“A black spot on a white skin is a blessing: but a white spot on a black skin is a curse”- thus spoke Omar Quayyam, about leucoderma, centuries ago. Perhaps he had in his mind, the severe  suffering, social stigma and the  emotional stress that these patients had to undergo. It is indeed unfortunate that even after centuries after his statement, patients of leucoderma still undergo so much stress and stigma. Even today, in the age of modern medicine, when  many new effective treatments are available, these patients suffer social embarrassment, find it difficult to get married, have difficulty getting proper jobs and undergo untold misery. Depressed and frustrated, they tend to seek isolation. All this for a disease which causes no bodily harm except change of colour and which can be treated effectively if help is sought at early stage!

What is leucoderma?
The medical name for leucoderma (leucos means white; derma means skin) is vitiligo. It is a disease caused by destruction of cells called melanocyte in skin, which produce the pigment melanin responsible for our skin colour. Loss of this pigment leads to white patches in different parts of the body — there are no other symptoms associated with it. It can occur at any age.

Why the stigma?
The social stigma seen about the disease is seen mostly in the Indian subcontinent, but not so much in other countries. The reasons for this are:

The white patches are more obvious and prominent on the brown-black Indian skin; in Western white skin, the disease is not taken seriously as it is not very obvious and apparent.

*Erroneous belief that it is infectious

Erroneous belief that it is always hereditary and that all the members of the family would also get the disease (and hence the fear of marrying such a person)

*Erroneous belief that it always spreads to all over the body

*Erroneous belief that there is no treatment for the disease

Leucodarma is not infectious. It is not contagious and does not spread from person to person. In ancient Ayurveda, the disease was referred to as ‘Shwetha kushta’ because of the white patches. This unfortunate and erroneous terminology is responsible for much of the suffering of vitiligo patients. Leucodarma is not related to leprosy.

Leucoderma is believed to be the result of antibodies produced by the body against pigment-producing melanocytes causing their destruction.

Environmental toxic substances such as phenolic chemicals in rubber and plastic industry may also be responsible for the death of these cells.

*Vitiligo is always hereditary
This is another misconception in the lay public, that vitiligo is always hereditary, which needs to be corrected.
Only 30% of vitiligo cases show hereditary background. In the majority of patients, there is no family history.
Even if one person in a family is affected, in most patients, other members of the family do not get the disease.
For this reason, there is no bar for these patients to get married and lead a normal life like any other person.

*Vitiligo causes harm to patients
Vitiligo does not affect any other organ in the body. These patients are otherwise healthy.

*Leucoderma spreads all over the body
No, in most cases, leucoderma does not spread all over the body. It is important to note that there are different types of vitiligo which behave differently.

*Leucoderma cannot be treated. Treatments are not effective
No. There are a number of excellent treatments available and vitiligo can be treated effectively in most cases.  For long there has been a belief that leucoderma cannot be treated effectively. The reasons for this is that vitiligo is a visible disease which is difficult to hide from people; most cured patients of vitiligo tend not to reveal or publicize the success of the treatment because of the social stigma associated with the disease. Hence, only those patients with longstanding, extensive, visible disease who have not responded well to treatment in the past when effective treatments were not available, get noticed.

*Diet is important in leucodarma
No. Many patients mistakenly believe that they should avoid sour substances (such as lemon and tamarind), fish, curds etc. The author has seen patients who have not tasted tamarind and lemon for years! There is no proof that diet affects leucoderma — eating fish with milk or sour products do not affect the course of the disease. A well-balanced diet is recommended.

Treatment
The treatment objectives are:
*to control disease and prevent further spread by drugs,
*to produce pigmentation in the lesions by phototherapy and
*Provide melanocyte cell reservoir in resistant cases by melanocyte transplantation
*Do all patients respond well? How many sessions of treatment are needed?

Treatment response is variable and depends on a number of factors. Response to treatment is best in hairy areas- hair follicles are the reservoir of pigmentation.

Early lesions, lesions in young people and children, lesions on face also respond very well to treatment. In such patients, treatment for few weeks or few months are enough.

Psychological effect
Patients need full support, understanding , sympathy and cooperation of the family. Often the patients suffer from an inferiority complex about their diseases and face uncomfortable questions, which leaves them depressed and even socially isolated. Patients should be encouraged to engage in their day-today activities without any inhibition.

Dr Venkataram Mysore
The author is a consultant dermatologist.