Vitiligo

Diagnosis

Diagnosing vitiligo entails reviewing an individual’s medical background and family medical history, along with performing a visual inspection. As part of this examination, a specialized lamp like the Wood’s lamp may be employed. This device emits ultraviolet (UV) light onto the skin, aiding in the identification of vitiligo and the exclusion of other skin disorders.

Healthcare providers might also do a skin biopsy, which involves taking a small sample of skin, and blood tests as part of the evaluation.

Treatment

Treatment for vitiligo is not always needed since it does not harm the body, but if it affects one’s emotional well-being, several treatment may be suggested.  Generally, the treatment for vitiligo depends on various factors like age, the extent and location of the affected skin, how fast the condition is spreading, and its impact on one’s life.

In some cases, it could take many months to see results, and one might need to try different or combined approaches to find what works best. Even if a treatment is initially effective, the results might not last, or new patches could appear. To help prevent relapse, skin-applied medication as maintenance therapy may be recommended.

Treatment options include:

  • Medications: Some medications can help restore some color when used alone, in combination, or in conjunction with light therapy. However, specific prescription that can stop vitiligo from causing damage the skin.
    • Corticosteroids: Children or individuals with extensive areas of discolored skin may receive prescriptions for mild corticosteroid creams. In cases where vitiligo is rapidly spreading, corticosteroid pills or injections could be advised. Corticosteroid creams are effective in reinstating skin color, particularly during the initial phases of vitiligo. Despite their user-friendly application, noticeable changes may take several months to manifest.
    • Calcineurin inhibitor: Small areas of depigmentation, particularly on the face and neck may be treated with calcineurin inhibitor ointments like tacrolimus or pimecrolimus.
  • Therapies
    • Light therapy: Also known as phototherapy, this treatment is used to help restore color to skin affected by vitiligo. Narrow band ultraviolet B (UVB) phototherapy can help slow down or stop the progression of active vitiligo. It might take several sessions to see results. Smaller portable or handheld UVB devices may also be available for home use.

This therapy involves sessions two to three times a week. It works better when combined with corticosteroids or calcineurin inhibitors. Using calcineurin inhibitors with UVB phototherapy might increase the risk of skin cancer, so it is important to discuss the risks and benefits with the healthcare provider.

    • Combining psoralen and light therapy: Another approach, called PUVA, combines an oral medication called psoralen with ultraviolet A (UVA) light. PUVA is used to treat larger areas of skin with vitiligo, especially on the head, neck, trunk, and upper arms and legs. Although this method is beneficial, it is more challenging to execute.
    • Depigmentation therapy: This treatment evens out the skin tone by removing its natural color, making it match areas affected by vitiligo. On skin sections that are unaffected, a depigmenting chemical called monobenzone, is applied. The skin becomes lighter with time, blending in with the discolored patches. This is usually an alternative if other treatments have failed and the vitiligo is extensive.
  • Surgery
    • Skin grafting: This treatment may be recommended for minor patches of vitiligo. With skin grafts, skin from one part of the body is moved to another part to cover areas with vitiligo. However, this can lead to complications such as scarring, infection, or not achieving repigmentation.
    • Blister grafting: The procedure involves creating a blister using suction, then transferring the top layer of that blister to a vitiligo-affected area. However, this, too, carries risks like scarring or infection.
    • Cellular suspension transplant: It usually takes four weeks for the effects of this repigmentation process to become visible. This involves taking a sample from the skin that still has color, dissolving the cells in a solution, and then transplanting those cells onto the affected areas.
  • Ongoing treatment research
    • Prostaglandin E2: This drug may help restore skin color in people with vitiligo that is not rapidly spreading as this helps control melanocytes. This is being tested as a gel applied to the skin.
    • Afamelanotide: This is inserted beneath the skin to encourage the development of melanocytes.