Amit Pandya, M.D. Answers Questions On: Vitiligo
Why does vitiligo occur?
Vitiligo occurs when the body is triggered to look at melanocytes as foreign or abnormal. Melanocytes are specialized cells that give color to the skin. With vitiligo, the body’s own immune system starts attacking those cells, which is why it’s considered an autoimmune disease. In fact, patients who have vitiligo are genetically predisposed to having it because they have certain types of genes that promote autoimmunity.
We are trying to figure out the trigger that starts the autoimmunity. Once it starts, it sets into motion a cascade of events, which causes cells to migrate into the skin that attack and kill the melanocytes.
Are the earliest signs of vitiligo something patients feel or see?
It’s usually something they see. They’ll notice a lighter spot on their body, often around the eyes, nostrils, or mouth. It also tends to affect areas that are over joints, like the fingers, the wrists, the elbows, the knees, the feet, and the ankles.
Patients with darker skin see a light spot. Patients with lighter skin will notice that they tend to sunburn in a certain area, such as the forehead, but then the rest of their face won’t be sunburned. Then, as other parts of their body tan over the coming weeks, their forehead, in this case, does not tan and in certain lights will appear white, with no color.
In addition to phototherapy, what other treatments do you offer for vitiligo?
We provide laser therapy for small areas of vitiligo using an excimer laser. We also provide surgical treatments for vitiligo that are offered in few other places in the United States. In fact, UT Southwestern is the only place in the South that offers surgical treatment for vitiligo with cellular grafting, and we offer three types of procedures.
One is micrografting, where we take 1.5 millimeter circles of skin from the hip or thigh and transplant them to the vitiligo area.
Another is blister grafting, where we create a small blister on the thigh then transplant it to the lesion of vitiligo.
And the third, most exciting improvement/advance, is that we now offer noncultured epidermal suspension grafting, also called cellular grafting and melanocyte keratinocyte transplant procedure, in which we take a small amount of skin from blisters on the thigh and process those cells at the patient’s bedside to make a suspension (small amount of liquid) containing the cells. Then we remove the area of vitiligo with a laser and apply the suspension to the areas of vitiligo, drop by drop. We cover it, and those cells from the thigh grow, replicate, and expand, just like plugs of grass would grow on a lawn, and fill in the area with pigmentation.