Restore Skin Color, Rebuild Confidence

Understanding Vitiligo in the Indian Context

Vitiligo affects 0.5-2% of the Indian population, presenting as depigmented white patches due to melanocyte (pigment cell) destruction. While not life-threatening, vitiligo carries significant psychological and social burden—especially in India, where skin color holds cultural importance and vitiligo is often stigmatized.

Vitiligo patterns:

• Focal: Single or few patches in one area
• Segmental: Unilateral patches along a dermatome (nerve distribution); often stable
• Generalized: Symmetrical patches on face, hands, elbows, knees (most common)
• Universal: >80% body surface depigmented

Associated conditions (30-40% comorbidity):

• Thyroid disease (Hashimoto's, Graves')
• Alopecia areata (patchy hair loss)
• Type 1 diabetes, pernicious anemia (autoimmune overlap)

At Ajuda Hospitals Dermatology, we deliver IADVL-aligned vitiligo care:

• Phototherapy (NB-UVB, excimer laser) for active repigmentation
• Topical immunomodulators to enhance phototherapy results
• Surgical grafting for stable, localized patches unresponsive to light
• Cosmetic camouflage and psychological support for quality of life

Our multilingual team (Telugu, Hindi, Urdu, English) provides compassionate, evidence-based care.

When to Consult Our Vitiligo Specialists

Schedule a consultation for accurate diagnosis, treatment planning, and psychological support to manage vitiligo confidently.

Our Diagnostic Approach

Clinical Examination & Wood's Lamp

Wood's lamp (365 nm UV light) examination:

• Vitiligo: Bright white fluorescence (complete melanin loss)
• Pityriasis alba: Dull white (partial hypopigmentation)
• Tinea versicolor: Yellow-green fluorescence (fungal)
• Post-inflammatory hypopigmentation: Variable (melanin reduced, not absent)

Visual assessment:

• Distribution pattern (focal, segmental, generalized, universal)
• Koebner phenomenon (new patches at trauma/friction sites—indicates active disease)
• Trichrome vitiligo (intermediate tan zone between normal and white skin)

Disease Activity & Stability Assessment

Active vitiligo (spreading):

• New patches within last 3-6 months
• Koebner-positive (patches at injury/friction sites)
• Trichrome appearance (gradual pigment loss)

Stable vitiligo:

• No new patches for 6-12 months
• No Koebner phenomenon
• Well-demarcated borders

Stability critical for surgical candidacy (grafting only works in stable disease).

Autoimmune Screening

Bloodwork for associated conditions:

• Thyroid: TSH, free T3/T4, anti-TPO antibodies (25-30% have thyroid disease)
• Vitamin B12, folate: Pernicious anemia screen
• Fasting glucose, HbA1c: Type 1 diabetes screen
• ANA, anti-dsDNA: Systemic lupus screen (rare)

Skin Biopsy (Atypical or Uncertain Cases)

Punch biopsy with Fontana-Masson stain:

• Vitiligo: Absent melanocytes; inflammatory infiltrate in active lesions
• Other hypopigmentation: Melanocytes present but decreased melanin production

Treatment Pathways

Our vitiligo management follows stepped protocols based on disease extent and activity:

Stage 1: Topical Therapy (Localized Vitiligo)

Potent corticosteroids (clobetasol 0.05%, mometasone 0.1%):

• Apply once daily for 3-6 months to small, recent patches
• Pulse therapy (5 days on, 2 days off) reduces skin thinning risk
• Best for: Facial vitiligo, small body patches
• Effectiveness: 30-50% repigmentation in 3-6 months

Topical calcineurin inhibitors (tacrolimus 0.1%, pimecrolimus 1%):

• Steroid-sparing option for face, eyelids, genitals
• Synergizes with phototherapy (use 30 min before UVB session)
• No skin thinning risk; safe for long-term use
• Effectiveness: Enhances phototherapy results by 20-30%

Stage 2: Narrowband UVB (NB-UVB) Phototherapy (Generalized Vitiligo)

311 nm UVB whole-body phototherapy:

• Mechanism: Stimulates melanocyte proliferation, migration, and melanin production
• Protocol: 3 sessions weekly for 6-12 months
  • Start with minimal erythema dose (MED); escalate gradually
  • Monitor cumulative dose via EMR dosimetry tracking
• Effectiveness:
  • Face/trunk: 60-75% achieve >50% repigmentation
  • Hands/feet: Slower response (acral vitiligo more resistant)
• Safe for: Adults, children >6 years, pregnant women (localized)
• Side effects: Transient erythema (redness), rare blistering (overdose)

Combination therapy: NB-UVB + topical tacrolimus enhances results by 30-40%.

Stage 3: Excimer Laser (308 nm Targeted Therapy)

Focused UVB laser for localized patches:

• Advantages: Higher energy than whole-body NB-UVB; targets specific patches (face, lips, fingers)
• Protocol: 2-3 sessions weekly for 12-24 sessions over 3-6 months
• Effectiveness: 70-80% success in facial vitiligo; faster than NB-UVB
• Best for: Localized patches on visible areas; children (shorter session time)

Stage 4: Surgical Grafting (Stable, Localized Vitiligo)

Autologous melanocyte transfer for stable patches unresponsive to phototherapy:

Techniques:

1. Punch grafting: Donor skin (pigmented) punched and transplanted to depigmented site
2. Split-thickness skin grafting: Thin donor skin grafted over vitiligo patches
3. Suction blister grafting: Blister roof (epidermis with melanocytes) transplanted
4. Non-cultured melanocyte-keratinocyte cell suspension: Melanocytes extracted, suspended, sprayed onto prepared vitiligo skin

Candidacy:

• Stable vitiligo: No new patches for 6-12 months
• Localized disease: Small to moderate patches (face, hands, lips)
• No Koebner phenomenon (grafts can trigger new vitiligo if active)

Effectiveness: 75-90% repigmentation in stable patches within 3-6 months post-surgery.

Procedure: Outpatient under local anesthesia; minimal downtime (bandage for 7 days).

Stage 5: Systemic Therapy (Rapidly Progressive Vitiligo)

Oral corticosteroids (mini-pulse therapy):

• Betamethasone 5mg 2 consecutive days/week for 3-6 months
• Indications: Rapidly spreading vitiligo to halt progression
• Effectiveness: Arrests progression in 60-80%; enables transition to phototherapy
• Monitoring: Blood pressure, glucose, bone density (long-term use)

JAK inhibitors (Off-label, Experimental):

• Tofacitinib, ruxolitinib cream or oral (under research protocols)
• Promising results in clinical trials; not yet standard care

Stage 6: Depigmentation (Extensive Vitiligo >50% Body)

Monobenzone 20% cream:

• Permanent depigmentation of remaining normal skin to achieve uniform light tone
• Indications: Universal vitiligo or >50% body involvement; patient preference
• Process: Apply to normal skin for 6-12 months until fully depigmented
• Irreversible; counsel thoroughly before initiating
• Psychological assessment recommended (permanent decision)

Stage 7: Cosmetic Camouflage

Medical-grade cover creams:

• Dermablend, Covermark (waterproof, long-lasting)
• Color-matched to skin tone; covers vitiligo patches temporarily
• Immediate cosmetic improvement while undergoing repigmentation therapy

Self-tanning agents (dihydroxyacetone):

• Temporary darkening of vitiligo patches (wears off in days)
• Reduces contrast with normal skin

What to Expect: Your Care Journey

First Visit (60 min)

• Comprehensive history: onset, progression, family history, autoimmune symptoms
• Wood's lamp and clinical exam to confirm vitiligo
• Disease activity and stability assessment (surgical candidacy)
• Baseline photography for tracking
• Labs ordered: Thyroid, vitamin B12, fasting glucose, ANA
• Treatment plan: Topicals ± NB-UVB referral

2-Week Follow-Up

• Review lab results; manage thyroid or vitamin deficiencies
• Initiate NB-UVB phototherapy if generalized vitiligo
• Reinforce sunscreen use (SPF 30+) to prevent normal skin darkening

Month Milestone

• Assess early repigmentation (perifollicular dots)
• Continue phototherapy; adjust doses based on response
• Add topical tacrolimus if suboptimal response

Month Review

• Evaluate repigmentation extent (photo comparison)
• Discuss surgical grafting if stable and localized patches unresponsive to light
• Psychological support referral if quality of life impacted

Month Outcome

• Maximal repigmentation achieved
• Transition to maintenance: NB-UVB quarterly or excimer laser as needed
• Annual autoimmune screening (thyroid, glucose)

Technology & Innovation

Narrowband UVB Phototherapy with EMR Dosimetry

Our NABH-compliant NB-UVB cabinets deliver precise 311 nm wavelengths. EMR-integrated dosimetry tracks cumulative UV exposure, preventing overtreatment and optimizing repigmentation. Photo tracking documents progress objectively.

Patient Benefits:

• Safe dose escalation tailored to skin type and response
• Outpatient convenience (15-min sessions, 3x weekly)
• Safe for children and pregnant women (no systemic drugs)

Surgical Grafting with Melanocyte Suspension

Non-cultured melanocyte-keratinocyte suspension:

• Advanced technique for large stable patches
• Single-session procedure with 75-90% success
• Cosmetically superior to punch grafting (no cobblestoning)

Preventing Complications

Untreated or poorly managed vitiligo causes:

• Psychological distress: Anxiety, depression, social withdrawal (especially in Indian cultural context)
• Sun damage: Depigmented skin lacks melanin protection; sunburns, skin cancer risk
• Thyroid disease progression: Undetected autoimmune thyroiditis worsens if not screened
• Irreversible depigmentation: Delayed treatment reduces repigmentation potential

Our Prevention Strategy:

• Early phototherapy halts progression and promotes repigmentation
• Annual thyroid/autoimmune screening catches comorbidities early
• Sun protection (SPF 30+, hats, clothing) prevents sunburns and contrast worsening
• Psychological counseling improves quality of life and treatment adherence

Why Ajuda for Vitiligo Care?

Take the First Step

Vitiligo is treatable—early intervention maximizes repigmentation potential. Whether you have localized patches or generalized vitiligo, personalized phototherapy, topicals, or surgical grafting can restore color and confidence.

Call 9010550550 or WhatsApp for vitiligo consultations and phototherapy. Our dermatology specialists are available Monday-Saturday, 9 AM-7 PM, with compassionate, evidence-based care.

Repigmentation is possible—let Ajuda Hospitals guide your journey to renewed skin and self-esteem.