Vitiligo medical therapy: Difference between revisions

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<!-- Unsourced image removed: [[Image:Girlwithvitiligo.jpg|thumb|left|Sharni Kaur, right, and her mother, Roop Singh. Sharni has had vitiligo, which causes her skin to lighten, since she was nine years old.]] -->
<!-- Unsourced image removed: [[Image:Girlwithvitiligo.jpg|thumb|left|Sharni Kaur, right, and her mother, Roop Singh. Sharni has had vitiligo, which causes her skin to lighten, since she was nine years old.]] -->
There are a number of ways to alter the appearance of vitiligo without addressing its underlying cause. In mild cases, vitiligo patches can be hidden with makeup or other cosmetic camouflage solutions. If the affected person is pale-skinned, the patches can be made less visible by avoiding [[sunlight]] and the [[sun tanning]] of unaffected skin. However, exposure to sunlight may also cause the melanocytes to regenerate to allow the pigmentation to come back to its original color.


The traditional treatment given by most dermatologists is [[corticosteroid]] cream.<ref>{{cite journal |author=Kwinter J, Pelletier J, Khambalia A, Pope E |title=High-potency steroid use in children with vitiligo: a retrospective study |journal=J. Am. Acad. Dermatol. |volume=56 |issue=2 |pages=236-41 |year=2007 |pmid=17224367 |doi=10.1016/j.jaad.2006.08.017}}</ref>
===Topical corticosteroids <small><small><small>'''Adapted from the 2012 Guidelines for the management of vitiligo: the European
 
Dermatology Forum consensus'''<ref name="pmid22860621">{{cite journal| author=Taieb A, Alomar A, Böhm M, Dell'anna ML, De Pase A, Eleftheriadou V et al.| title=Guidelines for the management of vitiligo: the European Dermatology Forum consensus. | journal=Br J Dermatol | year= 2013 | volume= 168 | issue= 1 | pages= 5-19 | pmid=22860621 | doi=10.1111/j.1365-2133.2012.11197.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22860621  }} </ref></small></small></small>===
[[Phototherapy]] may also beneficial using exposure to long-wave [[ultraviolet]] (UVA) light from the sun or from UVA, together with [[Psoralen]], called "[[PUVA]]", Or with UVB Narrowband lamps (without Psoralen), can help in many cases. Psoralen can be taken in a pill 1-2 hours before the exposure or as a Psoralen soaking of the area 1/2 hour before the exposure. Lately, PUVA is being more and more replaced with exposure UVB Narrowband light at a wavelength of 311-313 nanometers. This treatment does not involve Psoralen since the effect of the lamp is strong enough. The source for the UVB Narrowband UVB light can be special fluorecent lamps that treat large area in few minutes, or high power fiber-optic devices in a fraction of a second.
* Topical corticosteroids along, with topical calcineurin inhibitors, are considered the first line treatment for limited forms of vitiligo.
 
* Topical corticosteroids have shown repigmentation rates of up to 75%.
Studies have also shown that [[immunomodulator]] creams such as [[Protopic]] and [[Elidel]] also cause repigmentation in some cases, when used with UVB Narrowband treatments.<ref>{{cite journal |author=Tanghetti EA |title=Tacrolimus ointment 0.1% produces repigmentation in patients with vitiligo: results of a prospective patient series |journal=Cutis; cutaneous medicine for the practitioner |volume=71 |issue=2 |pages=158-62 |year=2003 |pmid=12635898 |doi=}}</ref><ref>{{cite journal |author=Silverberg NB, Lin P, Travis L, Farley-Li J, Mancini AJ, Wagner AM, Chamlin SL, Paller AS |title=Tacrolimus ointment promotes repigmentation of vitiligo in children: a review of 57 cases |journal=J. Am. Acad. Dermatol. |volume=51 |issue=5 |pages=760-6 |year=2004 |pmid=15523355 |doi=10.1016/j.jaad.2004.05.036}}</ref>
* Best results have been observed in areas exposed to sunlight (neck and face), dark skin and new lesions.
 
* No difference has been observed between the efficacy of potent (mometasone) versus superpotent (clobetasol) topical corticosteroids, then potent corticosteroids should be the first option.
Alternatively, some people with vitiligo opt for chemical depigmentation, which uses 20% monobenzylether of [[hydroquinone]]. This process is irreversible and generally ends up with complete or mostly complete depigmentation.
* Two schemes are recommended by the European Dermatology Forum consensus for the treatment of facial and extrafacial lesions:
 
:* Discontinuous scheme (preferred scheme): Daily application of a potent topical corticosteroid during 15 days a month for a total of 6 months.
In late October of 2004, doctors successfully transplanted [[melanocyte]]s to vitiligo affected areas, effectively repigmenting the region. The procedure involved taking a thin layer of pigmented skin from the patient's [[Gluteal muscles|gluteal]] region. Melanocytes were then separated out and used to make a [[Cell (biology)|cellular]] suspension. The area to be treated was then [[Ablation|ablated]] with a [[laser|medical laser]], and the melanocyte [[Skin grafting|graft]] applied. Three weeks later, the area was exposed to UV light repeatedly for two months. Between 73 and 84 percent of patients experienced nearly complete repigmentation of their skin. The longevity of the repigmentation differed from person to person.<ref>{{cite journal |author=van Geel N, Ongenae K, De Mil M, Haeghen YV, Vervaet C, Naeyaert JM |title=Double-blind placebo-controlled study of autologous transplanted epidermal cell suspensions for repigmenting vitiligo |journal=Archives of dermatology |volume=140 |issue=10 |pages=1203-8 |year=2004 |pmid=15492182 |doi=10.1001/archderm.140.10.1203}}</ref>
:* Continuous scheme: Daily application of a potent topical corticosteroid during 3 months.
 
:* Photographs should be taken to evaluate the response to the treatment.
In early 2008 scientists at King's College London, England, make a major breakthrough in treatment of Vitiligo. They discovered that piperine, a chemical derived from black pepper can aid repigmentaion in skin, especially when combined with pUVA therapy produces a longer lasting and more even pigmentation than previous treatments [http://news.bbc.co.uk/1/hi/health/7244474.stm].
* Both schemes are recommended for children and adults.
* If large areas are affected and risk of systemic absorption is a concern (specially in children), then mometasone furoate or methylprednisolone aceponate are the preferred options as this drugs present less systemic side effects.


==References==
==References==

Revision as of 14:44, 25 June 2014

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Medical Therapy

===Topical corticosteroids Adapted from the 2012 Guidelines for the management of vitiligo: the European Dermatology Forum consensus[1]===

  • Topical corticosteroids along, with topical calcineurin inhibitors, are considered the first line treatment for limited forms of vitiligo.
  • Topical corticosteroids have shown repigmentation rates of up to 75%.
  • Best results have been observed in areas exposed to sunlight (neck and face), dark skin and new lesions.
  • No difference has been observed between the efficacy of potent (mometasone) versus superpotent (clobetasol) topical corticosteroids, then potent corticosteroids should be the first option.
  • Two schemes are recommended by the European Dermatology Forum consensus for the treatment of facial and extrafacial lesions:
  • Discontinuous scheme (preferred scheme): Daily application of a potent topical corticosteroid during 15 days a month for a total of 6 months.
  • Continuous scheme: Daily application of a potent topical corticosteroid during 3 months.
  • Photographs should be taken to evaluate the response to the treatment.
  • Both schemes are recommended for children and adults.
  • If large areas are affected and risk of systemic absorption is a concern (specially in children), then mometasone furoate or methylprednisolone aceponate are the preferred options as this drugs present less systemic side effects.

References

  1. ↑ Taieb A, Alomar A, Böhm M, Dell'anna ML, De Pase A, Eleftheriadou V; et al. (2013). "Guidelines for the management of vitiligo: the European Dermatology Forum consensus". Br J Dermatol. 168 (1): 5–19. doi:10.1111/j.1365-2133.2012.11197.x. PMID 22860621.

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