Vitiligo is the most common chronic disorder of skin discoloration, which affects approximately the 0.5% of the world population.
• Corticosteroids (topical, intralesional and systemic)
• calcineurin inhibitors: Tacrolimus and pimecrolimus
• Surgery / Transplant
• Discoloration of existing melanin
• UVB (290-320 nm)
• Narrow Band -UVB (311 nm)
• VISIBLE LIGHT & wavelength of 633 nm
• Excimer Laser phototherapy (308nm)
Guidelines for vitiligo treatment by the European Academy of Dermatology:
The most effective treatment of vitiligo includes phototherapy and combination therapy, according to the most recent guidelines by the scientific group authoring Vitiligo European Task Force (VETF), which have been accepted for publishing and published in the prestigious magazine British Journal of Dermatology.
The European Academy of Dermatology and Venereology collaborated with the VETF to develop new data and guidelines for Vitiligo.
Vitiligo is a disease that has not definitively and fully effective treatments. However, phototherapy and combination therapies are more effective treatments.
The treatment should stop the further development of lesions and offer full or almost full repigmentation that patient thinks is satisfactory.
Worldwide, the prevalence of vitiligo is 0.5%, with no differentiation by specific age groups, races or gender.
The causes and the pathophysiological mechanisms that cause vitiligo are still poorly understood and remain insufficiently specified. This is the main cause of slow progress in diagnosis and treatment.
Recommended the following principles for the treatment of segmental vitiligo or limited non-segmental (less than 2% -3% of the body surface):
• First-line therapy is to avoid factors that may put into operation the mechanisms that develop vitiligo and use topical factors such as corticosteroids or calcineurin inhibitors.
• Second line therapy could be the localized narrow band ultraviolet B (nb-UVB 311nm), preferably with excimer monochromatic light or laser.
• Third-line therapy in patients with aesthetically unsatisfactory repigmentation in visible areas after treatment first or second line, as surgical techniques.
Recommended the following principles for the treatment of non-segmental vitiligo:
• First-line treatment is to avoid factors that may put into operation the mechanisms that develop vitiligo or aggravating factors and stabilize the patient with nb-UVB therapy for at least 3 months. Patients who respond to nb-UVB should continue the therapy for 9 months or more. An additional aspect is the combination of topical UVB therapy with systemic or topical treatments.
• Second-line therapy for patients with rapidly progressive disease or lack of stabilization with nb-UVB, is the systemic corticosteroids, minipulse treatment for 3-4 months, or immunosuppressants.
• Third line treatment is the transplantation areas that do not respond to previous treatment, particularly those areas that are important aesthetically. The Koebner phenomenon or the development of vitiligo again in an area of the skin that had not been affected before, in skin injury, can reduce the strength of the graft. The grafts are not suitable on the back of the hands and similar areas.
• Fourth line treatment for extensive vitiligo (covers more than 50% of the body surface) that resists treatment, or is visibly apparent, is the discoloration using hydroquinone monobenzyl ether or 4-methoxyphenol in monotherapy or in combination with a Q switched laser.