Vitiligo

Definition:
Vitiligo is a common skin disorder in which white spots appear on the skin usually occurring on both sides of the body in the same location. The disease has been around for thousands of years. Vitiligo occurs in 1-2% of the population. It affects both sexes, all races and all ages.

II. Causes:
The skin is made up of two main types of cells or building blocks: keratinocytes and melanocytes. The keratinocytes make up the bulk of the skin. The melanocytes are the cells that make the skin color. In people with vitiligo, the immune cells (cells which fight infection) attack the melanocytes and kill them. When the melanocytes in a certain area die the skin turns white. No one knows why the immune cells attack the melanocytes in people with vitiligo.
Patients with vitiligo are sensitive to free radicals and need aggressive vitamin therapy, see below.
Vitiligo sometimes runs in families, meaning that a genetic factor may be involved.
Vitiligo sometimes occurs at the site of an old injury.

III. Course:
Most people have slow progression of their disease. In some people the problem will disappear by itself.

IV. Treatment:
Patients with vitiligo should take a B-complex multivitamin each day. Also take Folic Acid 1 mg, Vitamin E 600 – 800 IU, and ascorbic acid 1000 mg a day. All of these nutrients can be found in a specialty supplement such as Total Balance.
Vitamin D ointment by prescription can help some people with vitiligo.
Tacrolimus ointment .1% for 6 months will help many people with vitiligo. This medication also requires a prescription.
Topical cortisone ointments by prescription can treat many cases of vitiligo.
There is no easy treatment of vitiligo. Cover-up cosmetics such as Dermablend, Chromelin Complexion Blender and Covermark work well.
PUVA light treatment has a high success rate. This treatment is very time-consuming. The patient must come to the office 2-4 times per week for 15-30 minutes to stand in a light box for 100-300 treatments. The treatment often takes a year or more and does not work for every patient that tries it; 50-70% of patients treated get a good response.
Narrowband UVB is safer than PUVA and works just as well for the treatment of vitiligo.
Severe case of vitiligo that do not respond to treatment can be treated with Benoquin by prescription. This medication causes permanent whitening of the dark areas of the skin and should only be used as a