Vitiligo happens when the pigment-forming cells of the skin are damaged. This malformation creates random skin patches over the body that can either spread or remain confined to a single side. This unilateral distribution of vitiligo is called Segmental vitiligo. It is often identified by early onset though has rapid stabilization and exhibits symptoms on just one side of the body. Studies have shown that both segmental and non-segmental vitiligo could stem from the same disease although the exact pathology of melanocytic destruction is unknown. Ayurvedic texts have holistic approach to vitiligo and numerous possible causes have been mentioned.
Segmental vitiligo is distinct from generalized vitiligo as its boundaries are confined to circumscribed patches of depigmented macules. Having an early onset progression, this vitiligo occurs over a period of 6-24 months and follows an immediate stabilized approach. There is no midline shift to the other part of the body because of its unique unilateral distribution. This subtype is also believed to be due to an autoimmune condition affecting the melanocytes. Though genetics cannot be ignored, somatic mosaicism can occur due to the distinct cell population within an individual. It is triggered by autoimmunity response of an organism against its own healthy tissues where the melanocytes are destroyed.
Compared with nonsegmental, Segmental vitiligo is rare among individuals and has an early onset of the disease process. There is no proper identification of age factors that trigger this disease but still, most cases are found before 30 years to adulthood. There are demarcated margins to depict the onset and it can spread to any variable lengths across centimeters. It is quite possible that progeny can have this condition if the ancestors were affected by vitiligo, but sunburn protection is warranted because it can aggravate the symptomatology of this condition.
There have been incidents where segmental vitiligo has not remained confined to the unilateral direction in rare cases, however, there is constant stability after some time. Segmental vitiligo can also occur with generalized vitiligo in mixed vitiligo where it occurs some months preceding the generalized form.
There are different forms of segmental vitiligo that depict various classes of patch distributions across the body. Although somewhat similar in nature, they have distinct margins to identify their forms. Some of them are:
Nevus depigmentosus – Hypopigmented patches that present at birth or in infancy with sharp borders. The lesions enlarge with body growth.
Nevus anemicus – There are satellite macules around the body mainly the chest or back, and arising at birth. Particular tests like diascopy are beneficial to distinguish normal skin from the confluent lesion that spreads to the skin.
Leukoderma – Another form of segmental vitiligo, Leukoderma exhibits depigmented macules around the face, hands or back.
Various types of medications, phototherapy, laser therapy, and surgical therapy are available today to treat this symptomatology. Cautious exposure to sun and in fact, careful sun protection can handle its symptoms in those with fair skin, otherwise, the lesions are visibly revealing. Ayurvedic treatment also helps cell rejuvenate and healthy tissue formation is exhibited. Toxins in blood and causing factors can be treated using Ayurveda.Otherwise, topical steroids and phototherapy are some commonly used treatments to counter this disease.
Nonsegmental vitiligo is the condition in which the skin becomes depigmented showing patch like areas of the skin having a progressive nature including depigmented mucosa and hair. Our skin has the melanin pigment in the deep layer that gives color to the skin, hair and eyes. Darker people have more melanin than fair ones. When the autoimmune response causes reaction damaging the melanin-producing cells called melanocytes, the result is the loss of color to the skin and affected areas. In patients with vitiligo, MCs are destroyed in the skin, the eyes, and also the ears. Both generalized and segmental vitiligo occur from the same disease of melanocytic destruction.
Although the disease could stem from an autoimmune loss of melanocytes, there are other autoimmune causes that have associations with this disease. These may include autoimmune thyroid diseases like Hashimoto's thyroiditis and Graves' disease. We do have rheumatoid arthritis, type 1 diabetes, psoriasis, pernicious anemia and alopecia areata apart from systemic lupus erythematosus and Addison's disease on the list. There could be other autoimmune disorders also. We can study the role of autoimmune pathogenesis in non-segmental vitiligo:
Nonsegmental vitiligo is also called generalized vitiligo as it has no boundary of the area where it spreads. There is no identifiable confinement of the disease. Genetic studies also observe that various phenotypes exist among nonsegmental vitiligo types like Acrofacial or Vulgaris and there is strong clinical evidence to suggest this finding. There is also the focal type formed by depigmented patches located in a small area without a typical segmental distribution but it is still an undetermined form where the lesion doesn’t spread into wider areas and a definitive diagnosis can be made of its occurrence when the lesions don’t involve any non-segmental or segmental characters after a few years but about 50% of people having focal vitiligo are likely to get nonsegmental vitiligo after its onset. Focal vitiligo also is a marker that can be used as a possible indicator of progression to NSV. Initially, in the focal kind, lesions start on the hands, fingers and face and slow the onset of disease continues.
There is also the vivid influence of genetic and environmental factors caused by autoimmune loss of melanocytes the development. Gene predisposition plays an inherent part involving the introduction of nonsegmental vitiligo in a child from his parent. It is studied that the dendritic cells including Th17 cells and CD8+ cytotoxic T lymphocytes infiltrate by the margin of vitiligo and the reduced number of regulatory T (Treg) cells in the affected skin area.
Genetic behavior is important to trace in the readings of genome-wide association studies in a patient with nonsegmental vitiligo. Caucasians of northern European origin have been known to be easy to susceptibility to this skin condition.
If there is spontaneous repigmentation, it could be due to sun exposure. Wood’s lamp is a good alternate examination to identify pigmented defects in people, especially the dark-skinned individuals. Tests like skin biopsy and blood draw can also detect vitiligo symptoms. Also personal and family medical history related to the genotype behavior whether a person has chances of getting it.
There are various treatment options to counter vitiligo and help restore skin color but some treatments could have side effects. Self-tanning products or makeup are temporary options. There are some topical creams and lotions to improve your skin color. In some cases, surgery also helps. But to go forward, it is always advisable to first find the best treatment option that suits your skin and texture.
Even if treatment is successful for a while, the results may not last or new patches may appear. Combining psoralen and light therapy is one of the feasible key approaches. Some people prefer tattooing. But it is warranted to see the side effects of each carefully before pursuing it any further.
Treatment should be done under proper medical supervision and no self-medication should be done.
The disease can be well managed in early stages so no time should be lost in home remedies.