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Vitiligo

Vitiligo is a common idiopathic acquired or inherited disease with loss of normal melanin pigments and functioning melanocytes from otherwise healthy looking skin. Clinically, vitiligo can be grouped into several unique types. The localized type includes focal and segmental vitiligo. Generalized types are vitiligo vulgaris. A genetic predisposition is considered.

The leukoderma of vitiligo does not contain any functioning melanocytes. Pathogenesis of vitiligo leukoderma is still unknown, but currently three major theories have been proposed. One is the neural theory.

THERAPEUTICS

Presently, there is no universally effective medical or surgical modality for vitiligo therapy; however, there are a number of active therapeutic approaches that are known to be effective. In addition to these medical and surgical therapies that are listed later in text, one has to always keep in mind adjunct therapies, such as broad-spectrum sunscreens to prevent photodamage of vitiliginous skin, and cosmetic camouflage of disfiguring skin with stains or make-up in exposed areas of vitiligo.

Medical/Nonsurgical Treatment

Oral or topical application of psoralen followed by long-wave UVA exposure is the most popular therapy for vitiligo and a detailed guideline has recently been well described. The basic concept of this therapy was developed from an ancient form of psoralen phototherapy in middle and far eastern countries, consisting of topical application of plant extracts or ingestion of seeds.

Khellin and UVA Therapy (KUVA)

Khellin, a furanochromone previously used in the treatment of angina pectoris and asthma, is now being used for the treatment of vitiligo. Khellin and UVA have been reported to be as effective as PUVA in the treatment of vitiligo. KUVA reportedly does not lead to the phototoxic erythema seen with PUVA. This advantage permits the patient to use KUVA at home.

Phenylalanine and UVA Therapy

Several investigators have reported a successful application of L-phenylalanine and ultraviolet light UVA to treat vitiligo patients. L-Phenylalanine is a precursor of tyrosine, a substrate for melanin synthesis in the presence of tyrosinase. After their patients underwent treatment of 6 to 8 months, Cormane et al reported a complete to partial response in 26.3% and partial to minimal.

Intradermal and topical corticosteroids have been used to treat vitiligo with mixed results. Intralesional triamcinolone acetonide given for 5 weeks produced 90% repigmentation in 30 of 52 depigmented macules, but caused skin atrophy in 26 of 52 macules treated. Topical therapy using betamethasone valerate and clobetasol propionate was successful in regimenting some vitiliginous.

Pseudocatalase and Calcium with UVB Therapy

Schallreuter et al reported successful treatment of vitiligo depigmentation with topical application of pseudocatalase and calcium followed by short-term UVB light exposure. According to their study, repigmentation occurred in the majority of cases after 2 to 4 months treatment. Complete repigmentation of face and dorsum of hands appeared in as many as 90% of the treated group.

Other medical therapeutic approaches, although based upon a limited number of cases, include topical application of melagenine, human placental extract, and systemic administration of levamisole. The topical melagenine treatment resulted in as much as 84% success rate in 80 vitiligo patients studied for 3 to 11 months. According to Pasricha et al, levamisole seems to be a

Surgical Treatment

Several surgical procedures for the treatment of depigmented skin have been reported to be effective in patients who have experienced difficulty in receiving good responses from medical treatments. The surgical therapeutic approaches include thin

Autologous epidermal grafts are the most frequently used surgical technique for treating vitiligo. This method involves transplanting a patient's normal epidermal sheet into the vitiliginous macule. Several different methods of obtaining autologous epidermis for grafting have been investigated. Full-thickness punch grafts have been used to replace depigmented skin. This technique, although

Autologous Melanocyte Grafts

Recent advances in culturing pigment cells from humans have made it possible to begin the transplantation of autologous melanocytes into areas of skin that are depigmented. This technique involves harvesting melanocytes from a

Other Surgical Therapies

In addition to autologous grafts, there are a number of surgical procedures applicable for repigmentation of vitiligo. Vitiliginous skin can be dermabraded, and 5% 5-fluorouracil (Effudex) applied twice daily for 7 to 10 days. Repigmentation can be developed.