Treatment for Vitiligo

Treatment for Vitiligo

Medical treatment for Vitiligo is not always necessary. Treatment includes topical corticosteroids, topical immunomodulators (e.g., tacrolimus), phototherapy etc.

Medical Therapies

• Topical corticosteroid therapy: Corticosteroids are effective agents to bring repigmentation of the skin. It may take as long as three months of treatment before you notice any changes in the color of your skin. Side effects include thinning of the skin (atrophy) and streaks or lines on the skin (striae).
• Calcipotriene (Dovonex), a vitamin D derivative is sometimes used with corticosteroids or ultraviolet light. It is used locally on the depigmented areas.
Topical immunomodulators: Ointments containing medications like tacrolimus or pimecrolimus are effective for people with small areas of depigmentation, especially on the face and neck. These drugs cause fewer side effects. However the possibility of increased risk of lymphoma and skin cancer cannot be ruled out. Further studies are required.
• Topical psoralen plus ultraviolet A (PUVA): People with less than 20 percent of the body surface area affected by depigmentation may benefit from this therapy. It is also called photochemotherapy (or phototherapy). A chemical called psoralen is first applied topically and then the patient is exposed to ultraviolet light. Side effects (rare) include sunburn and blistering. Temporary over darkening of the skin may happen.
• Oral psoralen photochemotherapy, or oral PUVA: Psoralen is administered orally before UVA radiation exposure in patients with depigmentation spanning over 20 percent of the body surface area.

It is highly recommended that a patient receiving any of the above two treatments stay out of direct sunlight for one or two days after treatment.

• Narrowband ultraviolet B (UVB) therapy is finding greater acceptance because of the simplicity. It does not require a prior dosage of psoralen. Unfortunately the devices used are expensive and the superiority of the technique over PUVA is yet to be confirmed.

The doctor may attempt depigmentation when more than half of the body surface area is affected. Here, a medication called monobenzylether of hydroquinone is applied on the unaffected areas to lighten these areas and make them match the lightness of the affected parts. Depigmentation is permanent. Treated patient will be permanently sensitive to sunlight. Potential side effects include redness, swelling, itching and dry skin.

Surgical Management

Autologous skin grafts: very small sections of the patient's own normal, pigmented skin are removed and placed on the affected parts. Complications include:

• Scarring
• A cobblestone appearance,
• Spotty pigmentation
• Failure of the transferred skin to repigment.

Blister grafting: This technique produces less scarring. Blisters are created on pigmented skin, principally by using suction. The top of these blisters are removed and transplanted where similar blisters have been created and removed in a depigmented (affected) area.

Tattooing (micropigmentation): Pigments are implanted into the skin using surgical instruments. This is effective around the lips and in dark skinned people.

References:

1. Cecil Medicine, 23rd Ed.
2. Harrison's PRINCIPLES OF INTERNAL MEDICINE, 17th Edition