Vitiligo Treatment

Vitiligo (vit-ih-LIE-go) is a disease that causes loss of skin color in patches. The discolored areas usually get bigger with time. The condition can affect the skin on any part of the body. It can also affect hair and the inside of the mouth.
Normally, the color of hair and skin is determined by melanin. Vitiligo occurs when cells that produce melanin die or stop functioning. Vitiligo affects people of all skin types, but it may be more noticeable in people with darker skin. The condition is not life-threatening or contagious. It can be stressful or make you feel bad about yourself.
Treatment for vitiligo may restore color to the affected skin. But it doesn't prevent continued loss of skin color or a recurrence.

Symptoms

Vitiligo signs include:

• Patchy loss of skin color, which usually first appears on the hands, face, and areas around body openings and the genitals.
• Premature whitening or graying of the hair on your scalp, eyelashes, eyebrows or beard
• Loss of color in the tissues that line the inside of your mouth and nose (mucous membranes)

Vitiligo can start at any age, but usually appears before age 30.
Depending on the type of vitiligo you have, it may affect:

• Nearly all skin surfaces. With this type, called universal vitiligo, the discoloration affects nearly all skin surfaces.
• Many parts of your body. With this most common type, called generalized vitiligo, the discolored patches often progress similarly on corresponding body parts (symmetrically).
• Only one side or part of your body. This type, called segmental vitiligo, tends to occur at a younger age, progress for a year or two, then stop.
• One or only a few areas of your body. This type is called localized (focal) vitiligo.
• The face and hands. With this type, called acrofacial vitiligo, the affected skin is on the face and hands, and around body openings, such as the eyes, nose and ears.

It's difficult to predict how your disease will progress. Sometimes the patches stop forming without treatment. In most cases, pigment loss spreads and eventually involves most of your skin. Occasionally, the skin gets its color back.

Diagnosis

Your doctor will ask about your medical history and examine your skin, possibly with a special lamp. Your evaluation might also include a skin biopsy and blood tests.

Treatment

The choice of treatment depends on your age, how much skin is involved and where, how quickly the disease is progressing, and how it's affecting your life.
Medications and light-based therapies are available to help restore skin color or even out skin tone, though results vary and are unpredictable.
If you and your doctor decide to treat your condition with a drug, surgery or therapy, the process may take many months to judge its effectiveness. And you may have to try more than one approach or a combination of approaches before you find the treatment that works best for you.
Even if treatment is successful for a while, the results may not last or new patches may appear. Your doctor might recommend a medication applied to the skin as maintenance therapy to help prevent relapse.

Medications

No drug can stop the process of vitiligo — the loss of pigment cells (melanocytes). But some drugs, used alone, in combination or with light therapy, can help restore some skin tone.
Drugs that control inflammation. Applying a corticosteroid cream to affected skin might return color. This is most effective when vitiligo is still in its early stages. This type of cream is effective and easy to use, but you might not see changes in your skin's color for several months.
Corticosteroid pills or injections might be an option for people whose condition is progressing rapidly.
Medications that affect the immune system.

Therapies

Light therapy. Phototherapy with narrow band ultraviolet B (UVB) has been shown to stop or slow the progression of active vitiligo. It might be more effective when used with corticosteroids or calcineurin inhibitors. You'll need therapy two to three times a week. It could take one to three months before you notice any change, and it could take six months or longer to get the full effect.
For people who can't go to a doctor's office for treatment, smaller portable or handheld devices for narrow band ultraviolet B therapy are available for home use. Talk with your doctor about this option as well if needed.
Possible side effects of narrow band ultraviolet B therapy include redness, itching and burning. These side effects usually clear up within a few hours after treatment.

Surgery

If light therapy and medications haven't worked, some people with stable disease may be candidates for surgery. The following techniques are intended to even out skin tone by restoring color:

• Skin grafting. In this procedure, your doctor transfers very small sections of your healthy, pigmented skin to areas that have lost pigment. This procedure is sometimes used if you have small patches of vitiligo.
• Blister grafting. In this procedure, your doctor creates blisters on your pigmented skin, usually with suction, and then transplants the tops of the blisters to discolored skin.
• Cellular suspension transplant. In this procedure, your doctor takes some tissue on your pigmented skin, puts the cells into a solution and then transplants them onto the prepared affected area. The results of this regimentation procedure start showing up within four weeks. Possible risks include scarring, infection and uneven skin tone.