How To Develop A Treatment Plan For Vitiligo?

Vitiligo is a common disorder characterized by loss of melanocytes from selective locations resulting in white patches. It has a multifactorial etiology, and its pathogenesis is still unclear. It arises due to cellular and molecular factors such as oxidative stress, neurogenic inflammation, autoimmune reactions, etc. Several treatment options are available for vitiligo, of which narrowband ultraviolet B (NBUVB) is the most reliable. Other treatment options are topical calcineurin inhibitors, phototherapy, and surgical procedures like melanocyte transplantation and excisional techniques. The management of vitiligo depends on the extent and location of lesions and response to previous therapies. All these factors should be considered while choosing a suitable treatment option for the patient. Let’s know first in detail about vitiligo.

Causes of vitiligo:

Vitiligo is a multifactorial disorder with complex etiology. It has an autoimmune, neurogenic, genetic basis in its pathogenesis. The proposed causes of vitiligo are as follows:

1) Genetic factors- In many cases, there is a family history of vitiligo.

2) Neurogenic factors can either be due to nerve injury or trophic factor deficiency that leads to the destruction of melanocytes in the skin.

3) Oxidative stress- During oxidative stress, free radicals damages molecules like DNA and proteins resulting in cell death.

4) Infections- It might be an important triggering factor for vitiligo development through the molecular mimicry hypothesis.

5) Hormonal factors- It is believed that it might be due to hyperthyroidism and hypothyroidism.

6) Psychological disorders- like stress, trauma, etc.

7) Autoimmune reactions: Vitiligo can occur as a manifestation of autoimmune diseases like Addison disease and pernicious anemia.

Types of vitiligo:

There are three different types of vitiligo which are as follows:

1) Non-segmental (NSV) comprises about 70%-80% cases of total body surface area involvement with minimal or no mucosal involvement.

2) Segmental (SV)- it is also called unilateral, centrifugal, or pan facial vitiligo, in which there is a linear distribution of lesions along the dermatomes. It accounts for about 8%-10% of cases.

3) Generalized Vitiligo- it is a widespread type of vitiligo. It comprises about 10%-20% of cases.

Diagnosis of vitiligo:

Vitiligo can be diagnosed on the following basis:

1) Clinical examination- Only certain types of lesions are present in typical areas.

2) Histopathological examination- It is used to confirm melanocyte loss in lesional skin.

3) Wood’s light examination helps diagnose vitiligo, especially in melanic patients with atypical forms of lesions.

4) Immunofluorescence studies- Demonstrate complete or partial absence of tyrosinase activity in the basal layer of the epidermis. Patients with generalized Type I vitiligo have absent tyrosinase staining, whereas patients with nonsegmental form have routine tyrosinase staining.

Once vitiligo is diagnosed, the first step should be to avoid trauma to lesions. Then, the treatment plan should be developed according to the extent and location of the lesions.

How should vitiligo treatment be planned?

1. First of all, the extent of vitiligo should be considered carefully.
2. Then, the stage of repigmentation or stability should be assessed to decide which therapy is suitable for the patient.
3. After that, get a thorough history of previous treatment(s), response(s), and adverse effects.
4. Treatment of vitiligo should be done in a well-lit room. Turn on the full-spectrum light source and remove all jewelry especially watches. Then, apply a sunscreen lotion to the skin before going out in the sun.
5. To reduce mental stress, oral antihistamines can be given at bedtime.

Treatment options for vitiligo

There are many vitiligo treatment options available for treating various types of vitiligo. The treatment plan should be developed based on the lesions’ extent and location and the previous response to treatment. The best treatment for you will depend on your preference, overall health, age, and where the vitiligo appears on your body.

1. Camouflage: 

Camouflage is a good option for people with vitiligo. It helps in hiding the areas affected by vitiligo. It can be done by using cosmetics specially made to cover up skin discoloration or tattoos, a long-term solution to treat vitiligo.

2. Topical steroid therapy:  

Topical steroids are used to promote the repigmentation of vitiligo-affected skin; however, it may take a few months to see any result. They should not be applied to the mucous membranes. Topical steroids are generally used after applying tacrolimus or pimecrolimus ointments which act as an immunosuppressant and suppress overactive immune system producing inflammation in the skin due to Vitiligo.

3. Phototherapy:  

Photo(chemically) involves exposure of the skin to ultraviolet lights that stimulate melanocytes and help grow new skin pigment cells in certain parts of the skin affected by Vitiligo. This treatment takes months to years to achieve results depending on the extent of the disease and the individual’s response. Different light sources used include UVA, UVB, PUVA, etc., which work differently on the face, hands, or legs.

4. Narrowband UVB (NBUVB) phototherapy: 

It is also called 311nm UVB treatment, which involves exposing the skin to ultraviolet light shorter than normal UV light. It is also called 311nm UVB treatment, which tells the skin to ultraviolet rays with shorter wavelengths than normal UV light. But NBUVB therapy works differently from PUVA treatment by suppressing cell-mediated immunity instead of humoral immunity. The risks involved are burning, itching, and swelling at the site of exposure.

5. Light Treatment:

Light treatment or phototherapy is a process through which the body absorbs a particular kind of light, and it helps in the production of the natural skin pigment melanin. It includes sunlight exposure, artificial ultraviolet rays like a sunshine simulator, or specific wavelengths on specialized lightboxes (also called Vitiligo lamps). This treatment is safe with minimal side effects.

6. Topical calcineurin inhibitors:  

Calcineurin inhibitor medications are applied directly to vitiligo-affected areas to reduce inflammation triggered by an overactive immune system. The most commonly used topical calcineurin inhibitor medication for vitiligo is Tacrolimus ointment 0.03% and pimecrolimus cream 1%. Apart from reducing inflammation, these medications also promote new skin pigment growth. But, it may take weeks to months to see any results, and the effect of this treatment is more negligible on the face and hands.

7. Corticosteroid injections: 

Corticosteroid injections are used for treating vitiligo affecting small areas like one digit or nose. The ointment form of steroid is applied over the lesion before applying tape occlusion for 6-12 hours every day for 2-3 months to stimulate pigmentation changes in that particular part of the body. This process can be repeated after 6-8 weeks if repigmentation doesn’t occur in the first attempt. Side effects include hyperpigmentation) (white patches at site of injection) and hyperpigmentationloss( of skin color).

8. Micropigmentation:  

It is also called permanent cosmetics, and it involves the use of organic pigments like titanium, iron oxides, or carbon black to form patterns on the skin’s surface. The main benefit of this method is that there is no fear for the reappearance of Vitiligo as long as we continue with the same tattoo; however, it takes several sessions to complete before one can get the desired result. Sometimes laser treatment or topical application of corticosteroids along with tattooing provides good results.

9. Autologous pigment grafts: 

Autologous pigment grafts are plant cells that contain brown color pigments called melanin. They are cultured in the laboratory and transplanted to the patient’s skin. The tattoo removal process is called microvascular grafts, which involves removing melanocytes (pigment-producing cells) from normal skin and then moving them into the newly created holes made by the punch grafting tool on the site of Vitiligo. This helps in creating new pigmented areas for cosmetic purposes. But it may take two procedures to get desired results; the first one will reduce the size of spots, and the second session will increase their number.

10. Skin graft:  

It is a surgical method where either partial or entire affected area gets replaced by normal un-affected skin. This method is usually used when other methods fail to provide satisfactory results after repeated attempts. It can be done through the autologous skin grafting method. The skin is taken from a non-affected body part of the same patient or through artificial skin grafting using cultured keratinocytes and fibroblasts. The most common side effect of this treatment is a delay in wound healing which can last for up to 3 months.

11. Microneedling:  

It is also known as collagen induction therapy (CIT), which involves using the fine-needle instrument, which is rolled over the affected area to stimulate the production of new collagen fibers that restore volume and elasticity of the skin. It has been reported that this process will induce the proliferation of melanocyte stem cells in vitiligo lesions leading to repigmentation. Many kinds of microneedling devices are available in the market, and there is no consensus on which one will work best for vitiligo. Repigmentation is dealy up to several months, and complete results can be seen after 2-3 months of repeated sessions.

12. Unconventional treatment:

 Some vitamins, minerals, supplements, herbs, oils, alternative medicine, etc., have proved beneficial in reducing the signs of vitiligo. Some of them are as follows:

1. a) Vitamin-B12 injection is given intramuscular or subcutaneously every month for six months. The person may start seeing repigmentation within 3-4 weeks and the final results after six months. This therapy can be used along with other treatments.
2. b) Recombinant human growth hormone (rhGH): It has been reported that this molecule enhances melanocyte proliferation and its activity in vitiligo patients; however, it should not be used until proven safe and effective by clinical trials.
3. c) UV Therapy: Ultraviolet (UV) light treatment is done to stimulate the production of melanin pigment in the body; however, its application is limited to very few cases only, as it can cause severe side effects like skin cancer.
4. d) Sunscreens:  Sunscreen lotion is applied on affected areas of skin to protect them from further damage by ultraviolet rays of the sun; however, they may not produce repigmentation by themselves. But their regular application should be made before going out in the sun.
5. e) Topical immunomodulatory: They are used to treat Neuro-fibromatosis type 2 (NF2) and act by suppressing T cells. Their use has also been reported in vitiligo patients for a limited period with variable results.
6. f) Acupuncture: It involves inserting needles at specific acupoints on the body, which has therapeutic value in stress reduction, pain management, prevention of wound healing, etc.
7. g) Yoga: It is some form of physical exercise which involves a sequence of postures, breathing exercises, and meditative practices. Some studies suggested positive results with yoga therapy in treating vitiligo patients.
8. h) Ayurveda treatment: These are the traditional system for health care used by Indian subcontinent people. The main aim of this therapy is to balance three body humors called Vata( air), Pitta ( fire), and Kapha ( earth/ water), which are responsible for maintaining optimum homeostasis in the human body.
9. i) Diet change: Vitamins deficiency may also cause skin depigmentation, which can be improved by taking foods rich in vitamin A, B complex, C, etc.; some studies have reported that supplementation of vitamin E helps prevent the progression of vitiligo.
10. j) Ginkgo Biloba: It can be used as it has an antioxidant property that helps to reduce oxidative stress, which causes melanocyte degeneration.
11. k) Zinc: Zinc deficiency may also cause vitiligo by reducing immune function and disrupting the DNA repair process. So, zinc supplementation should be taken along with the above therapies.
12. l) Homeopathic treatment for vitiligo: Homeopathic treatment is one of the best treatments in the world for all kinds of skin diseases. It is very effective in treating vitiligo also. Generally, homeopathy treats vitiligo with a single medicine. Still, sometimes it requires a combination of 2 or more medications to cover up other symptoms hidden under the primary disease condition to provide a complete cure for this disease. Homeopathic treatment for vitiligo treats the root cause of vitiligo and prevents the skin disease from reoccurring again. So homeopathic treatment is a very effective treatment for vitiligo cure. Homeopathy medicines to treat vitiligo are safe and free from any side effects to be taken along with other allopathic or ayurvedic medicines.

As we can see, there are many treatments for vitiligo, and you can decide which one you want to choose for your treatment. Visit your skin doctor or dermatologist so that they can guide you to choose the proper treatment for your vitiligo. You can book an appointment through OHO Homeopathy with a registered skin doctor or homeopathy doctor now!