To Your Health

What are the most effective treatments for curing and hiding the effects of vitiligo?

Q. I am a 17-year-old girl with vitiligo on my arms, legs, stomach, and a little on my face, made all the more noticeable because of my African ancestry. My doctor tells me that there is no sure cure but offered some ideas to make it less obvious. Is there anything new and perhaps more hopeful? Also, are my children going to have it?

A. First written about more than 4,000 years ago, vitiligo can be psychologically traumatic but appears to have no direct effect on health. Typically, vitiligo produces areas of milky-white skin, sometimes with different shades of pigment within the patch of white. It affects roughly 2% of the world's population. The exact cause of vitiligo is not known, but the best theory is that people with vitiligo have developed antibodies that destroy melanocytes, the cells in our skin that produce melanin, our skin pigment.

Vitiligo is not infectious, and if it is hereditary (that is, if it runs in families), inheritance is very complex. While children whose parents have vitiligo are more likely to develop it, most children will not get vitiligo even if a parent has it, and most people with vitiligo do not have any family history of vitiligo. It looks like a combination of several genes could be involved, and there still may need to be a trigger, a stress of some sort, that affects the immune system and leads to the body attacking its own melanocytes.

The goal of treatment is to restore the skin's color by restoring healthy melanocytes, allowing the skin to "repigment" and regain its normal appearance. Oral medication called psoralen combined with ultraviolet A radiation remains the most popular treatment for vitiligo, despite a success rate of only about 33%. Recent research at the New York Medical College, reported in the January 2006 issue of the International Journal of Dermatology (pages 63-65), indicates that combining the safer ultraviolet B radiation (instead of ultraviolet A) with large doses of three vitamins (vitamin C, vitamin B12, and folic acid) stopped the spread of vitiligo and resulted in more than 50% re-pigmentation within eight months. The three vitamins and the radiation therapy together are necessary for good results. Replacing the psoralen, which appears to be safe for humans but toxic to fish, with vitamins, and replacing ultraviolet A radiation with safer ultraviolet B, and still getting better results seems extremely sensible.

About half of vitiligo patients develop signs before the age of 20, and adolescents, who are often particularly concerned about their appearance, can be devastated by widespread vitiligo. This is especially true for darker-skinned people since the contrast between pigmented and depigmented skin can be quite striking. While you are waiting on whatever treatment you and your physician choose, there are a number of ways to alter the appearance of vitiligo. Sometimes vitiligo patches can be hidden with make-up. Covermark and Dermablend are special cosmetics that can be used to match most skin hues until medical treatment is effective. Remember that depigmented areas are easily sunburned, and people with vitiligo have an increased risk of skin cancer, so they should wear sunscreen containing an SPF of at least 30 on all areas of vitiligo not covered by clothing.

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vitiligo, melanocytes, psoralen

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