From the Guidelines
Vitiligo is an autoimmune condition where the immune system attacks melanocytes, the cells that produce skin pigment, resulting in white patches on the skin, and the most effective treatment option is phototherapy using narrowband UVB light 2-3 times weekly for several months, as it has been shown to achieve > 75% repigmentation in some patients 1.
Causes of Vitiligo
The exact cause of vitiligo is unknown, but it is believed to be an autoimmune condition where the immune system attacks melanocytes, resulting in white patches on the skin.
- Autoimmune response: The immune system mistakenly attacks and destroys melanocytes, the cells responsible for producing skin pigment.
- Genetic predisposition: Individuals with a family history of vitiligo are more likely to develop the condition.
- Environmental triggers: Exposure to certain chemicals, stress, and skin trauma may trigger the onset of vitiligo.
Treatment Options for Vitiligo
Treatment options for vitiligo include:
- Topical corticosteroids: Such as betamethasone or clobetasol, applied once or twice daily for limited periods (2-3 months) to affected areas.
- Calcineurin inhibitors: Such as tacrolimus 0.1% ointment, applied twice daily.
- Phototherapy: Using narrowband UVB light, 2-3 times weekly for several months, has been shown to be effective in achieving repigmentation in some patients 1.
- Surgical options: Skin grafting or melanocyte transplantation may be considered for small areas.
- Camouflage makeup: Can help conceal patches while undergoing treatment.
- Sun protection: Essential to prevent further skin damage and darkening of surrounding skin.
- Psychological support: May be beneficial as the condition can affect self-esteem and quality of life.
Quality of Life and Treatment Outcomes
The use of cosmetic camouflage has been shown to improve quality of life (QoL) in patients with vitiligo, with a reduction in DLQI scores from 7.3 to 5.9 1.
- Early intervention: Typically yields better results, and treatment should be supervised by a dermatologist as response varies between individuals.
- Treatment outcomes: May vary depending on the severity and extent of the condition, as well as the individual's response to treatment.
From the Research
Causes of Vitiligo
- The exact cause of vitiligo is still not known, but several hypotheses have been proposed, including the autoimmune, genetic, neural, self-destruction, growth factor deficiency, viral, and convergence theories 2
Treatments of Vitiligo
- Various treatments are available, including:
- Phototherapy: narrow-band ultraviolet B (NB-UVB) microphototherapy, narrow-band ultraviolet B excimer laser, and monochromatic excimer light 3, 4, 5, 6
- Topical treatments: corticosteroids, antioxidants, tacrolimus, pimecrolimus, prostaglandin E, and vitamin D derivatives 3, 2
- Combination therapies: combining topical treatments with phototherapy, such as NB-UVB and topical corticosteroids or calcineurin inhibitors 4, 5, 2
- Surgical intervention: reserved for adolescent or adult patients with stable vitiligo 3
- The choice of treatment depends on the individual patient's characteristics, including disease activity, vitiligo phenotype, lesion location, and skin phototype 4, 6
- New formulations, such as clobetasol propionate foam, have shown promise in treating vitiligo, with significant efficacy and a good safety profile compared to NB-UVB phototherapy 5