Vitiligo
I. Definition:
Vitiligo is a common skin disorder in which white spots appear on the skin usually occurring on both sides of the body in the same location. The disease has been around for thousands of years. Vitiligo occurs in 1-2% of the population. It affects both sexes, all races and all ages.
II. Causes:
III. Course:
IV. Treatment:
Vitiligo is a common skin disorder in which white spots appear on the skin usually occurring on both sides of the body in the same location. The disease has been around for thousands of years. Vitiligo occurs in 1-2% of the population. It affects both sexes, all races and all ages.
II. Causes:
- The skin is made up of two main types of cells or building blocks: keratinocytes and melanocytes. The keratinocytes make up the bulk of the skin. The melanocytes are the cells that make the skin color. In people with vitiligo, the immune cells (cells which fight infection) attack the melanocytes and kill them. When the melanocytes in a certain area die the skin turns white. No one knows why the immune cells attack the melanocytes in people with vitiligo.
- Patients with vitiligo are sensitive to free radicals and need aggressive vitamin therapy, see below.
- Vitiligo sometimes runs in families, meaning that a genetic factor may be involved.
- Vitiligo sometimes occurs at the site of an old injury.
III. Course:
- Most people have slow progression of their disease. In some people the problem will disappear by itself.
IV. Treatment:
- Patients with vitiligo should take a B-complex multivitamin each day. Also take Folic Acid 1 mg, Vitamin E 600 – 800 IU, and ascorbic acid (Vitamin C) 1000 mg a day.
- Vitamin D ointment by prescription can help some people with vitiligo.
- Tacrolimus ointment .1% for 6 months will help many people with vitiligo. This medication also requires a prescription.
- Topical cortisone ointments by prescription can treat many cases of vitiligo.
- There is no easy treatment of vitiligo. Cover-up cosmetics such as Dermablend and Covermark work well.
- PUVA light treatment has a high success rate. This treatment is very time-consuming. The patient must come to the office 2-4 times per week for 15-30 minutes to stand in a light box for 100-300 treatments. The treatment often takes a year or more and does not work for every patient that tries it; 50-70% of patients treated get a good response.
- Oxsoralen ointment, available by prescription (Oxsoralen 1% lotion, diluted to 0.001%, over $100 for a small jar), can be used for patients who can get daily sun exposure. The ointment is applied to the white areas. 30 minutes after application of the medication, allow 5 minutes of sun exposure on the first day of treatment. Use a Q-tip to apply the medication to small areas. The ointment is then washed off with soap and water. The skin remains sensitive to sunlight for 3 days, so you must keep the treated areas covered with sunblock (zinc oxide). The second day one would get 10 minutes of sun exposure 30 minutes after application. Each day the sun exposure would be increased by 5 minutes. For example, on the fourth day you would get 20 minutes of sun to the involved areas 30 minutes after applying the ointment. When 30 minutes of sun exposure per day is achieved, you no longer increase the amount of sun time. This treatment takes 6 months to work so do not expect results right away. Remember to always wash off the ointment after your time is up and to cover the areas with sunblock or a severe blistering reaction will occur. One should never sunbathe while under going this treatment. If blistering occurs skip a week or so until the areas heal, then restart the treatment but only increase by 1 minute each day.
- Severe case of vitiligo that do not respond to treatment can be treated with Benoquin by prescription. This medication causes permanent whitening of the dark areas of the skin and should only be used as a last resort.
- There is a lot of information on vitiligo treatment at www.avrf.org (American Vitiligo Research Foundation).