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vitiligo

Vitiligo

Vitiligo is a skin condition in which areas of the skin and of mucous membranes gradually lose their normal pigmentation and become white. It can occur at any age, but most commonly appears between 10‑30 years of age.

This autoimmune disease is manifested by the appearance of white spots and patches in various parts of the body, such as the hands, feet, and armpits, the area around the mouth, the eyes and the genitals, while it favors sites of skin injury from various causes (Koebner phenomenon).

Typically, vitiligo’s colorless spots gradually increase in size, leading to a significant aesthetic problem, particularly in people with dark skin. The disease may arise as a result of genetic-hereditary causes and is often associated with thyroid disorders and other autoimmune diseases.

Depending on the mode of its occurrence, vitiligo is classified as focal, segmental and generalized. Normally, it is diagnosed by its clinical presentation. Biopsy may be necessary if a differential diagnosis is necessary to distinguish from other diseases that cause hypopigmentation, such as post-inflammatory hypopigmentation, mycosis fungoides and pityriasis versicolor.

Each treatment about to be applied should be individualized depending on each patient and should take into account the benefit of treatment in relation to the possible side effects that each one of the treatments has. The results of the treatment available today vary and cannot guarantee complete repigmentation of the area.

The currently available options for the treatment of vitiligo are:

  • UVB Phototherapy – PUVA photochemotherapy: Can lead to re-pigmentation in more than 70 % of patients with a recent onset of the disease or localized (focal) disease.
  • Treatment with Laser Excimer: Effective in stable, small lesions which occupy less than 30% of the total body surface. It can be combined with the application of topical formulations or with short-term oral drug administration.
  • Topical Corticosteroids: It is the most frequently applied treatment with moderate efficacy.
  • Topical use of Calcineurin inhibitors: It is an alternative effective treatment, particularly if the lesions are located on the head and the neck. It may be combined with Laser Excimer or nb UVB treatment.
  • Topical use of Vitamin D analogs: They act through the suppression of the immune system and particularly, through acting on T‑lymphocytes. It may be combined with nb UVB or PUVA treatment.
  • Systemic Corticosteroids: Long-term treatment may be required with several side effects.
  • Depigmentation of healthy skin with monobenzyl ehter: Performed in special cases where the healthy areas occupy a small area and includes the depigmentation of the healthy skin in order to achieve a uniform skin color.
  • Surgical Treatments: Used in highly localized lesions and only if the disease has been stabilized, and does not show signs of progression for at least 2 years.
  • Use of topical cosmetic camouflage creams

In order to prevent vitiligo from spreading, it is essential to avoid friction injuries. Furthermore, the use of sunscreen is important both for the protection of the white patches of skin due to lack of melanin, and for the protection of normal skin from sunburns, on the ground of which new vitiligo lesions may develop.

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