Kernel Medical Sub-website : www.kerneluvb.com
Treatment of Vitiligo
Type:Uv phototherapy Time:2018-06-23 9:17:11Vitiligo is often brushed aside as being ¡°just a cosmetic problem¡± with the inference that it does not require or deserve any treatment. This is an unfortunate misconception. The treatment should be tailored individually to the needs of the patients, the extent and location of the vitiligo, and the likely response to the given treatment. The possible approaches are:
1.Sunscreen and Avoidance of the Sun
This is the minimum treatment that must be used by any patient with vitiligo on exposed areas of the body. The reason is simple: the skin in a patch of vitiligo has lost most of its protection against the damaging effects of ultraviolet light in sunlight. A patient with vitiligo should avoid exposing the white areas to sunlight. If exposure is inevitable, as for example with vitiligo on the face and hands, daily application of a sunscreen SPF 15 or higher is essential from March to November.
2. Masking
Self-tanning lotions can be applied to the skin every few days to camouflage areas of vitiligo. It is most important to remember these lotions do not provide any protection against sunlight. Cosmetics are available to mask small areas of vitiligo on the face. Covermark and Dermablend can be matched to the normal skin color and are very effective. There are also airbrush makeup preparations available that can cover pigment differences.
3. Repigmentation
Treatment with ultraviolet light therapy is the main means of restoring pigment to the white areas of vitiligo. Two types of light therapy are effective in vitiligo. PUVA therapy and narrow-band UVB (311 nm) phototherapy. PUVA therapy consists of taking a medication called psoralen and then being exposed to ultraviolet A (UVA) light. Psoralens are distributed to the skin and there interact with the UVA light to stimulate formation of new pigment cells in the skin. Narrow-band phototherapy does not involve taking a medication and has a similar effect on pigment cells. In some cases, narrow-band UVB can be delivered in a focal manner with an excimer laser.
Narrow-band UVB phototherapy is a more recent treatment for vitiligo although it has been used for other conditions since 1981. Presently, narrow-band UVB is generally used as first line phototherapy treatment for vitiligo.
Forms of PUVA therapy have been used in India and the Middle East for several thousand years for treatment of vitiligo and it has been used in America since 1952. Sunlight was used as the source of UVA light initially. Presently, more effective and consistent indoor sources of UVA light have been developed and are used today.
Light therapy produces some repigmentation in almost all patients but the extent of repigmentation does vary. The chief determinant of the response is the location of the vitiligo. Vitiligo on the face almost always responds well to phototherapy whereas the trunk has a less favorable response and so on down to the tips of the fingers/toes and genitals, which almost never respond.
Treatment has to be given two or three times each week. A trial of thirty consistent treatments gives a fairly accurate indication of whether or not treatment will be worthwhile. If there is no response by treatment number thirty, it is unlikely continued treatment with phototherapy will yield benefit. Treatment number fifty is the next milestone in that if the response is not sustained, it is unlikely that further repigmentation will occur. Continuation of treatment is only worthwhile if a sustained improvement is occurring.
Phototherapy does not stop new areas of vitiligo appearing and repigmented areas can lose pigment again. However, it is unusual for a patient to continue to show progression of vitiligo after 20-30 treatments if they are responding in other areas. Furthermore, if a given patch of vitiligo is completely repigmented and filled in, it is unusual to again lose the pigment. When a patch of vitiligo has partial repigmentation, the repigmentation can be lost.
The most recent light treatment for vitiligo involves use of an excimer laser which delivers narrowband UVB to focal areas. This is best for small areas of vitiligo and unfortunately, some insurance carriers do not cover treatment with excimer laser for vitiligo.
Note that other sources of ultraviolet light such as sunlight and tanning parlors rarely produce pigmentation in vitiligo.
www.kerneluvb.com
leading manufacturer of UV phototherapy
1.Sunscreen and Avoidance of the Sun
This is the minimum treatment that must be used by any patient with vitiligo on exposed areas of the body. The reason is simple: the skin in a patch of vitiligo has lost most of its protection against the damaging effects of ultraviolet light in sunlight. A patient with vitiligo should avoid exposing the white areas to sunlight. If exposure is inevitable, as for example with vitiligo on the face and hands, daily application of a sunscreen SPF 15 or higher is essential from March to November.
2. Masking
Self-tanning lotions can be applied to the skin every few days to camouflage areas of vitiligo. It is most important to remember these lotions do not provide any protection against sunlight. Cosmetics are available to mask small areas of vitiligo on the face. Covermark and Dermablend can be matched to the normal skin color and are very effective. There are also airbrush makeup preparations available that can cover pigment differences.
3. Repigmentation
Treatment with ultraviolet light therapy is the main means of restoring pigment to the white areas of vitiligo. Two types of light therapy are effective in vitiligo. PUVA therapy and narrow-band UVB (311 nm) phototherapy. PUVA therapy consists of taking a medication called psoralen and then being exposed to ultraviolet A (UVA) light. Psoralens are distributed to the skin and there interact with the UVA light to stimulate formation of new pigment cells in the skin. Narrow-band phototherapy does not involve taking a medication and has a similar effect on pigment cells. In some cases, narrow-band UVB can be delivered in a focal manner with an excimer laser.
Narrow-band UVB phototherapy is a more recent treatment for vitiligo although it has been used for other conditions since 1981. Presently, narrow-band UVB is generally used as first line phototherapy treatment for vitiligo.
Forms of PUVA therapy have been used in India and the Middle East for several thousand years for treatment of vitiligo and it has been used in America since 1952. Sunlight was used as the source of UVA light initially. Presently, more effective and consistent indoor sources of UVA light have been developed and are used today.
Light therapy produces some repigmentation in almost all patients but the extent of repigmentation does vary. The chief determinant of the response is the location of the vitiligo. Vitiligo on the face almost always responds well to phototherapy whereas the trunk has a less favorable response and so on down to the tips of the fingers/toes and genitals, which almost never respond.
Treatment has to be given two or three times each week. A trial of thirty consistent treatments gives a fairly accurate indication of whether or not treatment will be worthwhile. If there is no response by treatment number thirty, it is unlikely continued treatment with phototherapy will yield benefit. Treatment number fifty is the next milestone in that if the response is not sustained, it is unlikely that further repigmentation will occur. Continuation of treatment is only worthwhile if a sustained improvement is occurring.
Phototherapy does not stop new areas of vitiligo appearing and repigmented areas can lose pigment again. However, it is unusual for a patient to continue to show progression of vitiligo after 20-30 treatments if they are responding in other areas. Furthermore, if a given patch of vitiligo is completely repigmented and filled in, it is unusual to again lose the pigment. When a patch of vitiligo has partial repigmentation, the repigmentation can be lost.
The most recent light treatment for vitiligo involves use of an excimer laser which delivers narrowband UVB to focal areas. This is best for small areas of vitiligo and unfortunately, some insurance carriers do not cover treatment with excimer laser for vitiligo.
Note that other sources of ultraviolet light such as sunlight and tanning parlors rarely produce pigmentation in vitiligo.
www.kerneluvb.com leading manufacturer of UV phototherapy