When 49-year-old shopkeeper Indra Krishna Shrestha noticed an unusual white spot in his right arm for the first time, he wanted to try anything possible to get rid of it. But back then, at 30, he used to earn living working at a workshop and had no time to spare for anything else as he was totally consumed with his work-home-work routine. So despite the wish, he could not do much. In the past 19 years, he saw pale white patches spread all over his body except for the lower parts of the eyes. During all those years, he never visited a dermatologist for treatment of this ‘much-heard-about’ but ‘totally-unknown’ skin disease called Vitiligo (Dubi).
“Although I tried many ointments as suggested by people around me, I was kind of ignorant of the fact that I should go and consult a doctor. The fact that the disease was stigmatized and been looked at peculiarly baffled my wits to take an initial step for right medication. I am yet to understand how this disease develops in people,” said Shrestha.
A 40-year-old fish seller, Yadulal Sah of Thapagaon, Baneshwar, has seen vitiligo developing in him for the past six years now. It all started with a white spot on the lower part of his right armpit. He initially received medication from a hospital in Gorakhpur, India. However, he discontinued the medication after a couple of months.
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“The patches were increasing and I was not recuperating from the disease following the medications. Therefore, I stopped taking the medicine while the patches kept on increasing and I have no idea how I can stop them from spreading”, Sah said.
The color of skin is defined by the melanin pigment in the skin that is controlled by the cells called melanocytes. Vitiligo is an autoimmune situation where the white blood cells attack skin cells leading to the destruction of melanocytes and ultimately to the loss of pigment in the skin.It is believed to be triggered by emotional stress and poor adrenals as the adrenal gland is also involved in immune system. It can be hereditary, but one can develop it without any genetic reason as well. Many researches have implied that the contact with chemical phenol could also induce vitiligo.
“There are many types of vitiligo, of which vulgaris vitiligo is the common type in my patients. Varying from people to people, it could take time to recover from the white patches. There are myths that vitiligo is contagious and the consumption of meat and dairy products worsen it,” said Dr. Lalan Khatiwada of Nepal Skin Hospital, Bijulibazar. “The misconception and stress levels are high in patients, which have led them to migrate to other places,” he added.
“Research studies across the globe have discovered that vitiligo patients may have vitamin deficiencies, especially vitamin B12 and folic acid. Therefore intake of meat and dairy products is highly recommended,” Khatiwada said.
The advancement in research and medication has been quite an achievement today. Few treatments have been conducted depending on the skin condition and nature of the patches. There are basically three conditions of vitiligo observed in the patients: progressive, stable, and regressive. Progressive condition develops white patches while stable condition is static and is less likely to spread on the skin. In the regressive condition the skin patches are likely to recover leading to skin repigmentation.
“If patients have already developed 30-40 percent of the patches, we rather carry out processes to remove the remaining pigment in order to make it even. It is done with the usage of chemical called monobenzyl ether of hydroquinone,” Khatiwada said. “Moreover, Excimer laser treatment and Autologous melanocytes transplant are also carried out in stable and regressive conditions.”
Many people suffering from vitiligo have their own cause-and-effect stories. Some may entail the story of frustration and despondency while others have their tales of patience and perseverance. A 36-year-old homemaker residing in Kapan, Laxmi Tamang, is one among the many who was not any less-spirited due to the uneven specks she had over her body.
“The first time I started having white patches was in 2006, it had appeared out of nowhere without any signs and symptoms. It started spreading on my scalp and face but I did not lose patience,” said Tamang. “I underwent proper medication and phototherapy till 2012 when I discontinued taking medicines as I was expecting my first child. After that, I have been continuing with the medication till now and the white patches have been gaining its pigmentation back,” she added.
Vitiligo can happen to anyone, anywhere and to person of any age. It has no health hazards except for the societal stigma that it could be attached to.
