Treatment Option For Vitiligo

Fashion, Beauty and Health

Medical Therapies
Topical steroid therapy
Topical psoralen photochemotherapy
Oral psoralen photochemotherapy
Depigmentation

Surgical Therapies
Autologous skin grafts
Skin grafts using blisters
Micropigmentation (tattooing)
Autologous melanocyte transplants


Homeopathic soft treatment


Adjunctive Therapies
Sunscreens
Cosmetics
Counseling and support
Current treatment options for vitiligo include medical, surgical, and adjunctive therapies (therapies that can be used along with surgical or medical treatments).

Medical Therapies

Topical Steroid Therapy

Steroids may be helpful in repigmenting (returning the color to white patches) the skin, particularly if started early in the disease. Corticosteroids are a group of drugs similar to the hormones produced by the adrenal glands (such as cortisone). Doctors often prescribe a mild topical corticosteroid cream for children under 10 years old and a stronger one for adults. Patients must apply the cream to the white patches on their skin for at least 3 months before seeing any results. It is the simplest and safest treatment but not as effective as psoralen photochemotherapy (see below). The doctor will closely monitor the patient for side effects such as skin shrinkage and skin striae (streaks or lines on the skin).

Psoralen Photochemotherapy

Psoralen photochemotherapy (psoralen and ultraviolet A therapy, or PUVA) is probably the most beneficial treatment for vitiligo available in the United States. However, it is time-consuming and care must be taken to avoid side effects, which can sometimes be severe. Psoralens are drugs that contain chemicals that react with ultraviolet light to cause darkening of the skin. The treatment involves taking psoralen by mouth (orally) or applying it to the skin (topically). This is followed by carefully timed exposure to ultraviolet A (UVA) light from a special lamp or to sunlight. Patients usually receive treatments in their doctors' offices so they can be carefully watched for any side effects. Patients must minimize exposure to sunlight at other times. The goal of PUVA therapy is to repigment the white patches.


Topical Psoralen Photochemotherapy

Topical psoralen photochemotherapy often is used for people with a small number of depigmented patches (affecting less than 20 percent of the body). It is also used for children 2 years old and older who have localized patches of vitiligo. Treatments are done in a doctor's office under artificial UVA light once or twice a week. The doctor or nurse applies a thin coat of psoralen to the patient's depigmented patches about 30 minutes before UVA light exposure. The patient is then exposed to an amount of UVA light that turns the affected area pink. The doctor usually increases the dose of UVA light slowly over many weeks. Eventually, the pink areas fade and a more normal skin color appears. After each treatment, the patient washes his or her skin with soap and water and applies a sunscreen before leaving the doctor's office.

There are two major potential side effects of topical PUVA therapy: (1) severe sunburn and blistering and (2) too much repigmentation or darkening of the treated patches or the normal skin surrounding the vitiligo (hyperpigmentation). Patients can minimize their chances of sunburn if they avoid exposure to direct sunlight after each treatment. Hyperpigmentation is usually a temporary problem and eventually disappears when treatment is stopped.

Oral Psoralen Photochemotherapy

Oral PUVA therapy is used for people with more extensive vitiligo (affecting greater than 20 percent of the body) or for people who do not respond to topical PUVA therapy. Oral psoralen is not recommended for children under 10 years of age because of an increased risk of damage to the eyes, such as cataracts. For oral PUVA therapy, the patient takes a prescribed dose of psoralen by mouth about 2 hours before exposure to artificial UVA light or sunlight. The doctor adjusts the dose of light until the skin areas being treated become pink. Treatments are usually given two or three times a week, but never 2 days in a row.

For patients who cannot go to a PUVA facility, the doctor may prescribe psoralen to be used with natural sunlight exposure. The doctor will give the patient careful instructions on carrying out treatment at home and monitor the patient during scheduled checkups.

Known side effects of oral psoralen include sunburn, nausea and vomiting, itching, abnormal hair growth, and hyperpigmentation. Oral psoralen photochemotherapy may increase the risk of skin cancer. To avoid sunburn and reduce the risk of skin cancer, patients undergoing oral PUVA therapy should apply sunscreen and avoid direct sunlight for 24 to 48 hours after each treatment. Patients should also wear protective UVA sunglasses for 18 to 24 hours after each treatment to avoid eye damage, particularly cataracts.

Depigmentation

Depigmentation involves fading the rest of the skin on the body to match the already white areas. For people who have vitiligo on more than 50 percent of their body, depigmentation may be the best treatment option. Patients apply the drug monobenzylether of hydroquinone (monobenzone or Benoquin*) twice a day to pigmented areas until they match the already depigmented areas. Patients must avoid direct skin-to-skin contact with other people for at least 2 hours after applying the drug.

The major side effect of depigmentation therapy is inflammation (redness and swelling) of the skin. Patients may experience itching, dry skin, or abnormal darkening of the membrane that covers the white of the eye. Depigmentation is permanent and cannot be reversed. In addition, a person who undergoes depigmentation will always be abnormally sensitive to sunlight.

Surgical Therapies

All surgical therapies must be viewed as experimental because their effectiveness and side effects remain to be fully defined.


Autologous Skin Grafts

In an autologous (use of a person's own tissues) skin graft, the doctor removes skin from one area of a patient's body and attaches it to another area. This type of skin grafting is sometimes used for patients with small patches of vitiligo. The doctor removes sections of the normal, pigmented skin (donor sites) and places them on the depigmented areas (recipient sites). There are several possible complications of autologous skin grafting. Infections may occur at the donor or recipient sites. The recipient and donor sites may develop scarring, a cobblestone appearance, or a spotty pigmentation, or may fail to repigment at all. Treatment with grafting takes time and is costly, and most people find it neither acceptable nor affordable.

Skin Grafts Using Blisters

In this procedure, the doctor creates blisters on the patient's pigmented skin by using heat, suction, or freezing cold. The tops of the blisters are then cut out and transplanted to a depigmented skin area. The risks of blister grafting include the development of a cobblestone appearance, scarring, and lack of repigmentation. However, there is less risk of scarring with this procedure than with other types of grafting.

Micropigmentation (Tattooing)

Tattooing implants pigment into the skin with a special surgical instrument. This procedure works best for the lip area, particularly in people with dark skin; however, it is difficult for the doctor to match perfectly the color of the skin of the surrounding area. Tattooing tends to fade over time. In addition, tattooing of the lips may lead to episodes of blister outbreaks caused by the herpes simplex virus.

Autologous Melanocyte Transplants

In this procedure, the doctor takes a sample of the patient's normally pigmented skin and places it in a laboratory dish containing a special cell culture solution to grow melanocytes. When the melanocytes in the culture solution have multiplied, the doctor transplants them to the patient's depigmented skin patches. This procedure is currently experimental and is impractical for the routine care of people with vitiligo.


Adjunctive Therapies

Sunscreens

People who have vitiligo, particularly those with fair skin, should use a sunscreen that provides protection from both the UVA and UVB forms of ultraviolet light. Sunscreen helps protect the skin from sunburn and long-term damage. Sunscreen also minimizes tanning, which makes the contrast between normal and depigmented skin less noticeable.

Cosmetics

Some patients with vitiligo camouflage depigmented patches with stains, makeup, or self-tanning lotions. These cosmetic products can be particularly effective for people whose vitiligo is limited on exposed areas of the body. Dermablend, Lydia O'Leary, Clinique, Fashion Flair, Vitadye, and Chromelin offer makeup or dyes that patients may find helpful for covering up depigmented patches.

Counseling and Support

Many people with vitiligo find it helpful to get counseling from a mental health professional. People often find they can talk to their counselor about issues that are difficult to discuss with anyone else. A mental health counselor can also offer patients support and help in coping with vitiligo.

What Research Is Being Done on Vitiligo?

Over the past 10 years, research on how melanocytes play a role in vitiligo has greatly increased. This includes research on autologous melanocyte transplants. Doctors and researchers continue to look for the causes of and new treatments for vitiligo.

This nonprofit organization stimulates, coordinates, and sponsors scientific research on vitiligo. In addition, the Foundation educates the public about vitiligo and assists in making referrals for treatment. The Foundation holds annual and regional meetings and sponsors symposia open to both professionals and the public. It publishes a newsletter two times a year and can provide free brochures on vitiligo.