This review will explain you the different types of vitiligo disease and will discuss the best efforts towards its treatment.

The authors of this article try to explain the history, subtypes and treatment of this common and blemishing disease. Vitiligo has its presence worldwide and percentage of its presence is 0.5%. Half of the patients come to the doctor before the age of 20. The patients who have lighter skin can be diagnosed by the examination of wooden lamp. In rare cases skin biopsy is also needed.

There are two types of vitiligo: segmental vitiligo (SV) and nonsegmental vitiligo (NSV) and their treatments differ clinically. Segmental vitiligo is limited to a group or segmental region which appears on face most often. It started in early ages and has been found in around 30% of the childhood cases. It remains steady and has a rapid start as compare to the NSV. Over 90% of the vitiligo cases are marked to NSV. This type of vitiligo can be seen in childhood but it is most common in later ages. NSV is progressive, unending and relapsing and most often associated with the family or personal autoimmunity history. It appears commonly with regularity, at pressure sites, with roughness or trauma.

The treatment for extensive NSV is narrow-band UVB (NB-UVB) and as compare to the photochemotherapy (proralen and ultraviolet radiation [PUVA]) it has proven more effective. NB-UVB treatment is given twice in a week and it must be governed before the vitiligo disease resolute to be unresponsive. Vitiligo duration is inversely related to its reaction to NB-UVB. This treatment is best for facial vitiligo but not as good for feet and hands. However within one year time 2 third of the cases get improvement. In localized vitiligo topical therapies are used. Topical tacrolimus is very useful for vitiligo on face to avoid that atrophy which is steroid related. Surgical therapies can be used for stabilized lesions and focal but reaction is variable. Camouflage techniques like skin dyes, sunless self tanning lotion in which dihydroxyacetone is included and cosmetics are also very common but they are not long lasting remedies because they lasts for 5 to 7 days only. There are other depigmentations like laser or chemical but these are reserved for selected patients who are suffering from widespread disfigurement but results vary in this case too.

Comments: Vitiligo has no cure. As therapies are not that helpful to change the nature of disease and research is also limited in this regards. If phototherapy is not there then nature therapy of sunlight can also be considered. Fair skinned individuals use sun block most often on normal skin. Change of hair color vitiligo can easily be hidden with the help of hair dye. Camouflage therapies should be offered to everyone.

Mary Wu Chang, MD

Published on January 7, 2009 in Journal Watch Dermatology