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VITILIGO
TREATMENT GUIDANCE |
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“Abnormally low levels of Vitamin B12, Folic Acid
and Vitamin C are found in a large number of
vitiligo patients. Vitiligo: Nutritional Therapy, by
Leopoldo Montes, M.D., M.S., FRCPC Westhoven Press,
Buenos Aires.
• “Patients with vitiligo show diminished blood
levels of folic acid, Vitamin B12, and ascorbic acid
(vitamin C). Prolonged oral administration of these
vitamins was followed by definite repigmentation
without side effects,” Folic Acid and Vitamin B12 in
Vitiligo: A Nutritional Approach, Cutis Magazine,
Volume 50, July 1992 |
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Treatment of Vitiligo, "Making it
Simple"!
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Doctors have noticed some patients seem to have difficulty in
understanding why so many treatments are available for diseases in
general, and vitiligo in particular. The main objective of this
section is to describe and clarify for patients, families, friends,
and the general public the basis of, and options for, vitiligo
treatment. This material will be presented as simply as possible
while maintaining the most current and reliable medical and
scientific information. In an uncomplicated way, “Treatment of
Vitiligo, making it simple!” is presented for all to understand. I
have chosen the question/answer approach to present each topic
concerning vitiligo treatment. Why? Because most people initially
confronted with the subject of vitiligo are filled with questions
about this relatively unknown and undiscussed disease. You can
expect to have your DOUBTS or QUESTIONS about vitiligo treatment
ANSWERED here. You can then comfortably search the National Vitiligo
Foundation web site for more detailed answers to your questions and
interests
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The holy grail of vitiligo
research is to find a medication that safely and effectively
stops the progression of vitiligo. No such medication exists
today. Research on identifying the genes causing vitiligo
may lead to development of such a medication. If a molecule
can be identified that inactivates the vitiligo genes, it
will be possible to prevent vitiligo from spreading. Until
that time, there are limits on the efficacy of therapies
currently available.
Optimal therapy for vitiligo has been shown to be a
combination of topical medications and one form of
ultraviolet light. Vitiligo is caused by destruction of the
melanocyte in the epidermis. To repigment a patch of skin,
the melanocytes must be replaced from a reservoir. The
reservoir is the hair follicle. Usually the melanocytes in
the follicle are spared by vitiligo but not always. It is
essential before beginning therapy to determine if the skin
is able to repigment, i.e., there is a reservoir. Glabrous
(hairless) skin such as that on the dorsum of the fingers,
the ventral surface of the wrist, the genitalia, the ankles
and feet cannot respond to medical treatments because this
skin lacks a reservoir from which to stimulate melanocyte
growth back into the white patch. Hairy skin in which the
hairs are white (not blond) also cannot repigment. |
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It is
a rare event that a patient with vitiligo inquires about the
option of depigmentation. The usual course of action I take
when I see a patient for the first time who has extensive
vitiligo — more than 50 percent loss of pigment of the
exposed areas including the hands, arms, and face — is
repigmentation. But if repigmentation techniques fail, we
should consider depigmentation. Even after we have been
unsuccessful in repigmenting their skin with PUVA and
topical steroids, patients are sometimes still reluctant to
undergo depigmentation. They want to be of one color again,
but they fear that they will be too light, that they will
burn when they go out in the sun, and that they will not be
able to repigment if a cure for vitiligo becomes available
in the near future. Additionally, other concerns such as
obtaining the medication, allergic reactions due to the
depigmenting cream, pigment spots reappearing on the face,
extensive repigmentation and even hyperpigmentation occur in
a few cases. In spite of all these real difficulties, when
one becomes one color, that is totally white, the patient,
the families, and the physician have a feeling of great
accomplishment. |
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Guidelines for the Treatment of Patients with Vitiligo |
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Treatments
Guidelines for the Treatment of
Patients with Vitiligo
University of Cincinnati,
Department of Dermatology
James J. Nordlund, M.D. —
Chairman
Patients with Vitiligo almost
uniformly complain about lack of knowledge of dermatologists
about the treatment of Vitiligo, their disparaging remarks
and lack of interest. We as specialists must do better to
assist our patients. Although therapies are less than
optimal, they work for many patients and they are worth the
effort. The following are helpful hints to assist you with
your patients. |
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