dermatologic disorders
Vitiligo
Treatment of Vitiligo
Protection of affected areas from sunlight Topical corticosteroids andcalcipotriene Topical calcineurin inhibitors for face or groin involvement Narrowband ultraviolet B (UVB) or psoralen plus ultraviolet A (PUVA) therapy Vitiligo can be challenging to manage; initial repigmentation and maintenance of pigment can be unpredictable. Physicians must be aware of individual and ethnic sensibilities regarding uniform skin coloring; the disease can be psychologically devastating. All depigmented areas are prone to Sunburn and must be Small, scattered lesions may be camouflaged with makeup. With more extensive involvement, treatment is usually aimed at repigmentation. However, little is known about comparative efficacies of such treatments. Traditional first-line therapy is potent topical corticosteroids, which may also cause hypopigmentation or atrophy in normal surrounding skin as an adverse effect of chronic corticosteroid use. Calcineurin inhibitors (tacrolimusandpimecrolimus) may be particularly useful alternatives for treating areas of the skin (such as the face and groin), where adverse effects of topical corticosteroid therapy most commonly occur.Calcipotrieneblended withbetamethasonedipropionate may also be helpful and more successful than monotherapy with either drug. Oral and topical PUVA are often successful, but over a hundred treatment sessions may be necessary, which can increase risk of Overview of Skin Cancer . Narrowband UVB is as effective as topical PUVA and has few adverse effects, making narrowband UVB preferable to PUVA. Narrowband UVB is often the preferred initial treatment for widespread vitiligo. Excimer laser (308 nm) may be useful, particularly for localized disease that does not respond to initial topical therapy. Surgery is reasonable only for patients with stable, limited disease when medical therapy has failed. Therapies include autologous micrografting ( Treatment references ), suction blister grafting, and tattooing; tattooing is especially useful for difficult-to-repigment areas such as the nipples, lips, and fingertips. applied twice a day. This treatment is indicated only when most of the skin is involved and the patient is prepared for permanent pigment loss and the subsequent increased risks of photo-induced skin damage (eg, Overview of Skin Cancer , (JAK 1 and 2) is available for the treatment of vitiligo ( Treatment references ). Another JAK inhibitor, 1.Gan EY, Kong YL, Tan WD, et al: Twelve-month and sixty-month outcomes of noncultured cellular grafting for vitiligo.J Am Acad Dermatol75(3):564-571, 2016. doi: 10.1016/j.jaad.2016.04.007 2.Rothstein B, Joshipura D, Saraiya A, et al: Treatment of vitiligo with the topical Janus kinase inhibitorruxolitinib.J Am Acad Dermatol76(6):1054-1060.e1. doi: 10.1016/j.jaad.2017.02.049 