Skin is made up of many layers. Skin is the largest organ of the body. It protects, maintains the temperature balance , releases out the toxins out of the body in the form of sweat and maintains the equilibrium . It reflects the internal and general health of the person. Unhealthy ,Patchy, Dry, Discolored and Pigmented skin depicts indication for certain medical diseases. Though People crave for fair skin.
Skin cell contains Melanin, a dark pigment which gives the Colour to the Skin and protects it from the strong rays of the Sun which are particularly harmful. If the Melanin is destroyed at certain part of the body or not produced then the skin looses its colour and turns leave white spots known as Leucoderma or Phulveri in layman's language. Leucoderma means (Leuco- White and Derma - Skin) also known as Vitiligo in medical terminology. It is also true that all white spots are not of leucoderma.
Children born with congenital absence of Melanin have complete white skin of the whole body called Albinism which is a congenital and and incurable condition.
Though the exact cause of Leucoderma is not known to the medical world still Stress, and General Low Immunity level are considered certain precipitating factors for this ailment. Vitiligo the depigmentry disorder is wide spread in India and has higher percentage than in Westren countries.Because of its disfiguring presentation, it gives rise to severe Psychological Strain and Social Stigma. The Occurance of leucoderma is Stress related is about 42 %, Heriditory 28% and Worms infested 30%.
Leucoderma patch may start as a small white colored almost milky patch which keeps on increasing in varying size and shapes. Patches are usually uniform in colour with well demarcated edges because of peripheral hyperchromia. It may occur anywhere on the body or all over the body but still the commonest sites are around lips, on cheeks, bilaterally distributed on legs, hands, fingers, chest or back around the eyes and even on the head. A single white strand of hair could be the first sign of vitiligo on the scalp. Few patients have these patches around or over the joints like elbow, knee etc. Most of the times people get scared of any white patch on the body and fear it to be leucoderma, but any and every white patch is not of leucoderma they can be because of Liver disorders, Worms ,Taenia infection, Calcium deficiency Injury or burns spots or even Leprosy. As such patient of leucoderma does not have any problem or symptoms like Itching, Pain, Discharge etc. whatsoever but still the patient seek treatment for cosmetic reasons.
Hypothesis
Though the aetilogy of vitiligo is obscure, various hypothesis are suggestive of its genesis .Among these the important ones are:
1) Immune Hypothesis ¨C Melanocyte destruction and dysfunction or both may result into Hypopigmentation of vitiligo.
2) Neural Hypothesis ¨C Neurochemical inhibitors are released at nerve endings that destroy the melanocytes or inhibit their functioning.
3) Melanocyte Self-Destruction Hypothesis ¨C Proposes that an intermediate inmelanin synthesis causes melenocyte destruction.
4) Dietary deficiency of Proeins and Cupro minerals is a major factorfor causing vitiligo. Serum skin and cerebro-spinal fluid copper levels are low in theses cases.
5) A gastro-intestinal disorder like Chronic amoeboisis,chronic Dyspepsia and Intestinal Worms may be additional factors.
6) Use of Broad spectrum Antibiotics ,especially Chlormphenicol and Streptomycinleads to appearanceof vitiligo.
7) Trauma or Local irritation caused by wearing the sari or Trousers too tightly do produce vitiligo in individuals predisposed to it.
8) Acute Stress may be followed by fast spreading typeof vitiligo proving the theory of Troponeurosis. Emotional crisis may be an additional factor.
9) An Endocrinal disorder may be operative,Diabetes, Pernicious anaemia, Thyrotoxicosis, Myxoedema, and Addison¡¯sdisease may be associated with vitiligo.
10) Composite Hypothesis ¨C None of the theories alone is entirely satisfactory. Actual mechanism of inhibition or destruction of melancytes is much more complex than any of these mechanisms suggested.
 Factor Of Hypothesis
a) Emotional Crisis ?Death in family, Loss of job , Sudden shock etc.
b) Gastro intestinal tract disorders like Worms, Jaundice, amoeboisis etc.
c) Prolonged use of Drugs ,antibiotics,Oral anovulating agents etc.
d) Local causes like trauma,burns exposureto chemicals etc.