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Medical treatments for vitiligo
There is no cure for vitiligo. However, current treatments make it possible to limit the size and the number of depigmentation spots. In children, doctors rarely resort to vigorous treatment and more often than not favor protection from the sun and camouflage with clothing.
Camouflage by cosmetics. Applying cosmetics to depigmented areas, such as specialized foundations (Dermacolor®, ColorTration®, Kamaflage® in Canada, Couvrance® Unifiance®, Covermark® in France) or self-tanning creams, makes the discoloration less apparent. of the skin, without however treating the disease. Likewise, self-tanning creams can be helpful, as they work even in the absence of melanocytes. Cosmetics are especially useful for people who have vitiligo spots around the eyes, where topical corticosteroids and UV rays are contraindicated. |
Repigmentation treatments
The objective of these treatments is to stimulate the multiplication of melanocytes still present in the skin.. Dermatologists would be able to achieve repigmentation in many cases, especially if they are treated early. Repigmentation can be done by two methods: phototherapy or topical (local) treatments.
Topical treatments may be prescribed to re-pigment small spots of vitiligo. These creams reduce the activity of the immune system (including the autoimmune reaction), which has the effect of stopping the destruction of melanocytes. They should be applied once a day for several months. Unfortunately, they are not effective in all cases.
Creams based on corticosteroids are often prescribed to be applied to fresh spots. Be careful not to exceed the number of prescribed applications, as this can lead to thinning (atrophy) of the skin. These creams are sometimes prescribed to children, with increased supervision.
benefits topical immunomodulators, pimecrolimus (Elidel® in Canada) and tacrolimus (Prograf® in Canada, Protopic® in France) cream, can also be applied to spots. They only seem effective on localized spots on the neck and face25.
Photochemotherapy using the PUVA method (combination of psoralen and UVA rays) involves combining exposure of the skin to UVA rays with taking (orally, topically or as a bath) a substance called psoralen. Psoralen, ingested 2 to 3 hours before light therapy, makes the skin more sensitive to ultraviolet rays. Oral psoralen is usually reserved for extensive forms of vitiligo (more than 20% of the body surface affected). The treatment requires great attendance since it takes place in several sessions (from 100 to 300) at a rate of 1 to 3 times per week. You have to wait about 2 or 3 months (or 200 sessions) to get a visible effect. “PUVAtherapy” is quite effective, but complete re-pigmentation is only obtained in 15% to 20% of people treated.22. It can be itchy, sore, and a sunburn-like burning. In the long term, this treatment slightly increases the risk of skin cancer1.
Contraindication. Photochemotherapy is contraindicated for children under 12 and pregnant or breastfeeding women.
Narrow spectrum UVB phototherapy. It is a recent phototherapy method which does not require the intake or application of psoralen, and which is therefore simpler than photochemotherapy using the PUVA method. It is based on exposure to ultraviolet B radiation which stimulates the repigmentation of spots. It is mainly intended for cases of extensive vitiligo and it is especially effective on lesions of the face. Up to 3 sessions can be administered per week and there are fewer immediate side effects than with the PUVA method (less burning or pain). Doctors still lack the perspective to compare UVB phototherapy to PUVA therapy, but the first clinical trials have been very encouraging2. This technique can even be offered to some children with very troublesome forms of vitiligo.
Laser. The use of laser (308 nm excimer type) seems promising3, but there are still few clinical trials.
Depigmentation treatments
The objective here is to permanently depigment the whole of the skin in order to obtain a uniform appearance. This therapeutic option is quite radical and is only considered when vitiligo covers most of the body (vitiligo universalis). Chemical “bleaching” solutions (eg Benoquin®) are applied every day for more than a year. However, half of the people treated would suffer from side effects (redness and dryness of the skin, burns, etc.), and once the treatment is finished, exposure to the sun should be avoided as much as possible since the skin becomes strong there. sensitive.
Surgical treatments
In certain cases, in particular when the hairs and the hair themselves are depigmented, skin grafts may be proposed. These transplants are especially suitable for people with segmental vitiligo, that is to say, affecting only one part of the body and no longer evolving. These are autologous transplants, that is, grafts are taken from the patient himself, in areas of the body that are not affected by vitiligo. This makes it possible to avoid transplant rejection and the intake of immunosuppressive drugs.
A new technique, melanocyte transplantation (or “melanocyte graft”) makes it possible to recover melanocytes in healthy areas of skin and to inject them into depigmented spots. Still experimental, this treatment is not available everywhere.
Support group. Because it changes the appearance and often affects visible areas of the body, such as the hands, face and arms, the vitiligo can cause a malaise and a certain embarrassment in front of the gaze of others. Aesthetic damage can sometimes be the cause of a real psychological distress, which should not be minimized and which must absolutely be taken care of. For people who feel the need to talk about this, support groups can provide significant emotional support. A psychotherapy may also provide relief in some patients. See the Resources section.
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