By Azim j Khan April 10, 2013 - 12:36am

Q:What is Vitiligo (Phul-Behri or Leucoderma)?
A: In Indo-Pakistan region, Vitiligo is commonly known as (Phul-Behri) or Leukoderma. It is a disease in which the skin color is permanently lost from a small or a large area of the skin. It can affect the skin of the face, especially around the eyes, nostrils & mouth. It can affect virtually any part of the body including hands, feet, genitalia (private parts), scalp and hair. It usually affects children and adults less than 20 years of age. More than 90% of cases occur before 40 years of age.
Q: What is the cause of Vitiligo:
A: Most of the scientific evidence suggests that the immune system (body defence system that protects us from germs and infections) gets hyper-activated and rather than attacking on the foreign elements such as germs, starts to kill bodys own normal structures. In the case of Vitiligo, the bodys defence system starts to attack melanocytes (pronounced as Me-lan-o-cytes) these are the cells that produce the color in the skin. So these color producing cells are killed and white or colourless spots of vitiligo are produced.
Q: Can milk & fish is taken together cause vitiligo?
A: NO. Absolutely not. This myth exists only in India and Pakistan. Many cuisines in various parts of the world cook fish in milk routinely. If this were true, all of them should have gotten vitiligo. To date no substantial scientific evidence has ever been given to support this is whim which is no more than a regional mumbo jumbo existing in our part of the world.
Q: Is Vitiligo treatable?
A: Yes. In most of the cases vitiligo is a treatable disease, especially if diagnosed early and if the affected area is small.
Q: What are the different treatment options?
A: Following are some of the treatments available for Vitiligo:
1. Medical Treatment:
Different creams and lotions that contain certain specific medicines can be prescribed to be applied on the affected area. In most instances, such medicated creams and lotions are very effective especially if the area of vitiligo is small and relatively new.
2. Light Therapy / Phototherapy (PUVA & Narrow Band Ultra Violet B):
A special kind of light with a specific wavelength and frequency is used to treat the affected area. The patient is given timed and controlled exposure to light in a special chamber. We use highly advanced machines by some of the finest brands in United States for PUVA and Narrow Band UVB therapy. Treatment with this special light is especially indicated if the area involved is too large to be handled with topical medicines or if the later has failed to regenerate colour in the area. Narrow Band UVB (NBUVB) therapy is the latest and highly recommended treatment available in the world today which now is available in our clinic in Pakistan as well.
3. Surgical Treatments:
a. Skin Grafting (Old method): The white skin from the diseased area is removed and a small piece of normal skin is transferred in its place. Major disadvantage associated is that this procedure leaves a visible scar. Consequently, you end up trading an unsightly white patch with an equally unsightly scar. We do not recommend this surgery.
b. Punch Grafting: Still an old method but better than skin grafting. In this method small (less than cm circles of normal skin) are cut from the normal skin and then transferred to the Vitiligo struck spot of skin. The color of the skin returns to its normal but with uneven skin surface leaving small bumps or elevations where these punch grafts were placed.
c. Melanocyte Transplant (The most advanced & latest method): In this very sophisticated method, the cells which make color (Melanocytes) are transferred from the normal skin to the diseased area. Once they are transferred, they start to make the color in the white diseased vitiligo area. It is a difficult method to learn for surgeon but is the most satisfying procedure for the patient, as it does not leave any scars and the results are amazing. Dr.Azim Jahangir Khan is the only dermatologist / cosmetic surgeon who is trained and licensed to perform this refined surgical technique in the country.
Q: When can the surgery be considered?
A: Surgical treatment should be considered for all those patients in whom the course of Vitiligo has not changed over a period of six months to one year and/or if the medical treatments/phototherapy did not render desired or routinely anticipated results. Best and most satisfactory results are seen in patients who have only a few small areas of vitiligo, and no new areas have developed in the last one to two years. Small and stable (not increasing in size) areas are the most successfully treatable areas with the melanocyte transplant.
Q: Is the melanocyte transplant surgery painful?
A: No. The donor area (where the colour producing cells will be picked from) as well as the diseased/recipient area , both will be duly numbed with anesthetizing creams or injections using a very fin needle. All this ensures painlessness during the procedure.
Q: Is general anesthesia required?
A: No. Only local anesthesia is used for vitiligo surgery. Patient is awake and talking throughout the procedure while not experiencing any discomfort or pain.
Q: How long does the surgery take to perform?
A: It takes about 2-3 hours to perform this very delicate surgery.
Q: What happens after the surgery?
A: Patient goes home with bandages on the donor (area from where the color producing cells were taken) was well as the recipient area(the diseased area of vitiligo). The bandages are taken off after about ten days. Patient can resume his daily activities in a couple of days.

Q: When does the color starts to appear in the vitiligo area?
A: Usually it takes between 3 to 6 months for the color to appear in the melanocyte transplanted area.
Q: How long does it take to see the full results?
A: It may take from 6 months to a year before the color can spread to the whole treated area. Remember, it takes some time for the tiny color producing cells to make color, so the patient has to be patient!

Q: Would anyone be able to tell that I had the surgery done after a year or so?
A: Most likely not. It is sometimes difficult even for us to locate the exact spot where surgery was performed. Since stitches are not placed, scar is not visible. In some cases, the color may not match 100%, but it is so close to the surrounding skin that it is almost impossible to find out that the vitiligo ever existed there.