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Author:

Gary W. Cole, MD, FAAD

Gary W. Cole, MD, FAAD

Dr. Cole is board certified in dermatology. He obtained his BA degree in bacteriology, his MA degree in microbiology, and his MD at the University of California, Los Angeles. He trained in dermatology at the University of Oregon, where he completed his residency.

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Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Topical medical therapy generally involves the application of medications that inhibit the inflammation. Most commonly, potent topical steroids have been very useful in certain cases of limited vitiligo. Care must be taken to limit the use of such medications for a specific duration due to the side effects that stem from excessive use. Another popular approach is the application of topical calcineurin inhibitor, tacrolimus (Protopic ointment) for example. These types of medications can have a beneficial effect and may be somewhat safer to use for long periods of time. The use of certain a certain types of lasers, the monochromatic excimer laser for example, which emit light in the UVB range (308 nm) can be effective.

In patients with more extensive disease, exposure to certain wavelengths of ultraviolet light can be effective (usually UVB light sources with outputs in the range of 290 nm-320 nm). Exposure to longer wavelengths of light in the UVA range (320 nm-400 nm) plus the ingestion of certain drugs called porphyrins have induced pigment production in certain patients. Many exposures over a considerable period of time are often necessary to get optimal results. None of these treatments is likely to cure the basic problem, which can involve other areas of skin while the treated areas are improving.

Other options include cosmetic camouflages, skin stains, and tattoos. In light-skinned individuals, avoiding the tanning of normally pigmented skin would decrease the contrast with vitiligo skin.

If a patient is unfortunate enough to become almost entirely depigmented, it may be cosmetically prudent to consider a medication, monobenzyl ether of hydroquinone, which is likely to destroy the few remaining melanocytes.

There are no universally effective treatments that work in all patients. When selecting a treatment plan, it is important to consider that most patients with vitiligo live normal healthy lives.

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