Contact Vitiligo Lanka - Ayush Kendra Institute Sri Lanka

Directions to Vitiligo Lanka

You may contact us at the following address or simply fill in the form and click submit.

Dr. N. Nafeesdean, Vitiligo Lanka, Ayush Institute, No. 83, Main Street, Kekirawa, Sri Lanka or

No. 82, Jasmin Villa, Kalawewa, Vijithapura, Sri Lanka

Phone: +94 (0)25 2263344, +94 (0)777 801491, +94 (0)71 2208736

General Information

Assessment request

Age:
Sex:
Race:
Country:
Type of disease:
When did it start ?:
Detail of affected parts?:
Biggest area (size/ location):
Smallest area (size/ location):
Is any of these affected?:	Lips Finger Tips Genitalia
What about hair in affected areas?:
History of re-pigmentation:	No Yes, spontaneous Yes, with treatment
Family history details (specify Grand Parents, Siblings etc):
Who made the diagnosis?:
Basis of diagnosis:
Have pregnancies affected your disease?:
How has your vitiligo behaved in last six months?:
Summary of any co-existing chronic disease?:

Do you have family members with Vitiligo?
Do you or family members have any autoimmune diseases?
Do you have a rash, sun burn or other skin problem before?
Do you have some type of stress or physical illness?
Did your hair turn grey before age 35?
Are you sensitive to the sun?
Message Details: :