Q: I am 30 years old living in Spain from the last 10 years. I have vitiligo since the last 20 years. It has spread all over my body. My aunt and uncle too have it. When I developed vitiligo at 10 years I went through all the possible treatment and went to all types of skin specialists including homeopaths, but no results. I also took treatment with PUVA rays. So finally, I left all treatment. For the next 8 years I did not go through any treatment and my vitiligo kept spreading but at a very slow rate, sometimes it also stopped to spread. I checked through internet and decided to go through skin grafting surgery in India specially on the spot which I have below my eye lid. I made all arrangements with my doctor in India in Gujarat for the operation but due to the riots in Gujarat I could not get it done. Four months back I went to a skin doctor in Spain for some allergy problem and asked him if there was any treatment available for vitiligo at present. He advised me to try the cream Protopic 0.1% which is giving good results specially for the spots on my face. But on the other side my vitiligo is spreading very fast on areas like hands, legs and I am worried. I don't know why this is spreading - is it due to the treatment of protopic 0.1% which I am applying at the present? Please guide me on what I should do now?

A:First things first. Protopic is not the cause of your woes. Vitiligo is a pigmentation disorder in which melanocytes (the cells that make pigment) in the skin, the mucous membranes (tissues that line the inside of the mouth and nose and genital and rectal areas), and the retina (inner layer of the eyeball) are destroyed. As a result, white patches of skin appear on different parts of the body. The hair that grows in areas affected by vitiligo usually turns white. For some people, vitiligo spreads slowly, over many years. For other people, spreading occurs rapidly. Some people have reported additional depigmentation following periods of physical or emotional stress. Treatment options for Vitiligo include: 1. Medical Therapies - Topical & oral steroid therapy - Topical psoralen photochemotherapy - Oral psoralen photochemotherapy - Depigmentation (if repigmentation is not possible) 2. Surgical Therapies - You should consider the surgical treatment of vitiligo only if: - Your vitiligo has not changed in the last year. - You have not or no longer respond to PUVA treatment. - Your skin has never permanently lost its colour (pigment) when you have suffered a small cut or scrape. Surgical treatment is ideal for those that have Segmental vitiligo (this form involves an area only on one side of the body and tends not to be responsive to non surgical treatment methods) METHODS: - Skin grafts from a persons own tissues (autologous) - Skin grafts using blisters - Micropigmentation (tattooing) - Autologous melanocyte transplants 3. Adjunctive Therapies - Sunscreens - Cosmetics 4. Newer therapies: - Treatment of vitiligo with the 308-nm excimer laser - Oral dexamethasone pulse treatment for vitiligo - Narrowband UVB - Tacrolimus ointment (Protopic) - Calcipotriol, etc.