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Vitiligo treatment options
Vitiligo is a disease characterized by melanocyte damage, especially in the skin, and provides a depth of macular and patch depigmentation that gives rise to cosmetic complaints in patients.
The course of the disease is generally unpredictable, the depigmentation patch may be widespread, undergoing spontaneous or persistent repigmentation. Vitiligo can occur in all races and ages.
The prevalence of vitiligo is about 0.1-2% of the population worldwide and about more than half of it occurs at the age of 20 years.3,4,5 Based on records
register in Polyclinic Skin and Gender sub section Eritroskuamosa and Autoimun RSUP Dr. Sardjito Yogyakarta, the number of new cases of vitiligo during the period October 2008 - August 2011 as many as 136 new cases.
Sixty-eight cases were treated with NBUVB phototherapy, forty cases of which received NBUVB monotherapy, sixteen cases of which were combined with topical immunomodulators, twelve cases of which were treated with a combination of systemic steroids.
Treatment of vitiligo is still a challenge for clinicians. A number of existing therapies provide unsatisfactory results with the limitations of incomplete and consistent therapy responses, side-effects of therapy and the ongoing course of vitiligo disease that have so far been unpredictable. Numerous studies combine NBUVB phototherapy with certain preparations, including vitamin D3 analogues, topical takrolimus, pseudocatalase and antioxidants, to improve the efficacy of therapy.
Ultraviolet B (NBUVB) narrow-band phototherapy (NBUVB) is one of the most effective treatment options for vitiligo with minimal side effects, but to achieve optimal results, 6-12 months of therapy is required.
In this paper will be reported combination therapy of NBUVB phototherapy, 0.1% takrolimus ointment, and alpha tocopherol in one case of vitiligo segmental. Aim making this paper is in order to provide insight into one of the options of combination therapy of NBUVB phototherapy on vitiligo.
CASE REPORT
A 53-year-old woman, housewife, domicile in Kalasan Sleman, MR 1447482 came to the Skin and Gynecologist RSUP Dr Sardjito Yogyakarta on December 7, 2009 with complaints of white patches on the face area. These white patches appear since 4 months ago. Early spots appear as white dots on the nose rapidly extending to the cheeks and forehead. Since 2 months ago, the patient went to SpKK and received Stenirol® 16 mg daily and Medicort® and Calacort® concoction ointment that was applied every morning and evening. White patches are not reduced, but the expansion is somewhat slowed down.
Patients went to Polyclinic Skin and Gender RSUP Dr. Sardjito Yogyakarta in therapy 0,1% takrolimus ointment and planned fototerapi. But phototherapy is temporarily suspended because the tool is under repair. Complaints felt no improvement but felt did not increase. Patients then returned control to the Skin and Gynecology Polyclinic of Dr. Sardjito Yogyakarta.
A previous similar complaint history was denied. History of previous wounds or skin diseases on white patches is denied. A similar family history of diseases denied. The history of diabetes mellitus suffered in patients and families is denied. Dermatological status in the facial area around the left nose extends to the cheeks and forehead obtained patches depigmentation firm bounds irregular shape, seen in some lesions obtained very minimal erytem, in the lashes on the left looks polyiosis.
On examination with Wood lamps appear depigmentation area, borderless, colored like white chalk. The work diagnosis is vitiligo segmental with value of Vitiligo Area Score Index (VASI) of 45. It is planned to give combination therapy fototerapi NBUVB 3 times a week with initial dose 200 mJ / cm2, takrolimus ointment 0,1% applied twice daily, and alpha tocopherol 400 mg per day. Phototherapy is increased 50 mj / cm 2 per week. In the 5th week felt by the patient the complaints improved.
On dermatological examination of the facial area around the left nose, left cheek and forehead, a patch of irregularly irregular borderline depigmentation with diffuse repigmentation, appears as a contrasting area between the lesion and surrounding skin which decreases with the VASI value to 40.
In the 19th month felt by the patient the complaints continue to decrease. Dermatological examination of the facial area around the left nose, cheeks and forehead
left, a reduced depigmentation patch with an irregularly irregular border with diffuse repigmentation, appears to be a contrast area between the lesion and surrounding skin decreasing with the VASI value being 10. (Figure 3). The VASI value in the first patient was 45 and the end of evaluation at month 19 was 10. During treatment there were no complaints of side effects from the therapy.
Vitiligo is the disease characterized by destruction of melanocytes, especially in the skin, and clinicaly showing depigmentation macula and patches. A number of therapies do not provide satisfactory results, thus a combination therapy
is required. Purpose: To evaluate the choice of combination treatment of NBUVB phototerapy in vitiligo. Case: A woman,53 year-old, complained about white patches on the left of her forehead, nose, around the eye and cheek. The white patches appeared 4 months ago. Dermatological status showed well-defined and irregular-shaped of depigmentation patches with slight erythem on some lesions.
Poliosis was seen on the left eyelashes. Wood's lamp examination showed well defined and white chalk-like coloures depigmentation. Working diagnosis was segmental vitiligo. Case management: The initial dose of NBUVB 200 mj/cm2, 0,1% tacrolimus ointment twice daily, and alpha-tocopherol 400mg pe day for nineteen-months. NBUVB works synergistically with topical tacrolimus by inhibiting proinflammatory cytokines and stimulating the proliferation and migration of melanocytes. Alpha tocopherol works as a radical scavenger and has the fotoprotecting capability. Conclusion: Combination therapy for 19 months demonstrated satisfactory result of repigmentation (Vitiligo Area Score Index 45 to 10).
Vitiligo treatment options
What is Vitiligo?
Vitiligo is a skin disorder that causes patches of white skin to appear on different parts of the body. It can occur in anyone, and affects all races and both genders equally. Worldwide, about 100 million people suffer from this condition and its prevalence in the United States is estimated to be around 1%.
What Causes Vitiligo?
In vitiligo, the cells responsible for giving the skin's its color (the melanocytes) are destroyed, hence the appearance of white patches. There may be several factors that can cause these cells to be destroyed, and sometimes the exact cause is unknown. It is believed that vitiligo may be an autoimmune disease, which causes the immune system to start attacking the melanocytes. It can also arise due to a disorder in the melanocytes themselves, causing them to trigger pathways that result in 'cell suicide'. Some researchers also believe that sunburn and chronic stress can cause vitiligo.
Symptoms of Vitiligo
The main symptoms of vitiligo are white patches on the skin. These patches often spread and become larger with time. The rate of spreading is highly variable - some people report very quick spreading while in others they spread slowly over several years. These patches tend to be found mostly on the areas that are exposed to the sun, such as the hands, feet, face and around the lips. However, they are also commonly found in the armpits and groin, at the navel, in the genital area, and at the nostrils. In addition, people with vitiligo often suffer from early graying of the hair.
Diagnosis of Vitiligo
White patches of skin are tell-tale signs of vitiligo, but there are other factors that confirm this diagnosis. These include whether the patient has a parent who suffers from vitiligo, whether autoimmune diseases run in the family, and whether the patient experienced grey hair before the age of 35. Sometimes, a biopsy and a blood test will be used to rule out other medical conditions.
How is Vitiligo Treated?
Treatment for vitiligo is still a highly-researched and changing area. Treatment will depend on the extent of the condition, and also how much the patient can afford, as many treatments tend to be very expensive. In addition, even the most specialized treatments are not always effective and are associated with a number of side effects.
Usually, one of the first treatment options recommended is steroid therapy and/or immunomodulators. However, both these pharmaceutical treatments can only be used in the short term and are notoriously ineffective and suffer from a high incidence of side effects. Another treatment option involves the use of ultraviolet light coupled with medications. However, this involves bi- or tri- weekly visits to a specialized clinic for weeks or months, is very expensive, and side effects include eye damage and an increased risk of skin cancer.
Yet another treatment option involves surgical skin grafting, but sometimes this causes skin trauma that ends up aggravating vitiligo even more. For very small patches of white skin, tattoos are sometimes used to cover these up.
It is interesting to note that as early as the 1980's, medical researchers had reported that they cured people of vitiligo using herbal extracts, mega doses of vitamins or a combination of herbs and vitamins. Several such reports were also published in the 1990s; for example, there was a group of Swedish doctors who cured patients of their vitiligo in just 3 weeks using only vitamin supplementation. However, nowadays such research has been hidden both from the general public and from the scientific community itself. This is because there is too much money involved in the more expensive treatments, and indeed vitiligo accounts for a large chunk of the pharmaceutical and medical industry's annual revenue. Doctors who know about the natural cures for vitiligo will not mention it as doing so will cause them to miss out on thousands of dollars from each patient. Worse, young doctors may never know about the natural alternative, as this research has been removed from all modern medical textbooks.
Due to the pharmaceutical and medical industry's wide-reaching influence and the money involved for all health professionals who deal with vitiligo, very few are willing to publicize findings that vitiligo can indeed be treated naturally, safely, extremely cheaply and in just a few weeks. One of these few medical researchers who dares to go against the current is Michael Dawson, a UK-based researcher and certified nutritionist who is doing a lot of work to try to make these findings available to the general public. He is the creator of the "Natural Vitiligo Treatment System™", a step-by-step guide to self-curing vitiligo holistically using an amalgamation of all the research done in the area together with his own research and self-experimentation.
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