Vitiligo affects millions of people in the United States and presents as white, porcelain-colored patches on the skin. While some patients simply cover their vitiligo with sunscreens and/or covers, there are effective treatments that often bring back the color.
First of all, you need to eat a balanced diet that contains protein. The body especially needs two proteins, phenylalanine and glutamine, to make melanin, the skin pigment. An alternative is to take them in pill form. Antioxidant vitamins have also helped some patients. There are prescription creams that can be applied at night to restore color. Cortisone and tacrolimus are the most used. These take months to work. When the color begins to return, it begins as small dots that gradually get larger.
A newer topical treatment is cayenne oil that contains piperine. Recent studies show promise. These topicals work alone, but the best results are achieved when combined with narrow band UV light. This is best delivered with the excimer laser or on a light box. An older treatment that is used occasionally is PUVA. Narrowband UVB is better tolerated than PUVA, as with narrowband UVB here there are no complications such as abdominal pain and the need for eye protection required with PUVA. With PUVA the patient takes an extract of celery orally or applies this chemical to the skin and UVA, the tanning rays are delivered to the skin. Sometimes we use surgery to treat the white areas.
Normally, pigmented skin is removed and grown in the laboratory. On the same day they are transplanted to the white spots. This is called uncultured MK and can be done on all areas, even sensitive areas like the eyelids, genitals, fingers and toes. If patients lose more than 50% of their pigment and do not want to undergo treatment, all of the pigment can be removed from the body. This is accomplished with a topical cream called monobenzone. This is a drastic step and should only be done if the patient understands the permanence of this action.
Cultural counseling before doing this is important. If a vitiligo patient chooses to wear a cosmetic cover-up, she should avoid self-tanners that contain dihydroxyacetone. There is recent evidence that self-tanners with this chemical may impede the effectiveness of the treatments discussed above. Remember that there are vitiligo treatments. Find a doctor who understands your concerns, your illness, and your treatment.
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