Clinical Profile And Management Pattern Of Vitiligo Patients In A Teaching Hospital In Western NepalCorrespondence Address :
Rajpal S VI Semester MBBS student,Manipal College of Medical Sciences Pokhara,Nepal.Email:Uniquegal35@yahoo.com
The present study analyzed the clinical profile and management pattern of vitiligo patients in a teaching hospital in western Nepal. The list of vitiligo patients who visited the dermatology outpatient department was collected. Based on the list, the patientsâ€™ files were taken from the medical record department and were analyzed as per study objectives. Vitiligo was found to be more common in the age group of 11- 20 years (41.7%) and in urban population (64%). It generally started at teen and pre-teen ages. Most of the patients were given Psoralen ultraviolet â€“A (PUVA) therapy and corticosteroids. Most patients had no history of prolonged drug intake prior to onset of lesions. Concurrent dermatological diseases were found in 12.17% of the patients with vitiligo, 48.68% of patients had no other illness and the rest had unrelated diseases affecting gastrointestinal, gynecological and respiratory systems. Similar studies covering larger number of patients are needed to confirm our findings.
Clinical profile, Nepal, Vitiligo
Vitiligo is a depigmenting disorder of the skin of spontaneous onset. Occasionally, the loss of melanin (ie, hypopigmentation) is partial (1). It is an acquired progressive disorder in which some or all of the melanocytes in the interfollicular epidermis, and occasionally those in the hair follicles, are selectively destroyed. It presents in childhood or adult life. It often involves the hands, wrists, axilla, periorbital, perioral and anogenital skin (2). Spontaneous repigmentation may occur. Trauma and sunburn may precipitate the appearance of Vitiligo. A curious phenomenon called koebnerization often occurs in vitiligo, where lesions develop primarily at the sites of repeated trauma (1), (3). Most evidence support autoimmune etiology, focusing on the presence of circulating antibodies against melanocytes and the association of Vitiligo with other autoimmune disorders such as pernicious anemia (1), addison disease (4), Diabetes Mellitus (5) and autoimmune Thyroiditis (1), (2), (6). Worldwide it is estimated that nearly 1% of the population is affected by vitiligo (2), (7). The highest incidence of the condition has been recorded in Indians from the Indian subcontinent, followed by Mexicans and Japanese(8). Data regarding the clinical profile and management pattern of vitiligo are lacking in Nepal. Hence we carried out the present study with the following objectives.
1. To study the demographic details of the vitiligo patients visiting the Manipal Teaching Hospital (MTH)
2. To study the drugs used in management of vitiligo
3. To study the concurrent illness of the patients suffering from vitiligo.
All vitiligo patients visiting the dermatology outpatient department of Manipal Teaching hospital between the periods of January 1st 2006- Dec 31st 2006 were included.
MTH, 700 bedded hospital located at Phulbari, Pokhara (having an average occupancy of around 300 beds)
One year duration
Method of data collection
We went through the records of the patient presenting to from Jan 1st to Dec 31st, 2006, and collected the data regarding people diagnosed as vitiligo.
Method of Data Analysis
The data obtained from the filled patient profile form were entered in the Microsoft excel programme and were analyzed. The SPSS version 9.0 was used for descriptive statistics.
Total 139 patients visited the dermatology out patient department during the study period. The distribution of vitiligo among the patients was 53.2% in males (n=74) and 46.8% in females (n=65). Among the total 139 patients 89 (64%) were from urban areas and the remaining 50 (36%) were from rural areas. The Mean Â± SD age of the patients was 25.06Â± 17.6 years. The age distribution of the patients is listed in
Follow-up details: The number of times the patients were followed up was noted. We found that number of visits were more than five per patient. The details regarding the follow ups are listed in (Table/Fig 2).
Onset of vitiligo: The age of onset of vitiligo was studied and the details are listed in (Table/Fig 3).
Drug therapy for vitiligo: The drugs used in the management of vitiligo were studied and the details are listed in (Table/Fig 4).
Drug history of the patients: The drug history of the vitiligo patients was studied and the details are listed in (Table/Fig 5).
Concurrent illness: The various concurrent illnesses of the patients are listed in (Table/Fig 6).
In our study, vitiligo was found to be more common among the age group of 11-20 years of age which is in agreement with few other studies (1), (9). This may be artefactual as this age group is more cosmetically conscious. In the contrary, one study (8) showed that it is equally common in all age group. Our study revealed an almost equal prevalence in both sexes,which is similar to other studies. (8), (9), (10)
The compliance was found to be poor in patients which may be because of unsatisfactory treatment, (1), (2), (11) expensive medicines and long duration of therapy. The disease was found to be more common in people in urban setting compared to the people in rural settings. This however may be due to the fact that people in urban areas are more conscious about health and the other fact being that our hospital is located in an urban area.
In our study, the most commonly used treatment modalities were Bath PUVA therapy (in which patient lies in a bathtub containing 0.75% topical psoralen for 20 minutes, and later exposes to UVA source, either in a UVA chamber or to natural sunlight) and corticosteroids. PUVA therapy has been commonly used worldwide (1), (2), (11), (12), (13), (14), (15). Other modalities, especially in stable vitiligo and localized lesions are surgical manipulations including minigrafts (16) and autologous transplantation methods (17) which are yet to be tried in our part of the world.
We found drug history to be irrelevant in the causation of vitiligo. It is unclear whether use of certain oral medications may also be associated with vitiligo. For example, whereas infliximab has been known to produce a lupus-like syndrome; it has also been described as inducing vitiligo, probably through the same or similar autoimmune mechanism (18).
Generally, vitiligo is found to be concurrent with other dermatological illnesses like tinea versicolor, tinea cruris and leukotrichia. Leukotrichia (8) and halo nevi (8), (12) have been mentioned in other studies as well. Vogt-Koyanagi-Harada syndrome is the commonest vitiligo associated syndrome mentioned in some studies (19), (20), (21), (22) the full constellation of which includes vitiligo, poliosis, alopecia with panuveitis and auditory and neurological manifestations.
Our study had a few limitations, notable ones being: a retrospective study with occasional incomplete data due to poor documentation in the patient files. Only one centre was involved and the population studied was less. Hence, it is difficult to generalize our finding to the entire western Nepal. We could not assess the response to the above mentioned treatments as there was no adequate follow-up in most cases.
The present study was successful in identifying the clinical profile and management pattern of vitiligo patients in Western region of Nepal. Vitiligo was found to be more common in the age group of 11- 20 years (41.7%). Vitiligo was found to be associated with other auto-immune diseases only in 2.1% of the total cases. PUVA therapy and Corticosteroids were the common management pattern. Vitiligo was found to be concurrent in 12.17% of the patients with other dermatological illness. Similar studies covering larger number of patients are needed to confirm our findings.
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