly spreading or generalized vitiligo may require oral steroids to arrest the progression in addition to the topical therapy. So, therapy varies according to the way the disease behaves. You can begin with topical treatment as of now but in case you develop new patches in future(if at all), your treatment can be adjusted according to it. regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Kakkar (1 hour later)

Thank you. And maybe I am asking the same questions. But one last question. In your many years of treating people with vitilago have you come across people after 40 who got a patch under their armpit and spread to their face ? And if so what would you say the percentage is ? I am trying to ease my worry I guess. Been very worries for the last 2 + weeks thinking about this. Thanks you again for your replies.

Answered by Dr. Dr. Kakkar (38 minutes later)

Brief Answer: Vitiligo treatment Detailed Answer: Hi. See, if a vitiligo spreads it can spread to any body site. However most of the patients with focal vitiligo that present to me with facial vitiligo already have them beforehand and i have seen very less cases who develop a new patch on face during the treatment. regards

Note: Hope the answers resolves your concerns, however for further guidance of skin related queries consult our Dermatologist.Click here to book a consultation

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar