Dermatography

Skin discolouration
General

What is vitiligo?

Vitiligo is an affliction in which skin and hair loses its pigments. The pigment cells are destroyed and melanin, the pigment colouring the skin, is no longer produced. As a result, white areas appear in the skin, often surrounded by darker spots. In other words, vitiligo is a combination of hypopigmentation (too little colour pigment) and hyperpigmentation (too much colour pigment).

In dermatology the group of patients with this type of pigment deviations is growing. Such skin afflictions are increasing worldwide. Patients may experience social isolation and psychosocial problems. The people around them do not properly understand the affliction and are not aware that vitiligo is not contagious!

History

The oldest descriptions of vitiligo are found in the Indian Atharva Veda (1400 BC), where Shweta Kushta and Dhaval Kushta are mentioned, meaning white lepra. In Latin manuscripts the terms vitium and vitulus occur (Celsus, 200 AD). In the Arabic literature one finds the terms bohak/bahak and baras to indicate vitiligo. The bible mentions ‘white spots’; the Hebrew term is zora'at (Leviticus 13). Another term that is sometimes found is ‘bible spots’.

Since 1848 hundreds of publications about vitiligo have been published. Again and again roughly the same lengthy therapies are described in publications that give little relevant information, with poor results and a lack of follow-up.

Several doctors and even a few tattooists in recent years tried to treat vitiligo patients with tattooing, medical tattooing or ‘micropigmentation’. The stories reached the national press, but as was to be expected the results weren’t very positive.

In popular magazines ads frequently appear recommending ointments and lotions with which to alter the skin colour, including the camouflage of vitiligo. Spending much money on these products not only results in disappointment, but the contents may even contain harmful substances: some of the so-called self-tanning lotions in the market may actually damage the skin.

In addition all sorts of health gurus, faith healers and other non-official healers frequently appear on the stage, all with just one goal: to help the unsuspecting patient to lose as much money as possible.

A vitiligo patient tattooed with skin colour and subsequently lasered by an inexperienced doctor, resulting in a serious blue discoloration.

Treatment with dermatography

Contrary to many other therapists we do not claim that dermatography can cure vitiligo. Under certain conditions however it may be a good method for camouflaging disturbing skin discolorations caused by vitiligo.

Our first publication with an overview of dermatography treatments (including vitiligo) appeared as early as 1994. (Nederlands tijdschrift voor Dermatologie & Venereologie, Vol. 4, 1994, 211-214)

Vitiligo before and after 8 dermatography treatments

The fact that dermatography may be performed successfully by expert professionals is proven by these pictures, taken of representative patients, with a 10-year follow-up.

Vitiligo before and after 6 dermatography treatments

Vitiligo before and after 4 dermatography treatments

The following therapies are most frequently used in The Netherlands for the treatment of vitiligo. Hypo- and depigmentation are treated with:
● Light therapy
● PUVA with or without psoralen
● UVB-therapy
● Skin graft techniques (punch biopsies, Thiers grafts)
● Camouflage therapy
● Dermatography

The origin of vitiligo

About the origin of vitiligo a number of theories have been developed. They include genetic factors, the auto-immune hypothesis, de neurogenic hypothesis and the selfdestructing melanocytes hypothesis. Up to now, an unequivocal explanation is still missing.

Our own research

Research among 126 patients conducted by me over a 15-year period has shown that thus far at least one explanation has been overlooked. In the anamnesis, which on average takes a little over 1 hour to record, new patients were questioned extensively about their medical and psychological history. It turned out that 74% of them had recently experienced severe emotional trauma (loss of a beloved person, divorce etc.) that had to a certain extent been repressed. Vitiligo occurred in the families of 18% of the patients, indicating a genetic component. In the remaining 8% no obvious cause could be indicated.

Alopecia areata was found in the history of 6 patients. 65 % of the patients possessed a skin type classified as type I according to Fitzpatrick’s typology. Over 50% of the patients reported hypersensitivity for multiple substances, including powders, soap, perfume, specific foods and fungus infections, or of having a history of asthma or bronchitis.

Own research::

Number of patients seen, 1987-2002: 126. Men: 48, women: 78. Average age: 27.

Total number treated: 39 (32.3%) Finger, hand, face, leg, areola: 31. Penis and/or scrotum only: 8

Average number of treatments: 11 Average duration: 1h.

Local anaesthesia was not administered. On average treatment was well endured.

The results after a 10-year follow-up are positive. As an additional effect the protection of the colour pigments against sunburn was reported.

In 5 patients a skin biopsy was taken before and after treatment for histopathology and electron-microscopic research.

Untreated vitiligo.

After a number of tests to obtain the right colour.

The same hand as above after 24 dermatography treatments. See histology on the right and EMmicroscopy below.


Results of microscopy and electronmicroscopy: The pigments show no inflammatory reactions. They are localised in the papillary dermis between the collagen bundles and the endothelium cells. The macrophages are loaded with finely grained colour pigment.

EM-microscopy (11.000x). Macrophage full of colour pigments

EM-microscopy (11.000x). Pigments in endothelium cells.


Only one other species...

Vitiligo is seen in only one other species beside man: the Indian elephant. Extensive light discolorations often appear on its trunk, head and ears. Curiously, this phenomenon is absent in the African elephant. E.M. van der Velden is researching the possible causes.

E.M. van der Velden in Sri-Lanka

Indian elephant with vitiligo