Not All Vitiligo Affected Need To Be Treated
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You may choose not to attempt to deal with your affected vitiligo skin, especially if it is not easily seen. Fair-skinned people who do not tan may find that their vitiligo areas are barely noticeable. They may be happy using sunscreen and avoiding the sun, and not treating their vitiligo. Small areas of vitiligo may be able to be satisfactorily hidden with cosmetics. There is no medical reason that you must attempt to treat vitiligo. At times the affected skin will spontaneously head back towards normal because it may re-attain melanocytes.
Medical treatments focus on the skin's color. No known treatment will get vitiligo process to leave your body, like taking an antibiotic that gets rid of a bacterial infection. You may decide that you wish to treat the vitiligo affected areas in hopes of making them blend in better and become less obviously visible. Treatments will either try to restore pigment and melanocytes or will attempt to get rid of pigment that remains around the area of the affected skin. Treatment routinely takes an extended time. It can easily take a period of 6 months to even 18 months or more to get the best results. You might need to try more than one treatment to find one that works best for you, or you could find a combination of treatments that gives you the desired result.
Topical Corticosteroid Therapy and Its Side Effects
Topical corticosteroids in the form of cream or ointment can be used in an attempt to get color back. This will work the best in early vitiligo where the changes have been present in a short amount of time. A relatively active corticosteroid and high dose ointment can be used for small areas in hopes of getting a faster result. With large areas to treat a weaker corticosteroid in a lower dose ointment or cream will need to be used. A child will also need to use a weaker corticosteroid compared to an adult. Your doctor has to consider the total dose you will be using each day. It can easily take up to 3 months or more to see a difference so you must be ready to be diligent with treatment but laid back waiting to see a change.
If you get too anxious to see the change, you will disappoint yourself without giving the treatment its best chance to work.
There has been some research that has shown an improved result with topical corticosteroids if vitamin D is included in the cream or ointment. You could also consider taking vitamin D in pill form since it is right for you in other ways too.
Side effects can occur because the corticosteroids will be absorbed into your system. Your doctor should go over the systemic problems that they are worried about based on how much your total dose per day is. The actual area of treatment can have skin changes that make it look shiny. The skin can thin and atrophy and could even develop striae (stretch marks). You need to stay in contact with your doctor so that you can discuss side effects as they are happening and the two of you can decide if there needs to be a change in treatment.
Topical Immunomodulators and Its Side Effects
Topical immunomodulator ointments contain either pimecrolimus or tacrolimus. They can work very well for patients with vitiligo in a small, localized area. Many times it is the treatment of choice when vitiligo is affecting skin on the face or neck. These ointments can be used with UVB treatment. Overall, the topical immunomodulators have fewer side effects than corticosteroids, but as with any medication, there can be side effects. There remains a concern that these drugs could increase the risk for development of lymphoma or skin cancer. This is still being studied.
Topical Psoralen with Ultraviolet A (PUVA) and Its Side Effects
Another topical treatment is the use of a topical psoralen with ultraviolet light therapy (phototherapy). This form of therapy of called PUVA for short. It can be used for people with under 20% of their body's skin which is vitiligo affected. A thin covering of the psoralen cream is spread over the depigmented areas of the skin and allowed to sit for about 30 minutes, and then the UVA light is shone on the affected skin. The psoralen leaves skin more sensitive to sunlight, especially the UVA radiation. The UVA light will turn the areas of skin that were just treated a light pink. Normal skin color will return as the patient's skin heals. The form of treatment requires trips to your doctor's office up to twice a week. As long as your doctor is comfortable with this, you can keep your visits as short as possible by applying the psoralen at home and getting to your physician's office just in time for the light treatment.
Methoxsalen Top and Oxsoralen Top are topical forms of psoralen that can be used. Remember that it is being used to sensitize your skin to UVA light. UVA is part of sunlight so be careful about your sun exposure if you are undergoing light therapy at your doctor's office. Don't spend a lot of extra time in the sun if you are using it as your UVA source. Hopefully, you will start to see change happening about 2 weeks into therapy, but the final effect can take 6 to 9 months. If you feel that your condition is remaining the same or reversing, tell you doctor before your next scheduled treatment.
Another method of applying the psoralen is for the patient to lie in a bathtub of psoralen solution. It is called water bath PUVA. The psoralen soak occurs about 15 minutes before the UVA light exposure.
PUVA treatment has side effects, just like every other treatment. You can develop significant blistering and a sunburn in the treated areas. Hyperpigmentation of treated skin can occur. Avoidance of sunlight with the careful use of sunscreen and long sleeve/long leg clothing will usually help avoid the hyperpigmentation. The treated skin can become extra dry and itchy. Using lotion and emollients is crucial. Some people notice premature aging and other signs of skin damage. The skin is at an increased risk of developing skin cancer, though this could also be an effect of the vitiligo by itself.
Oral Psoralen Photochemotherapy (Oral PUVA) and Its Side Effects
Oral psoralen with phototherapy (UVA) can be used for patients with more than 20% of their skin involved with vitiligo. The oral drug is taken about two hours before UVA light exposure. The exposed vitiligo affected skin will turn pink and gradually take on a more normal color. This treatment usually involves 2 to 3 trips to your doctor's office each week, essentially Monday, Wednesday, Friday, to keep the necessary distance between appointments. Natural sunlight can also work instead of the UVA light treatments. Your doctor needs to determine how long you need to stay in the sun and will want to monitor you during your treatment.
Methoxsalen Oral is an oral form of psoralen you may take. It may increase all of your skin's sensitivity to sunlight so be extra careful. You may also wish to avoid eating limes, figs, parsley, parsnips, mustard, carrots, and celery while you are in treatment as this may help limit the increased sun sensitivity. Never increase the dose of this drug even if you feel as though it may not be working. It can take 6 to 8 weeks before you see changes in the vitiligo affected skin. It will take even longer for the full effect.
Oral psoralen-UVA has more side effects. Once again, darkening of the skin beyond what you desire can occur. Sunburn, itchy skin and abnormal hair growth may happen. Some people don't tolerate the oral psoralen that well and have difficulties with nausea, sometimes to the point of vomiting. With psoralen-UVA treatment, you probably increase your risk of skin cancer because of the exposure to UVA. It is an excellent idea to limit your social, leisure exposure to sunlight significantly. Always wear sunglasses when getting treated to limit UVA exposure to your eyes. And don't forget them whenever you are outside, summer or winter. Children under 10 years of age should not use this treatment. It can damage their eyes and increase the risk of developing cataracts.
Narrowband ultraviolet B (UVB) Phototherapy
A somewhat different, newer light therapy alternative exists. It involves narrow band UVB at a very particular wavelength. You do not need to use psoralen for it to be effective. Routinely you would go to your physician's office three times a week. The debate is still occurring as to whether UVB treatments are as effective as PUVA. At this point in time, long-term side effects have not been well studied.
Excimer Laser Treatment and Its Side Effects
With the use of the narrow band UVB treatment, others have decided to look at the use of lasers, which are highly specialized and narrow wavelength beams of light. Studies are ongoing, but so far results have been good. Excimer laser treatment uses UVB light. It is currently only being used to treat small sections of affected skin. Side effects can include redness of the treated skin, blistering, and swelling. Sometimes hyperpigmentation can occur. It can be difficult to find a doctor's office that has this laser, and treatments may be expensive.
Depigmentation Treatment and Its Side Effects
If over half of the skin on your body is vitiligo affected, you may want to consider depigmentation treatment. The idea is to lighten the areas of skin that still have normal melanocytes. In this treatment, a particular chemical (there are various options) is applied to the skin two times a day. The final results can easily take up to a year or more as you continue until your vitiligo and non-vitiligo areas are approximately the same color.
Many times treatment is accompanied by swelling and redness of the skin. The side effects can make you need to slow down therapy. You can have difficulties with dry, itchy skin, and it can become permanently overly sensitive to sun exposure without any pigmentation to help work against the sun's rays. The process should not be considered reversible because results when attempting to reverse it are variable. You need to be very careful while using this treatment because you do not want the medication to rub off onto anyone else.
Micro-tattooing/Micro-pigmentation and Side Effects
Micro-tattooing or micro-pigmentation sits somewhere between medical and surgical therapy. It involves a highly skilled tattoo artist who works very carefully to match a tattoo color to your skin tone and place many microdots of tattoo pigment into the vitiligo affected skin. This is best for only small areas and many times is used in highly visible areas once it is shown to work well in a hidden but comparable area. The tattoo artist must work very hard to match colors, and sometimes they will still fail. The tattoo artist really needs to know what they are doing, preferably being experienced in this type of medical tattooing.
There is no known problem with tattooing vitiligo affected skin compared to healthy skin. Sometimes tattoos will fade with time. The act of tattooing can cause inflammation, which might be able to set off a new round of vitiligo. Keloid scars can occur, but hopefully, the person having this done would be old enough to know whether they form keloids easily. Attempting micropigmentation on children would be rare. It is safer to do on someone whose vitiligo is relatively stable. Allergic reactions can occur. You also need to remember that tattoo color will not tan, so if your healthy skin around the area is allowed to tan, the tattooed/vitiligo area will become noticeable once again.
In conclusion, I feel this article on the vitiligo affected will get its worth once people like you feel that you have benefited from reading this. Take care, and the best of luck.