Vitiligo is an skin condition believed to be caused by an autoimmune process against melanocytes (pigment cells) which results in the loss of pigment from areas of the skin. There are no known specific directed options for reducing risk of occurrence of this condition. It may be associated with other autoimmune conditions. A genetic association may be present with about a 1 in 5 chance of having vitiligo if another member of the family was previously diagnosed. It may also be associated with lymphoma of the skin or melanoma.
Conventional basic vitiligo treatment:
According to Tamesis ME et al, localized vitiligo may generally be treated with creams containing corticosteroids, tacrolimus and calcipotriol. In more widespread vitiligo, phototherapy is an option. (1)
Vitiligo and phototherapy:
Vitiligo treated with the options of ultraviolet A (UVA) and ultraviolet B (UVB). If vitiligo becomes generalized or widespread on the body, phototherapy may be recommended by the Dermatologist but comes with some risks. According to the Skin cancer Foundation, at skin cancer.org, an article “Shining Light on Ultraviolet Radiation,” explains that ultraviolet A (UVA), ultraviolet B (UVB), and ultraviolet C (UVC) are the three wavebands which make up sunlight. This source explains that UVA is the deepest penetrating waveband into the skin which is able to shine through windows, pass through clouds and makes up 95% of sunlight. The source described that both UVA and UVB is responsible for development of skin cancer and that UVA is more dangerous because it can damage the DNA in deeper layers of the skin. UVB was described in the source as responsible for more superficial damage, faster aging of the skin, tanning and sunburn. (2)
For generalized vitiligo, options include phototherapy with narrowband ultraviolet B or psoralen (a plant based photosensitizing medication taken prior to phototherapy) plus ultraviolet A. It is known that the greater the exposure to ultraviolet light, the greater the risk of skin cancers. Research shows that UVA exposure is directly associated with skin cancers (3), but UVB exposure may result in less risk of skin cancer because the damage it causes is more superficial (2), and several studies have shown that UVB does not have an increase in risk of skin cancers (3). However, it is generally accepted by the majority of authorities that both UVA and UVB exposure increase the risk of skin cancer.
The effectiveness of narrowband ultraviolet B (NBUVB) and oral psoralen-ultraviolet A (PUVA) therapy for the treatment of vitiligo was studied by Sapam R et al. 56 participants were analyzed, with ages 13 to 70 in a parallel-group, assessor blinded, randomized, controlled trial. At the end of 6 months of treatment, half of those in the NBUVB group reported median repigmentation of 45% with 40% repigmentation in the PUVA group. Adverse effects were reported by 7.4% and 57.2% of NBUVB and PUVA participants, respectively. NBUVB carried a greater response rate and might be superior to oral PUVA with better tolerance and color match with the surrounding normal skin. (4)
Summary and Conclusion: Vitiligo
- There are no known specific directed options for prevention of vitiligo exacerbations.
- Localized vitiligo may be treated with creams containing corticosteroids, tacrolimus and calcipotriol (1). In more widespread vitiligo, phototherapy is a good option(1,3,4) with awareness of the dangers of skin cancer as the number of exposures to ultraviolet light increases (2, 3).
References:
1.Tamesis ME, Morelli JG. Vitiligo treatment in childhood: A state of the art review. Pediatr Dermatol 2010;27:437-45. http://www.ncbi.nlm.nih.gov/pubmed/20553403
2.Skin cancer Foundation. skincancer.org, Shining Light on Ultraviolet Radiation. Accessed 8/11/2013. http://www.skincancer.org/prevention/uva-and-uvb/shining-light-on-ultraviolet-radiation
3.Archier E, Devaux S, Castela E, Gallini A, Aubin F, Le Maître M, Aractingi S, Bachelez H, Cribier B, Joly P, Jullien D, Misery L, Paul C, Ortonne JP, Richard MA.J Eur Acad Dermatol Venereol. Carcinogenic risks of psoralen UV-A therapy and narrowband UV-B therapy in chronic plaque psoriasis: a systematic literature review. 2012 May;26 Suppl 3:22-31. http://www.ncbi.nlm.nih.gov/pubmed/22512677