Vitiligo Treatment

Vitiligo
Treatment
The objective of treatment is to limit the spreading and the number of depigmented areas. In some cases, medical treatment for vitiligo is not necessary. Self-care measures - use of sunscreen creams and application of cosmetics - are sufficient.
No single therapy for vitiligo do not give good results in all patients. Response to therapy is variable. Treatment should be individualized and the patient should be warned of the risks associated with therapy. During medical therapy, pigment cells grow and proliferate in the following three sources: Pilosebacee-unit, which has the largest number of cells migrating to the external root epidermis Not challenged, the epidermal melanocytes -The side of lesion, migrant, 2-4 mm from the edge.

In children, treatment is rarely used extensively, preferring to protect against sunlight and hide depigmented areas, using cosmetics or apparel. Obtaining a uniform appearance of the skin can be achieved either by repigmenting affected areas or by skin pigmentation on the entire body. Opting for a particular treatment is based on the number of white spots on their extension.
Using cosmetic products

Application of special cosmetics (foundation, self-tanning creams) has the effect of making depigmented areas less visible, though no disease to treat. Self-tanning creams do not need to give this melanocyte skin color. Cosmetic products are particularly useful to persons who have depigmented areas around the eyes, the application of topical corticosteroids and ultraviolet radiation is contraindicated.
Tacrolimus is an effective alternative to topical vitiligo especially when involving the head and neck disease. Combination treatment with topical tacrolimus and excimer laser excimer laser is superior to monotherapy with UV-resistant vitiligo lesions. On the front is used UV-B band combined with pimecrolimus short.
Medications
Corticosteroid Corticosteroids contribute to repigmenting skin, especially if the medication is initiated soon. These drugs (which include cortisone) are similar to hormones produced by the adrenal glands. Corticosteroids may be prescribed in the form of cream or ointment in children under 10. Depigmented areas that medication is applied for at least 3 months to get results.
Systemic prednisone was used although the toxic effects of prolonged administration is undesirable. Successes have been reported when administered in small doses or pulse doses to minimize adverse effects. Benefit ratio should be carefully weighed against toxicity. Frequently opt for a topical localized vitiligo because it is easy and convenient for doctors and patients to maintain treatment. The result is reported as moderately effective therapy, especially in patients with localized vitiligo and inflammatory component. Generally intralesional steroid injection should be avoided because of pain and risk of cutaneous atrophy.
Fotochimioterapia PUVA method Method associated PUVA psoralen drug (orally or by topical application) and ultraviolet (UVA). Psoralen, ingested 2 to 3 hours before phototherapy, makes the skin more sensitive to ultraviolet light. Topical application of psoralen drug is indicated for patients with a small number of depigmented areas (which affects more than 20% of body surface). Oral administration is indicated in cases of generalized vitiligo (affecting more than 20% of body surface), or in cases of failure of topical therapy. PUVA is a treatment with the highest efficiency (50% -70% of cases). Side effects are pruritus (itching), pain and burns like heatstroke, hyperpigmentation of the areas affected by vitiligo or normal surrounding areas. The risk of burns can be reduced by avoiding direct exposure to sunlight after each treatment session. In the long term, PUVA slightly increase the risk of skin cancer. Fotochimioterapia is contraindicated in children under 12, pregnant or nursing women.
Phototherapy with UVB narrow band Ultraviolet radiation therapy UVB narrow band method is used as an alternative to PUVA. Therapy does not require administration of psoralen and is considered a safer alternative in the long term. Satisfactory cosmetic induces repigmentation in 70% of patients with early or localized disease. Use short ultraviolet B band. Frequency of treatment is 2-3 times a week but never on consecutive days. This treatment can be used safely in children, pregnant and lactating. Short-term side effects include itching and xerosis. Several studies have demonstrated effective UV-B phototherapy alone.
Depigmentation
The aim of this treatment is skin pigmentation on the whole body to obtain a uniform appearance of the skin. This therapeutic option is taken into account when vitiligo affects a large part of the body (over 50% of body surface). It consists in applying the hydroquinone twice daily on the part of the pigmented skin, they become similar to the portions affected by vitiligo. Avoid direct contact with other people, at least 2 hours after drug application. Among the adverse effects of the drug include skin inflammation, pruritus (itching), dry skin and burns. Depigmentation is permanent. In addition, after completing treatment, sun exposure should be avoided whenever possible, because the skin becomes very sensitive.
Laser therapy
Excimer laser therapy that produces monochromatic beams can treat stains limited stable vitiligo. This new treatment is effective, safe and well tolerated when vitiligo affecting less than 30% of the body. But therapy is expensive. Localized vitiligo lesions are treated 2 times per week for 24-48 sessions.

Surgery

In severe cases, especially those in which the apparent pigmentation of hair, can make a skin graft or a transplant of melanocytes.
  Skin graft Skin graft is recommended for small patches of vitiligo. The procedure consists in taking a portion of normal skin, pigmented (donor) and placing it on a depigmented area (recipient area). The possible complications are infections of the skin grefarii or absence of pigmentation.
Melanocyte transplantation This procedure involves the harvesting of a piece of pigmented skin and putting them in a special solution that stimulates the development of melanocytes. Then, melanocytes in culture are transplanted to areas affected by vitiligo depigmented.