Current State of Vitiligo Therapy Evidence Based Analysis of The Literature

Vitiligo is a type of skin disorder. It is one in which white patches of skin appear on different parts of the body. This happens in vitiligo because the cells that make pigment in the skin are destroyed. These microscopic cells are the melanocytes. Vitiligo can also affect the mucous membranes, aside from the skin. It can affect the tissue inside the mouth and nose and the eye. The cause of vitiligo is not known. Vitiligo may be an autoimmune disease. Vitiligo can be clearly seen under a inspection microscope. In vitiligo cases, the immune system may destroy the melanocytes in the skin. Some researchers think that the melanocytes that can be seen under a microscope destroy themselves. Others think that a single event such as sunburn or emotional distress can cause vitiligo. Such theories are not proven up to the present however. Vitiligo has been observed to run in families. Children whose parents have the disorder are more likely to develop vitiligo.

However, most children will not get vitiligo even if a parent has it. Signs of vitiligo include white patches on the skin. Such is the main sign of vitiligo. These patches are more common in areas where the skin is exposed to the sun. Aside from the arms and legs, white patches also commonly appear in the armpits and groin, around the mouth, eyes, nostrils, navel, genitals and the rectal areas. People with vitiligo often also have hair that turns gray early. Those with dark skin may notice a loss of color inside their mouths. There is no way to tell if the white patches of vitiligo will spread. Often though, when one has vitiligo, the white patches will spread to other areas of the body. For some people, vitiligo spreads slowly over many years. For other people, spreading occurs quickly. The choice of treatment depends on the number of white patches, how widespread they are, and depending on the treatment option the patient prefers. Current treatment options for vitiligo include medical, surgical, and other treatments. Most treatments are aimed at restoring color to the white patches of skin.

As vitiligo becomes a worldwide prevalent disease, ranging from 0.5 percent to 4 percent. Conservative therapies include photochemotherapy, phototherapy with UVB radiation including a broadband UVB 290 to 320 nm, narrow band UVB 311 nm, systemic steroids and pseudocatalase. Modern therapeutic options include treatment with topical immunomodulators and with the aid of inspection microscope, analogues of vitamin D3, excimer laser and surgery/transplantation. The article shows the analysis of the researchers as they try to compare these therapies for vitiligo and the evidence levels supporting their effectiveness. The researchers have found in their results that the face and neck respond best to all therapeutic approaches. The acral areas on the other hand are least responsive. For cases of generalized vitiligo, phototherapy with UVB radiation is most effective. It also showed as the treatment with the fewest side effects. The PUVA treatment is the second best choice. Topical corticosteroids are the preferred drugs for localized vitiligo according to the results. They may be replaced by topical immunomodulators, which display comparable effectiveness and fewer side effects. The article likewise claims that the effectiveness of vitamin D analogues is controversial with limited data. Surgical therapy has also proven to be very successful, but then it requires an experienced surgeon and is very demanding of time and facilities. All those factors thus limit its widespread use. For a clearer view, you can see vitiligo under a microscope.

According to the researchers, the L phenylalanine therapy appears effective on the face. However it is not used widespread and it has no extensive data support. The study concludes that no single therapy for vitiligo can be regarded as the most effective. This is for the reason that the success of each treatment modality depends on the type and location of vitiligo. Original article