Piebaldism: Treatment, Procedure, Cost and Side Effects

Piebaldism is an autosomal dominant trait that causes patches of non pigmented and hypopigmented skin cells to develop. It is found in all mammals and is very common in non primates like dogs, horses, mice, etc. where the trait is built up by selective breeding for aesthetic purpose. Although a dominant trait, piebaldism is rare in primates including humans. Most common mutations leading to piebaldism in humans occur in the kit and snai2 genes. Piebaldism occurs in all racial groups and is sometimes associated with developmental disorders like Waaldenburg’s Syndrome.

While they may have similar symptoms, piebaldism is very different from albinism. In albinism, patches of cells cannot produce pigments at all, while in piebaldism, cells have the ability of pigmentation, but the function remains turned off in patches. Also pigmentation of the eyes remains normal in piebaldism, while albinism is associated with defective eye pigmentation and visual defects. Piebaldism is also completely different from other inherited of infectious diseases that affect skin pigmentation like vitiligo, Alezzandrini Syndrome, poliosis, etc.

Piebaldism is an inherited autosomal dominant disorder and has no complete cure. However, the white or discoloured patches of the skin may be treated and reduced in size, number, and intensity.

Piebaldism has no known cure or prevention, only the symptoms may be tackled. Even then these treatment methods have no guarantee and may or may not produce results. Dermabrasion is one of the treatment methods, where a small abrasive tool is used to rub on the discoloured patches on the skin. This removes the outer layer of dead skin cells and also stimulates the nearby cells to produce pigments. Skin grafting is another treatment method that may be followed, where a portion of skin with normal pigmentation is excised and grafted onto an area with lack of pigments. A slight modification of this is the melanocyte and keratinocyte transplantation technique, where just pigment producing cells are transplanted onto the area with no pigmentation. Another advanced technique is the use of Erbium doped Yttrium Aluminium Garnet Laser for surgical grafting. Er:YAG laser emits infrared light of wavelength 2940nm.

The commonest symptom of piebaldism is the appearance of a triangular, diamond, or elongated strip shaped patch of white hair on the hairline at the forehead. Other areas of the body may be affected, so white patches may appear on the eyebrows and eyelashes, middle of the arms and legs, forehead, and front and sides of chest and abdomen. Appearance of patches in this pattern without visual defects indicates piebaldism and may be thus treated.

Presence of visual defects due to lack of eye pigmentation indicates albinism. Vitiligo is an autoimmune disease where pigment producing cells are destroyed by the body’s own immune system, leading loss of skin pigmentation over time and symptoms do not usually appear at birth or soon after. The white forelock, also called poliosis circumscripta is associated with a number of other diseases like Wardenburg’s syndrome, tuberculosis, etc. Alezzandrini Syndrome is another condition causing skin colour changes also accompanied by hearing loss. In these conditions, treatments for piebaldism are ineffective.

There may be some side effects to the treatment for piebaldism, the most prominent of which is that he treatment may turn out ineffective. Dermabrasion may lead to injury if done inexpertly. Skin grafts have a chance of scarring.

There are no specific post treatment guidelines to treatment for piebaldism. Some generic guidelines need to be followed, like protecting the skin from overexposure to sunlight, protecting it from harsh chemicals of some soaps and beauty products.

Recovery period after the treatment for piebaldism is usually low, but it also depends on the effectiveness of the treatment and whether or not any complications arise with the procedure.

Piebaldism treatment cost varies widely in the country. Dermabrasion treatments start from Rs.2,000 and the costs can go up to Rs.50,000 or higher for the more elaborate procedures.

Results of piebaldism treatment, if successful, lasts only for a short time, and further touching up is required to keep skin pigmentation normal for longer periods of time.