If you have been diagnosed with Vitiligo you are probably aware of the many treatments available at your disposal. The vast majority of them are not recommended by ethical doctors because they are created to take advantage of the desperation some Vitiligo patients go through after their initial diagnosis. This period generally doesn’t last long because most patients educate themselves about the disease and the reliable therapies available to them.
The Goal of Treatment
When you are looking for Vitiligo treatment the goal should be to stop the spreading and return pigmentation to the areas that have been affected. The options you choose should be based on your condition, amount of affected area and the decision you and your doctor agree to implement as a form of treatment. You also have to understand the disease can have different characteristics for each patient and not every treatment option can be applied to treat your Vitiligo.The medications for Vitiligo work differently for different parts of the body. This means you might have to take several medications to effectively treat your entire body.
When you start your therapy a measurable approach to your treatment must be used to determine the efficacy. These outcomes have to be measured with objective means such as photographs. Comparing the photographs you and your doctor will be able to determine if your Vitiligo has stopped increasing in size, pigment has returned and there hasn’t been any outbreak of new patches.
The available treatments try to address two different issues one is to fight the cause of the Vitiligo and the other is to stimulate melanocytes so they can start producing melanin in the affected area. The options are:
- Systemic drugs
- Topical drugs
- Surgical options
- Alternative therapy
- Counseling and support
Before you begin any therapy talk to your doctor to find out what you can expect from the treatment. Ask him or her how long it will take, the side effects, effectiveness and different options available to you if you don’t get the results you are expecting.
A topical drug is a medication used to affect a specific area on your body. This type medication is generally applied on the skin in the form of creams and ointments. In the case of Vitiligo topical drugs are used to stop it from spreading, returning pigmentation and removing all pigment by depigmentation. Thisis a trial and error process because you might need more than one topical drug which will provide an overall remedy for your Vitiligo.
Corticosteroids are drugs that resemble cortisol, which is a hormone produced in your body by your adrenal glands. Corticosteroids work by reducing the chemicals responsible for inflammation to decrease the damage caused to tissues and minimizing the effect of white blood cells in your immune system. Since Vitiligo is considered an autoimmune disorder it is believed corticosteroids can stop or slow down your immune system from attacking your pigment cells and help re-pigment your skin. Some of the prescribed medications are clobetasol, betamethasone and fluocinonide. Corticosteroids have many side effects so talk to your doctor before you start this type of therapy. A side effect depends on the type of corticosteroid, the dosage and length of treatment, which can include:
- Thinning of the skin
- Acne spots
- Inflammation of the skin
- Contact dermatitis
- Excessive hair growth
As with most medications the most common side effects are listed, but it is possible to exhibit unusual side effects your doctor many not be aware of. If you notice any negative reaction because of the medication you are taking talk to your doctor immediately.
Vitamin D analogues (Calcipotriol and Tacalcitol)
An analog is a chemical compound that looks like another in the constituents or structure but can have a similar or opposite effect when you take it. Topical vitamin D analogues are used to treat different skin conditions such as psoriasis. Calcipotriol and Tacalcitol are two such medications. The effectiveness on Vitiligo is not conclusive but some patients have shown positive results when it is used in combination with topical steroids or phototherapy. Vitamin D analogues affect Vitiligo in two different ways in regard to immune function and melanocytes. In the immune response it acts on T cell activation to inhibit pro-inflammatory cytokines genes. In melanocytes it influences the maturation and differentiation.
Calcineurin inhibitors are types of drugs that have immunomodulatory effects. This means they slow down or stop the effectiveness of the immune system of the skin which for a Vitiligo patient means it can stop your melanocytes from being destroyed. Tacrolimus (Protopic) and Pimecrolimus (Elidel) are two such topical drugs your doctor can prescribe. The benefit of using calcineurin inhibitors is they don’t have as many side effects as corticosteroids. Some of the side effects you can experience are redness, skin sensitivity to light and burning or pain.
V-Tar is a prescription coal tar product used to treat Vitiligo and some patients have seen re-pigmentation on their face after more than two months of therapy. It is applied once a week for five to six hours or overnight and then removed. It is used in combination with other topical therapies and it can be used by everyone.
Pseudocatalase (PC-KUS) and catalase/dismutasesuperoxide
The original PC-KUS was developed by Dr. Karin Shallreuter and it was designed based on the hypothesis that patients with Vitiligo have high levels of hydrogen peroxide (H2O2) and low levels of the enzyme catalase. The therapy uses pseudocatalase applied on the skin along with photo or light therapy with narrow band UVB to help the melanocytes start producing melanin. PCAT is the alternative version available in the US and Canada. It is only available at pharmacies that are able to compound the medication.
Phenylalanine is an essential amino acid and your body changes it into tyrosine another amino acid responsible for making important chemicals in your brain which regulate mood and growth as well as many other functions. Topical and oral L-Phenylalanine has helped patients with the stimulation of melanin and migration of melanocytes to depigmented areas. The therapy involves oral and topical application as well as sun exposure.
Placentrex and Melangenina
These two products are derived from human placental extract. It is believed they help melanin synthesis by providing tyrosine, an amino acid. The therapy is performed by applying the medication after dermabrasion has been performed on the affected area of the skin.
Doctors don’t know what causes Vitiligo and as of now have not find a cure. This makes it very difficult to find a method of therapy which can be applied across the board. However it doesn’t mean you have to give up because there are many individuals who have overcome this condition. What you have to realize is what works for another person might not work on you so always look for other options because they are available.
Photo or light therapy is a key component in treating Vitiligo. The best methods for re-pigmenting patches of skin that have been discolored involve topical or systemic drugs and surgical procedures along with different types of light therapy.
What is Phototherapy?
Phototherapy or light therapy uses artificial light wavelengths to treat different skin conditions including atopic dermatitis, psoriasis and Vitiligo. The light removes visible and infrared light the spectrum responsible for heat and only uses ultraviolet or blue light delivered with higher intensity.
PUVA and PUVAsol
PUVA is psoralen and ultraviolet A light. Psoralen is a chemical found in plants which changes your skins sensitivity to light. This helps concentrate the light promoting repigmentation in areas affected with Vitiligo. Psoralen can be applied topically or taken orally in capsules. The topical application can be targeted and applied only on the areas with discoloration or in in a bath to cover the whole body. The capsule will affect your whole body including your eyes so you have to protect your eyes with wrap-around sunglasses and your skin with high SPF sunblock. PUVA uses artificial UVA light while PUVAsol uses the sun as the light.
Narrow-band Ultraviolet B – NBUVB
This type of light therapy uses special lamps with a very specific frequency of ultraviolet B light. This technology has a high rate of success in treating Vitiligo and doesn’t need psoralen as part of the therapy. The light is available in hand held sizes making it possible for Vitiligo patients to use this therapy in the privacy of their home.
This is an advanced phototherapy which combines UVA and NBUVB. Just like NBUVB it does not require psoralen and it does not have many side effects related to UV burn.
The excimer laser uses the 308nm spectrum to create a condensed beam of UVB light on your skin. This type of phototherapy is used for small targeted areas with stable Vitiligo. The procedure is performed by dermatologist in their office. The therapy can be used with or without topical medications.
Helium Neon Laser
Helium neon laser is a gas laser that uses the red spectrum at 632.8nm to treat Vitiligo. This therapy is used as a solo therapy or in conjunction with topical ointments.
Monochromatic Excimer-Light (MEL)
Monochromatic excimer light or MEL uses targeted UVB light without a laser. This allows MEL to be used for large areas of Vitiligo.
How Phototherapy Works
Phototherapy works by reducing skin inflammation and balancing the immune system of the skin reducing hyper proliferation of skin cells.
Phototherapy is administered two to three times a week. Depending on the type of therapy medication is applied orally or topically before or after the procedure.
The benefit of using phototherapy is it has very few side effects. Some of the most common side effects are dry skin and itching. If the therapy is used for an extended amount of time the risk of aging and skin cancer are possible. Proper monitoring and early detection can resolve any issues related to these side effects.
The right treatments for your Vitiligo depends on many different factors and before you choose the latest and greatest therapy make sure talk to your doctor to determine if it will be effective for you.