How To Treat And Manage Vitiligo

Vitiligo is a skin disease characterized by the patchy loss of pigment. These white patches may appear just about anywhere, but they may be more likely to appear on areas of the body that have been sunburned or exposed to sunlight for many years. The face, hands, and arms are common areas for vitiligo to strike. However, the disease can also occur on body parts typically never exposed to the sun, such as the genital area. Vitiligo is not painful or contagious. It's thought to probably be an autoimmune disease, which is one in which the body attacks its tissues. In the case of vitiligo, this attack would be directed at the melanocytes, which are specialized skin cells that produce melanin, which colors the skin, hair, and eyes.

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Anti-Inflammatory Creams

Anti-inflammatory creams are corticosteroidal topical preparations used to help restore normal color to patches of vitiligo. These medications range in strength from mild to very strong. Generally, the more potent corticosteroid creams are used for vitiligo. When steroid creams are applied to large areas of the skin, they can have negative systemic effects, and because of this, the use of anti-inflammatory creams may be limited to small areas of vitiligo only.

Sometimes steroid creams are combined with other medications to enhance results. In addition to possible systemic side effects, steroid creams can cause the skin to become very thin and dry. Vitiligo patches on the hands and feet may not respond as well to this treatment as other body areas. According to the American Academy of Dermatology, about half of patients with vitiligo who try steroid creams will see at least a partial restoration of normal skin color after four to six months of treatment.

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Medications

Vitiligo cannot be cured, though some oral medications can produce marked repigmentation of white patches in some vitiligo patients. One of them is called afamelanotide, which is a type of hormone that stimulates melanocytes to produce more pigment. It's usually combined with light therapy, also called phototherapy. Abatacept is a biological protein-based substance and is often used to treat rheumatoid arthritis. However, there is a clinical trial underway to see if it may also improve symptoms of vitiligo. Tofacitinib is a similar type of medication also used for rheumatoid arthritis. When combined with UVB phototherapy, tofacitinib has shown great promise as an effective vitiligo treatment. Vitamins B-12 and folic acid may be useful in helping to re-pigment white patches when combined with sunlight. Another medication called psoralen, a plant derivative, is combined with phototherapy to help restore normal skin pigment. It can take up to one year to see results.

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Light Therapy

Vitiligo patients encounter a lot of ignorance in their daily lives and are often shunned by others who are afraid the condition is contagious, though it is not. A defect in the immune system almost certainly causes vitiligo. Light therapy has always been a first-line treatment for vitiligo, but results are mixed and unpredictable. Patients are often dissatisfied with both the results and the sheer time it takes to undergo phototherapy. For vitiligo patients with patches covering more than twenty percent of the body, there is a procedure called Narrowband UVB, which uses a very narrow band of the UVB light spectrum. Because it works quickly to stimulate the melanocytes to produce pigment, burning of the white patches avoided. The treatment can be administered in a doctor's office or at home. A doctor's note is necessary to purchase a Narrowband UVB unit for home use. The Narrowband UVB treatment is largely superior to the older PUVA phototherapy, which uses a medication called psoralen along with UVA light.

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Depigmentation

A more drastic option for individuals with large white patches all over a large area is depigmentation. Rather than trying to re-pigment the white patches, this treatment focuses on removing the normal pigment still present in the areas of skin not affected by vitiligo. The chemical most commonly used for this is called monobenzone. Monobenzone, while often effective, can be irritating to the skin. Side effects include redness and itching. The chemical is usually applied daily for many months or even years. In fact, it can take up to two years for the full effect of monobenzone to appear. It may not be possible to match the vitiligo patches exactly, but patients are still often satisfied with the results. Once skin treated with monobenzone has lightened, the effects are permanent, though the patient will always need to be extra careful to limit sun exposure.

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Surgery

Vitiligo is a stubborn, capricious disease, and not everyone will respond to less invasive treatments. When other therapies fail, there is surgery that aims to restore normal skin color to patients. For smaller areas of vitiligo, a surgical procedure called skin grafting may be performed, in which pigmented skin is removed in tiny pieces and then attached to areas of the skin with vitiligo. In another similar procedure, blister grafting, the surgeon uses a suction device to create small blisters on normal skin. The tops of these blisters are then lifted off and transplanted to skin with vitiligo. The results of these procedures are difficult to predict. They can result in a spotty appearance, rather than the smoothly colored look of normal skin, and there is also the risk of infection and scarring. Either or both types of surgery may fail altogether.