Vitiligo

Vitiligo is the complete loss of melanocytes from a circumscribed patch of skin. Sometimes inherited as an autosomal dominant propensity, vitiligo most commonly occurs sporadically. Depigmentation occurs symmetrically, or at sites of trauma. There can be erythema present in early lesions of vitiligo. Some patients have an associated autoimmune thyroiditis, myasthenia gravis, or pernicious anemia.

Treatment

• Early vitiligo in a cosmetically important area such as the face, can be treated with a topical mid strength cortisone cream. One protocol, not well substantiated by controlled trials, is for 6 weeks of treatment, 4 weeks off treatment, followed by a repeating cycle.
• Generalized vitiligo occasionally responds to PUVA therapy. Time to response, if there is going to be a response, can be upwards of 30 weeks of twice weekly treatments.
• Alternative therapies include the application of vegetable and other dyes to the white areas of the skin to make them less of a cosmetic problem.
• Trauma can result in new lesions, and should be avoided.
• If depigmentation is extensive, residual pigment can be removed with monobenzone ether of hydroquinone.
• Narrow band UVB Eximer laser. This is in the UVB range and early results are encouraging.

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