Vitiligo

Cells called melanocytes produce melanin, the pigment that determines color in the skin, hair and eyes. Vitiligo results when these cells die or cannot produce melanin. No one knows why this happens, though several theories are being explored.

The white patches that occur with vitiligo can vary widely in number, size and degree of pigment loss. Some people may have only a few small patches; others may lose pigment virtually everywhere. Patches can be milky white, have different shades of pigment or have a border of darker skin.

People with vitiligo often experience cycles of rapid pigment loss, followed by times when, for unknown reasons pigment loss stops. These cycles may continue indefinitely.

Topical Corticosteroids: Creams containing corticosteroids can be effective in returning pigment to small areas of the skin. Because of potential side effects, these should be used under your dermatologist's care.

PUVA: PUVA combines a medication known as psoralen, which makes the skin very sensitive to light, and treatment with a special type of ultraviolet light called UVA. Special medical equipment is needed for PUVA treatment and it must be given under close supervision by your dermatologist to reduce the risk of side effects. Treatment is usually required twice weekly for at least a year and has a 50 to 70 percent chance of restoring color on the face, trunk and upper arms and legs. Hands and feet usually respond poorly. Because psoralen also increases light sensitivity in the eyes, patients must wear UVA blocking eyeglasses until sunset after exposure to psoralen.

For some patients with severe vitiligo, removing remaining pigment from the skin to produce an even white color may be the most practical treatment. Pigment is permanently removed using special chemicals and treatment takes about a year to complete.

Sunscreens and cover-up measures are usually the best treatments for vitiligo in children. Topical corticosteroids can also be used, but must be monitored by your dermatologist. PUVA may be recommended after age 12, but the risks and benefits must be carefully weighed.

In some cases, treatment is not necessary. Avoiding tanning of normal skin can make vitiligo almost unnoticeable in fair-skinned people. Because the white skin of vitiligo has no natural sun protection, people of all skin colors should use a sunscreen with an SPF of at least 15 on all areas not covered by clothing to avoid burns.

Make-up, self-tanning compounds or dyes that stain the skin are a safe, easy way to make vitiligo less noticeable and improve the appearance of the patches.

If sunscreens and cover-ups do not produce satisfactory results, your dermatologist may recommend one of two types of treatment, repigmentation to restore color to the skin or depigmentation to destroy the remaining pigment.