by Thomas B. Fitzpatrick, MD , Ph.D
Myths About Vitiligo Treatment
Three myths about the treatment of vitiligo prevail in the medical profession.
The first myth is that treatment of vitiligo is “impossible.” This is clearly not true and the majority of patients can achieve good results.
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 squamous cell cancers of the skin.
Vitiligo Treatment Options
Four options are currently available for the treatment of vitiligo: sunscreens; cover-up; restoration of normal skin color; and bleaching of normal skin with topical creams to remove normal skin pigment to make an even color.
The two goals of sunscreen treatments are: to protect unpigmented involved skin from sunburn reaction and to limit the tanning of normal pigmented skin. The sun protection factor (SPF) of sunscreens should be no less than SPF 30, as this grade blocks not only erythema, but also the affects of sunlight on the DNA of the skin cells. Sunscreen treatment skin phototypes 1, 2, and sometimes 3 (those who burn, then tan to some degree).
The goal of cover-up with dyes or make-up is to hide the white macules so that the vitiligo is less visible. Self-tanning lotions and camouflage are quite helpful for some patients.
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