Vitiligo / Depigmentation

What Is Vitiligo?

Vitiligo is a pigmentation disorder that results in white discoloration of the skin. This can appear at any time of life, often causing devastating psychological consequences. It involves males and females equally. While the white lesions are very noticeable, there are no other symptoms associated with the lesions. The psychological consequences of this condition can be devastating for people with darker skin, whose lightened skin due to this condition is very noticeable.

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Vitiligo can occur in a segmental pattern, which is more common or in a scattered random pattern. It affects approximately 1% of the population in the United States with occasional clustering in families suggesting a genetic link. Vitiligo is often classified as localized, generalized and universal. It can involve any area of the body, but often our attention is drawn to lesions on the face, neck, and hands. Universal vitiligo involves more than 80% of the skin. Generalized vitiligo, the most common type, targets the fingers, wrists, underarms, groin, areas around the mouth, eyes, and genitals. In lighter skinned individuals, a wood‘s light or blue light can help identify areas that are difficult to see. A full body examination is recommended to identify the extent of involvement and to identify atypical moles or nevi that sometimes can be associated with this condition.

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Other conditions sometimes can be mistaken for vitiligo. The most common are tinea versicolor, a superficial fungal skin infection that causes areas of lightening and often superficial scaliness of the skin. A skin scraping can show fungal elements in the skin.

Treatments and Therapy for Vitiligo

Topical Treatments

Topical treatments are useful in patients with vitiligo, especially with facial and neck involvement.* Short-term treatments with topical corticosteroids are often useful for weeks at a time.* Chronic use of these agents can result in thinning of the skin. Topical Calcineurin inhibitors such as Protopic and Elidel have proven useful in treating this condition over longer periods of time.* Our center pioneered this field, first reporting the utility of Protopic in the treatment of this condition.* Our outcomes suggested that on the head and neck, patients realized a significant degree of re-pigmentation.* The outcomes were clearly better in the summer months with daily sun exposure.* The FDA has issued a warning label about sun exposure in patients receiving these agents, but there is no warning label for the treatment of vitiligo with these agents. However, there are multiple clinical studies in addition to our own that support the efficacy and safety of these drugs.* Some data suggest that topical vitamin-D is also helpful for this condition.*

Phototherapy

Phototherapy has been used for the treatment of vitiligo since the 1800s. UVB, especially 311nm narrowband UVB, appears to be the most efficacious and safe form of treatment.* Our center is a referral practice for ultraviolet light therapy.* The Excimer laser at 308nm has also proved useful in treating vitiligo providing a more pinpoint targeting of the affected areas.* We have broad experience with this device for the treatment of this problem.* Surgical treatment using grafting procedures can be helpful for some patients.* However, this is a difficult and expensive method of treatment.