Treatment of vitiligo
There is no treatment for vitiligo that is entirely satisfactory, but some quite remarkable results have been achieved. The treatment should always be specific for each patient, depending on the type of condition.
The most important thing in the first place is photoprotection , either with sun creams or with clothes, to avoid burns that can lead to the formation of more injuries. These sun creams, in addition to protecting the diseased skin, limit the tanning of healthy skin; in this way an attempt is made to achieve a uniform skin tone that allows the stains to be hidden as much as possible. It can also be accompanied by camouflage techniques such as makeup or self-tanning, which are not harmful to the skin with vitiligo.
It will also help the patient maintain a diet rich in fruits and vegetables , since these contain vitamin C , which works as a powerful antioxidant and photoprotector.
In topical treatment, potent corticosteroids such as 0.1% betamethasone valerate or 0.05% clobetasol are used, always assessing the secondary effects that they entail: osteoporosis , diabetes mellitus , candidiasis , and dysphonia. Other topical treatments combine kellin, calcium and pseudocalatase with UVA and UVB rays, with quite satisfactory results.
The most effective treatment for patients older than 10 years is oral PUVA (photochemotherapy) . Achieves repigmentation in up to 40-50% of cases. It consists of the intake of psoralens two hours before exposure to UVA. 2-3 sessions per week are performed for 6-18 months. This stimulates the melanocytes that still work. This treatment has an efficacy of 80%, although there are no good results in injuries to the genitals, hands and feet. Oral PUVA is not recommended in children under 10 years of age. Adverse effects include nausea, digestive discomfort, dryness and aging of the skin.
The depigmentation aims to unify the skin color in patients with extensive vitiligo or those who failed PUVA. Bleaching of normal skin is performed by creams with 20% hydrobenone monobenzylether twice daily. It takes two or three months to initiate a response to this treatment, and up to 12 or more to complete it. The final result is that all the skin of the patient becomes a white chalk, similar to the lesions of vitiligo. It must be taken into account that it is an irreversible process, that is, once the results have been achieved, the skin never returns to its normal state. There are also some adverse effects such as dryness, itching, redness and even dermatitis .
In facial vitiligo, oral phenylalanine is used 45 minutes before sun exposure.
In stable vitiligo, surgical techniques have been used . Active melanocytes are transplanted from other areas of the patient’s body. This technique can be useful for segmental spots.
The treatment of the diseases that may accompany vitiligo does not influence the evolution of the disorder in question.