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Patching up the patches
Children suffering from leukoderma are getting a new lease of life at the Lady Ridgeway Hospital. Kumudini Hettiarachchi reports on this medical breakthrough

A little child with a blob of white cream daubed on her skin is seated without a murmur while people around her bustle about scraping behind her ear. Look closely and the cream is on a stark white patch of skin.

The girl is a sufferer of leukoderma or vitiligo which creates stigma and ostracism. Derogatorily dubbed kabara, this skin disease linked to one’s pigmentation going awry, creates much heartache and sorrow because most people dare not touch the person due to many widely-held misconceptions
One such entrenched belief among men, women and children is that leukoderma is incurable. If you have it, you’ve got to live with it, is the general thinking. But as soon as one steps into the skin clinic of the Lady Ridgeway Hospital for Children, that thinking changes drastically.

Right before one’s eyes, a procedure is being performed under local anaesthesia to correct the problem and in the case of another child one sees the white patches getting covered by brown dots which spread gradually, bringing back the normal pigmentation of the skin.

“Normal skin is taken from a place not visible directly and then grafted to a patch of vitiligo,” says Dr. Jayamini Seneviratne, LRH’s Consultant Dermatologist, explaining that the pigment then starts spreading after two-three weeks.

Calling it a good, rapid response, he stresses, “The pigmentation is identical to the surrounding skin. This type of grafting is very effective if the disease is stable and no new lesions have occurred within three months.” The procedure takes from anything between half-an-hour to three hours and in recent times the clinic has attended to about 100 children ranging from babies to teens.

Detailing other treatment for the same condition, Dr. Seneviratne said it should be on a case-by-case basis. “It has to be very individualistic and include use of sunscreen for extensive lesions which could be susceptible to sunburn, various creams and lotions, a special type of light therapy, cover-up cosmetics and surgical treatment using the patient’s own melanocytes. In a few rare cases we carry out de-pigmentation of the remaining brown patches to bring about extensive discolouration.”

The Sunday Times learns that some people, not of the medical profession, try out various methods of ineffective treatment including scraping the affected section of the body with a sharp three-pronged instrument, causing immense suffering to these children.

“Come early,” Dr. Seneviratne urges parents offering them hope. “Come as soon as you see the first signs.”

Leukoderma: What is it?
The main pigment in the human skin is melanin found in the cells called melanocytes, says Dr. Seneviratne giving a picture of the human skin.
Melanin is synthesized in the human body using a number of enzymes and is stored and transferred to other cells, giving the colour or pigment of each individual’s skin.

Any problem in the whole process, either of synthesis or transfer can lead to a marked pigmentary dilution known as albinism and related disorders. When the melanocytes are destroyed due to acquired causes there is patchy pigmentary loss known as vitiligo or leukoderma.

“The commonest way this happens is when one’s own immune system destroys the melanocytes. This condition is called auto-immunity. While the other causes could be neuro-chemical or self-destructive, in a rare case it could be hereditary,” he says. Leukoderma can be categorised into generalized or acrofacial, segmental, focal and universal.

In vitiligo there is pigmentary loss or white areas and light brown areas, he says, and spontaneous re-pigmentation within the white areas. There can be associated white hairs but the texture of the skin is normal. On rare occasions vitiligo can be associated with other diseases including diabetes, thyroid disease and even rare conditions involving the eye and the brain. “The onset of the disease can be at any age, childhood to adulthood. It is a polygenic disorder with some family members being affected.”

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