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What is leucoderma?
Leucoderma is also known as vitiligo. Leucoderma is the most common chronic depigmentation disorder or hypopigmentation disorder affecting 1-2% of the world population. It includes the loss of functioning melanocytes which causes the appearance of white patches on the skin. These white patches tend to become progressive with time. Any location on the body can be affected and the people with leucoderma have white patches in many areas of the body. The disorder affects all the races and both the sexes equally; however, it is more noticeable in people with dark skin.
Although leucoderma is usually not harmful medically and causes no physically pain, its emotional and psychological effects can be devastating. Infact, in India, those with the disease, especially women, are sometimes discriminated against in marriage. Developing leucoderma after marriage can be ground for divorce. Regardless of person's race and culture, white patches of leucoderma can affect emotional and psychological well-being and self-esteem. People with leucoderma can experience emotional stress, particularly if the condition develops on the visible areas of the body (such as face, hands, arms and feet) or on the genitals. Adolescents, who are particularly concerned about their appearance, can be devastated by widespread leucoderma. Some people who have leucoderma feel embarrassed, ashamed, depressed or worried about how others will react.
What types can leucoderma be divided into?
Leucoderma can be classified into two two types.
• Bilateral (or Generalized)
Bilateral or Generalized Leucoderma can begin at any age and tends to progress intermittently over the life of the patient. It produces depigmentation which is remarkably symmetrical in distribution. A patch on the right side of the body is matched by a patch in a similar location on the left side of the body. The entire body can depigment although it rarely does so.

Unilateral (or Segmental)
Unilateral or Segmental Leucoderma commonly begins in children and young adults and progresses for a limited period, usually 1-2 years, and then remains static for the rest of the life of the individual. It affects just one side of the body contrast to Bilateral Leucoderma, the distribution is asymmetrical on the skin.
Who gets leucoderma?
Millions of people worldwide have leucoderma. Nearly half get it before they reach 21 years of age. Most will have leucoderma for the rest of their lives. It is very rare for leucoderma to disappear. Leucoderma occurs about equally in people of all skin colors and races. About half the people who get leucoderma are male and half are female.
The risk of getting leucoderma increases if a person has:
* ��A close blood relative who has leucoderma.
* ��An autoimmune disease, especially Hashimoto's disease (a thyroid disease) or alopecia areata (causes hair loss).
What causes leucoderma?
Leucoderma develops when cells called melanocytes (meh-lan-o-sites) die. These cells give our skin and hair color. Scientists do not completely understand why these cells die. One type of leucoderma, non-segmental (bilateral) leucoderma, may be an autoimmune disease. An autoimmune disease develops when the body mistakes a part of itself as foreign. If the body mistakes these cells as foreigners, it will attack and kill these cells. Studies suggest that the other type of leucoderma, segmental leucoderma, has a different cause. This type seems to develop when something in the body's nervous system goes awry.
How is leucoderma diagnosed?
If the dermatologist suspects that you have Leucoderma, the dermatologist will:
* ��Review your medical history, and may ask specific questions such as whether anyone in your family has leucoderma.
* ��Perform a physical exam, looking carefully at the affected skin.
You also may need a blood test to check the health of your thyroid gland. People who have leucoderma often have an autoimmune thyroid disease. A blood test will tell whether your thyroid is healthy. If you have thyroid disease, treatment can successfully control it.

How do dermatologists treat leucoderma?
There are many treatment options. The goal of most treatments is to restore lost skin color. Here are some key facts about treatment options The type of treatment that is best will depend on the preference, overall health, age and where the leucoderma appears on the body.
No medical treatment (use cosmetics to add lost color):
* ��Cosmetic options include makeup, a self-tanner and skin dye.
* ��Offers safe way to make leucoderma less noticeable.
* ��Often recommended for children because it avoids possible side effects from medicine.
* ��Drawbacks: Must be repeatedly applied, can be time-consuming, takes practice to get natural-looking result.
Medicine applied to the skin:
* ��Several different topical (applied to the skin) medicines can repigment the skin.
* ��Prescribed for small areas.
* ��The most commonly prescribed medicine is a potent or super-potent topical corticosteroid. About half, 45 percent, of patients regain at least some skin color after 4 to 6 months.
* ��A topical corticosteroid may be combined with another medicine to improve results.
* ��Topical medicine works best in people with darkly pigmented skin.
* ��Topical medicines are most effective on certain areas of the body, such as the face. They are least effective on the hands and feet.
* ��Not all topical medicines should be used on the face.
* ��Drawbacks: These medicines have possible side effects, so patients must be carefully monitored. A possible serious side effect of using of a topical corticosteroid for a year or longer is skin atrophy. This means the skin becomes paper thin, very dry and fragile.
Light treatment:
* ��Uses light to repigment the skin.
* ��Patient may sit in a light box or receive excimer laser treatments.
* ��Light box used to treat widespread Leucoderma; laser used to treat small area.
* ��Works best on the face; least effective on hands and feet.
* ��Effective for many patients; about 70 percent see results with excimer laser.
* ��Results can disappear. About half, 44 percent, see results disappear within 1 year of stopping treatment. After 4 years, about 86 percent lose some color restored by treatment.
* ��May cause patients with darkly pigmented skin to see areas of darker skin after treatment, but treated skin usually matches untreated skin within a few months.
* ��Requires a time commitment. Patients need 2 to 3 treatments per week for several weeks.
* ��May be combined with another treatment such as topical corticosteroid.
PUVA light therapy:
* ��Uses UVA light and a medicine called psoralen to restore skin color.
* ��Psoralen may be applied to the skin or taken as a pill
* ��Can treat widespread Leucoderma.
* ��About 50 percent to 75 percent effective in restoring pigment to the face, trunk, upper arms and upper legs.
* ��Not very effective for the hands or feet.
* ��Time-consuming, requiring treatment at a hospital or PUVA center twice a week for about 1 year.
* ��Psoralen can affect the eyes, so this treatment requires eye exams before starting treatment and after finishing treatment.
* ��To help prevent serious side effects, patients need to be carefully monitored.
Surgery:
* ��May be an option when light therapy and medicines applied to the skin do not work.
* ��For adults whose Leucoderma has been stable (not changed for at least 6 months.
* ��Not for children.
* ��Not for people who scar easily or develop keloids (scars that rise above the skin).
* ��Different surgical procedures available. Most involve removing unaffected skin or skin cells and placing where need pigment.
* ��Can be effective for 90 percent to 95 percent of patients.
* ��Possible side effects include failure to work, cobblestone-like skin and infection.
Unconventional treatment:
* ��Some vitamins, minerals, amino acids and enzymes have been reported to restore skin color in people who have Leucoderma.�Most have not been studied, so there is no evidence to support these treatments and no knowledge of possible side effects.
* ��Ginkgo biloba, an herb, has been studied in a clinical trial. Results from this trial indicate that the herb may restore skin color and stop Leucoderma from worsening.
*
* In the ginkgo biloba trial, 10 patients given ginkgo biloba had noticeable or complete return of skin color. Two patients taking the placebo (contains no active ingredient) also had noticeable or complete return of skin color.
* ��Because some patients taking the placebo regained their skin color, more study is needed.
Depigmentation:
* ��This treatment removes the remaining pigment from the skin.
* ��Very few patients opt for this treatment.
* ��Removing the rest of the pigment leaves a person with completely white skin.
* ��It may be an option for an adult who has little pigment left and other treatment has not worked. Removing the remaining pigment can be an effective way to get one skin color.
* ��To remove the remaining color requires you to apply a cream once or twice day.�This cream gradually removes color from the skin.
* ��Depigmentation can take 1 to 4 years.
* ��Once treatment is finished, some people see spots of pigment on their skin from being out in the sun. To get rid of these spots, you can use the cream that removed your remaining skin color.
Outcome
It is not possible to predict how a patient will respond to treatment. It is important to keep in mind that no one treatment works for everyone. Results can vary from one part of the body to another. Combining two or more treatments often gives the best results.
Can a child with leucoderma be treated?
Yes, but some treatments are not appropriate for children. The following may be an option for a child:
* ��Medicine applied to the skin.
* ��PUVA that uses psoralen applied to the skin. PUVA therapy that uses the psoralen pill is usually not recommended until after 12 years of age. Even then, the risk and benefits of this treatment must be carefully weighed.
* ��For children with extensive Leucoderma, a dermatologist may recommend narrowband UVB light treatments.
Are researchers looking for more effective treatment?
Yes. They are studying the genes involved in Leucoderma. Researchers believe that by identifying all of the genes involved in Leucoderma, they will learn what destroys the cells that give skin its color. With this knowledge, it should be possible to develop better treatments. One of the key goals of this research is to develop a treatment that will permanently stop the skin from losing color.

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