Vitiligo affects millions of people in the United States and presents as white, porcelain-colored patches on the skin. While some patients simply cover their vitiligo with sunscreens and / or cover-ups, there are effective treatments that often bring the color back.
First of all, you must eat a balanced diet that contains protein. The body especially needs two proteins, phenylalanine and glutamine, to make melanin, the pigment in the skin. An alternative is to take them in pill form. Antioxidant vitamins have also helped some patients. There are prescription creams that can be applied at night to restore color. Cortisone and tacrolimus are used more frequently. These take months to work. When the color starts to return, it starts out as little dots that gradually get larger.
A newer topical treatment is pepper oil which contains piperine. Recent studies are promising. These topicals work alone, but the best results are obtained when combined with narrow-band UV light. This is best done with the excimer laser or in a light box. An older treatment that is occasionally used is PUVA. Narrowband UVB is better tolerated than PUVA, as with narrowband UVB there are no complications such as abdominal pain and the need for necessary PUVA eye protection. With PUVA the patient takes a celery extract orally or applies this chemical on the skin and UVA, the tanning rays are delivered to the skin. Sometimes we use surgery to treat the white areas.
The normally pigmented skin is removed and grown in the laboratory. The same day they are transplanted to the white spots. This is called uncultured MK and can be performed on all areas, including sensitive areas such as the eyelids, genitals, fingers, and toes. If patients have lost more than 50% of their pigment and do not want to undergo treatment, then all pigment can be removed from the body. This is accomplished with a topical cream called monobenzone. This is a drastic step and should only be done if the patient understands the permanence of this action.
Cultural counseling before this is done is important. If a vitiligo patient chooses to use a cosmetic cover-up, then they should avoid self-tanners that contain dihydroxyacetone. There is recent evidence that self-tanners with this chemical can prevent the effectiveness of the treatments discussed above. Remember that there are treatments for vitiligo. Find a doctor who understands your concerns, your illness, and your treatment.
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