Vitiligo is a pigmentation disorder resulting in
de-pigmentation of skin. Melanocytes are responsible for normal skin color. In
vitiligo melanocytes either die or are unable to function properly.
The exact cause of
vitiligo is unknown. However genetic, autoimmune, neural, and viral causes are
thought to induce vitiligo. Oxidative stress may be another cause.
It may affect the
skin, hair and sometimes the mucus membrane. It affects about 8 percent people
across the world and 1 percent in United States.
itself as patches of hypopigmentation in hyperpigmented areas like face,
elbows, hands, etc.
In vitiligo the
epidermis contain high levels of hydrogen peroxide. This leads to oxidative
stress in the epidermis and damages the melanocytes.
Besides being a
cosmetic problem, vitiligo is also associated with the development of Addison's
disease, pernicious anemia and insulin dependent diabetes mellitus.
Vitiligo affects the
quality of a person's life. It has an adverse impact on the self esteem,
intimate relationships, body image and results in undue emotional stress.
Treatment Options for Vitiligo:
Since the exact cause
of vitiligo is unknown, a multifaceted approach is required.
Three approaches are
widely used for the treatment of vitiligo- camouflaging depigmented skin,
restoring pigmentation, and destroying the remaining pigmentation.
Camouflaging Depigmented Skin:
In cases of mild
vitiligo, makeup is used to conceal or camouflage the patches. If the vitiligo
patient is pale-skinned, the patches can be made light by avoiding sunlight-exposure
and tanning of the unaffected regions of the skin.
that provides protection against both ultraviolet A (UVA) and ultraviolet B
(UVB) and has at least sun protection factor (SPF) of 15 should be reapplied
every 90 minutes. It should be replied after sweating and swimming.
Restoration of the
pigment is the oldest form of vitiligo treatment. Photochemotherapy and
Phototherapy are techniques used for restoring pigmentation. Photochemotherapy
is the blend of UVA (Psoralen plus UVA [PUVA]) and photoactive chemicals (such
as khellin, Psoralen, etc.) Phototherapy on the other hand includes UVA and
narrow band of UVB. Adverse effects of phototherapy are skin malignancies,
blistering and hyperpigmentation of unaffected skin.
widely used as topical treatment of vitiligo. Betamethasone valerate is the
initially recommended corticosteroid for use on skin. Clobetasol propionate, a
high potency steroid, should be used if results are not achieved by
corticosteroids can be applied as a thin layer is the affected skin. This
reduces the risk of skin atrophy, striae, hypertrichosis, acne and steroid
Some potential side
effects are weight gain, insomnia, agitation and adrenal insufficiency.
Other useful topical
choices are calcineurin inhibitors, tacrolimus and pimecrolimus. It is seen
that skin lesions on the head and neck respond positively calcineurin
inhibitors. Calcineurin inhibitors yield identical results but without the
Calcipotriene - a
vitamin D analogue is the third effective topical immune-modulatory agent. It
accelerates the melanocyte development. Calcipotriene is less effective when
used alone but in adjunct therapy it is very effective. Some common adverse
effects of calcipotriene are dryness, stinging, burning and erythema.
medications offer good results in vitiligo patients. Ginkgo biloba is a
traditional Chinese herb. It is very useful owing to its immunomodulatory and
anti-oxidant properties. Further researches are needed to establish its
efficacy in curing vitiligo.
If medical treatment
proves ineffective, surgical implantation of melanocytes in de-pigmented skin
can be done. Grafting melanocyte-rich tissue and grafting melanocyte cell
suspensions are the two common types of surgeries for vitiligo.
The associated risks
are graft failure, scarring and new lesions at the surgery site.
Destroying the Remaining Pigmentation:
If more than 50
percent of the body is affected by vitiligo then de-pigmentation is the best
treatment option. Hydroquinone and monobenzone are the de-pigmentation agents
that result in the death of the remaining monocytes. Expected results are
attained in one month but as long as ten months may be needed. Re-pigmentation,
burning and erythema are the possible side-effects.
Extreme sensitivity to
sunlight is noticed after complete depigmentation. Sunscreen therefore is very
important for patients seeking this treatment.
Although vitiligo is
not a very common skin disorder, it definitely poses significant social,
psychological and cosmetic challenges.
It can be concluded
that proper treatment for vitiligo patients is recommended. Household remedies
and treatment from quacks should not be taken, authentic and reliable treatment
should be taken.
Treatment Options for Vitiligo; Johannes Bennett
et al; US Pharmacist 2012