Treatment of Vitiligo is surrounded by three myths.
- The first myth is that the treatment of vitiligo is “impossible.” This is clearly not true and good results are achieved with a majority of patients.
- The second myth is that oral psoralens, which form the basis for some vitiligo treatments are “toxic to the liver.” Oral psoralens are not toxic to the liver.
- The third myth is that psoralen + UVA (PUVA) treatments for vitiligo “cause cancer of the skin.” When used to treat vitiligo, PUVA therapy requires only a limited number of treatments-approximately 150 in number that has not been shown to cause skin cancer. By comparison, PUVA treatments for psoriasis can be as many as double the number for vitiligo. It has been shown that a small percentage of patients who receive more than 250 PUVA
treatments can develop treatable squalors cell cancers of the skin.
Why is treating vitiligo important?
Many physicians, and even some dermatologists, fail to recognize the profound social and psychological impact vitiligo may have on its victims. Vitiligo is painless and non-pruritic and, unlike psoriasis, it is not associated with shedding of skin scales. But the disfigurement of vitiligo, accentuated among persons with brown or black skin, can be devastating.
The recent media publicity about Michael Jackson’s battle with vitiligo has helped raise public awareness of the disease. While vitiligo is worldwide and affects all races equally, it is a particularly troubling social problem for persons whose normal skin color is brown or black. The contrast between brown skin and white vitiligo spots can create a grotesque “harlequin” appearance. The same kind of disfigurement can become a problem for vitiligo victims with normally fair skin who tan deeply during the summer months or, among those who live in sunny climates, throughout the year.
In India, vitiligo, or “leukoderma” as it is called here, is regarded as “white leprosy.”
A woman in India cannot marry if she has even one spot of vitiligo, and if a woman develops vitiligo after marriage it is considered grounds for divorce.
It is no wonder vitiligo patients can turn aggressive, feel a sense of shame, or become withdrawn and resentful. For many, vitiligo is not just a cosmetic problem-it is a major social dysfunction that seriously curtails their ability to lead a normal work, social or married life. Reversal of the white spots and restoration of normal skin color is therefore the primary hope for all these disfigured vitiligo patients.
Self Care & Sun Safety
Certain self-care tactics may help you care for your skin and improve its appearance: Protect your skin. If you have vitiligo, particularly if you have fair skin, use sunscreen to protect your skin from the sun’s harmful rays. Sunscreen helps protect your skin from sunburn and long-term damage.
Sunscreen also minimizes tanning, which makes the contrast between normal and depigmented skin less noticeable. Conceal imperfections. Cosmetics that cover the white patches on your skin may improve your appearance and help you feel better about yourself. These cosmetic products may be particularly effective if you have vitiligo that’s limited to exposed areas of your body. You may need to experiment with several brands of concealing cosmetics, such as Dermablend or Chromelin, before finding a product that works best for you.
MORE ON THE SUBJECT OF VITILIGO, SUN AND SKIN
WHAT IS VITILIGO ?
This seems like a redundant question. However, it seems important to recognise that vitiligo is a disease according to the World Health Organization.
VITILIGO IS NEITHER A CONDITION NOR A SYMPTOM :
However, not all white skin patches are vitiligo. There are other conditions and diseases that are associated with white skin. A long time ago the term leucoderma has been introduced. This word originates from the Greek language and means white skin. Clearly it seems mandatory to make the correct diagnose. This can be done by Wood’s light.
SUTON NEVUS (HALO-NEVUS) IS NOT VITILIGO:
SKIN COLOUR AND SUN PROTECTION :
It is becoming evident that besides melanin formation many other mechanisms and factors are in place to defend the human body against environmental reactive oxygen species (ROS) formation (Schallreuter KU and Wood JM Photobiology (2001)). ROS can also be generated by ultraviolet light directly inducing a plethora of signalling and defence mechanisms.In vitiligo patches the pigment is mostly completely absent, but not all individuals suffer from sunburn despite sun exposure (Schallreuter KU et al, Dermatology (2002)).
SKIN AGING AND VITILIGO :
The development depends on the genetic background and on the accumulation of sun exposure times / sunburns over time. In this context it is noteworthy that fair skin people who always burn and never tan are much more prone to develop skin cancer compared to good tanners and dark skin coloured individuals. But there are also exceptions. Even dark skin people can occasionally.
VITILIGO AND MELANOMA :
Based on the above results the take home message and recommendation is that patients who have vitiligo should undergo an annual total body examination at their Dermatologists in order to recognise a possible melanoma as early as possible
MELANOMA ASSOCIATED LEUCODERMA :
Therefore the term melanoma associated leucoderma seems more appropriate as already suggested earlier by the late Fitzpatrick. Are white skin patches associated with melanoma beneficial for the outcome?
The development of white patches anywhere on the skin in association with melanoma was interpreted to be a beneficial sign in the outcome for survival time. There is still an ongoing debate whether the development of such leucoderma associated with melanoma is of true value for the individual’s outcome or not
statement. Larger patient groups are needed in order to conclude. Therefore, it is simply not correct to advise patients with vitiligo that they have a decreased risk to develop melanoma and that they are well protected against this tumour.
The development depends on the genetic background and on the accumulation of sun exposure times / sunburns over time. In this context it is noteworthy that fair skin people who always burn and never tan are much more prone to develop skin cancer compared to good tanners and dark skin coloured individuals. But there are also exceptions. Even dark skin people can occasionally be very sun sensitive.
VITILIGO AND SKIN CANCER :
However, until now there is no documentation in the literature about a true coincidence.
enhanced risk after the use of narrowband UVB exposure which is a treatment modality utilized as mono therapy with increasing doses 2-3x per week in adults and even in children.
If your doctor suspects you have vitiligo, he or she will ask about your medical history. Important factors in your medical history include:
A family history of vitiligo. A rash, sunburn or other skin trauma at the site of vitiligo within two to three months of the start of depigmentation premature graying of the hair (before age 35)
Stress or physical illness In addition, your doctor will need to know whether you or anyone in your family has had an autoimmune disease.
He or she will ask if your skin is sensitive to the sun. Your doctor will examine you to rule out other medical problems or skin conditions, such as dermatitis or psoriasis. Your doctor may take a small sample (biopsy) of your affected skin. He or she may take a blood sample to check your blood cell count and thyroid function. In some cases, your doctor may recommend an eye examination to check for inflammation in your eye (uveitis). A blood test to look for the presence of antinuclear antibodies (a type of autoantibody) also may be done to determine if you have an autoimmune disease.