Vitiligo and treatments

Vitiligo is one of the most ancient chronic skin diseases, but not fully understood. It occurs suddenly and cannot be completely cured. It is characterized by an unpredictable course and can manifest itself at any age, but it more often affects young people under 25. It does not threaten health but completely changes a person’s life due to its strong effect on his appearance. It is manifested by prominently discolored (depigmented) areas of the skin on the face, body, and limbs.

The natural skin dye, melanin, ceases to be produced in these places. Due to the characteristic symptoms of vitiligo, it is even diagnosed visually. This disease has been known for a long time, but a life-saving medicine has not yet been found to restore the skin to its previous appearance. But this does not mean that the therapy is ineffective. Not only do medicines help achieve results,

Vitiligo spots: types and localization

The disease has two forms: segmental (SV) and non-segmental (NSV). In the first case, the lesions are located on one part of the body and do not move to another. More often, they are located on the face and capture the scalp, causing leukotrichia (graying of hair, eyebrows, and eyelashes). A rapid onset in childhood characterizes it, but after a year or two, the process stabilizes and does not progress further. The non-segmental form is more common in adults. With this type of vitiligo, the spots have a bilateral symmetrical arrangement on the limbs and body. Over time, they spread and merge, but the hair is rarely affected. In some medical writings, these two varieties are considered independent diseases with their manifestations.

Depending on the prevalence, the depigmentation process is localized and generalized. With a localized form, single discolored foci are detected; with a generalized form, more than 50% of the skin area is affected. A universal form is diagnosed if almost the entire body is captured. Vitiligo spots can also be polychrome: three-, four-, and even five-colored. This is manifested by the fact that the skin acquires several shades. With a tricolor type, it is natural, corresponding to a person’s phototype, bleached and almost white.

Another dark brown tint appears with a four-color one, and with a five-color one, a grayish one appears. The darker the skin, the more noticeable this difference will be. Rare varieties also include depigmented foci in the form of confetti or very small peas (1-2 mm), randomly “scattered” over the body.

Is there a cure for vitiligo?

Qualified dermatologists always warn patients that this disease is not completely curable. The help of a psychologist may also be required because, after a diagnosis, a person experiences severe stress. To reduce the negative impact on the quality of life, you need to accept this disease and learn to live with it. Indeed, apart from aesthetic discomfort, other symptoms of patients do not bother them. People with fair skin are advised not to treat vitiligo but to limit themselves to masking creams. But this is the wrong approach because any neglected disease can progress.

Although vitiligo is not completely cured, various therapies are practiced. These are external means in the form of creams, medicines, and courses of ultraviolet irradiation of the skin (phototherapy). Each of them acts in its way, but the common goal of their use is to normalize the production of melanin pigment and other processes in the epidermis. Both individually and in combination, they stop the appearance of new spots and reduce the severity of depigmentation. If successful, patients note that the lesions darken and no longer stand out on the skin. This result is the main goal of therapy.

Causes and principles of treatment for vitiligo

Doctors and patients need to know the mechanisms of development and causes of chronic skin diseases. This helps to explain how certain methods work and why they do not lead to a complete recovery. Despite the large amount of data collected, investigating the entire chain leading to permanent skin discoloration has not yet been possible. But several mechanisms are known that allow them to be affected by therapeutic agents. They can have a superficial effect or influence internal processes. Internal influences on cells are more effective than attempts to eliminate external manifestations.

The pigment melanin, which is responsible for skin coloring, is produced in melanocyte cells. First, the amino acid tyrosine is oxidized, and after several other transformations, a coloring pigment is formed. The causes of vitiligo are considered to be a delay in converting tyrosine to melanin and the destruction of melanocytes by T lymphocytes or oxidative stress.

There is a version of damaged genes that parents pass on to their children. This year, scientists also researched and determined that the main skin cells (keratinocytes) are also involved in the disease. This is expected to help search for new drugs that will affect their metabolic processes. But so far, the basic treatment of vitiligo aims to normalize the production of coloring pigment and inhibit the atypical immune response that damages melanocytes.

Treatment of vitiligo with folk remedies

People resort to alternative medicine for chronic skin diseases before or after classical therapy. Herbal remedies cannot eliminate the disease, but when used correctly, they have a certain effect on the skin. There are many positive reviews about using homemade pastes, decoctions, and tinctures for depigmentation. St. John’s wort oils are used, which increase the skin’s sensitivity to ultraviolet radiation and promote the natural production of melanin.

One of the causes of the disease is oxidative stress, which black cumin protects against. Often used, folk remedies for vitiligo with duckweed containing iodine and bromine salts. You can prepare a decoction based on duckweed with honey or choose other plants: chamomile, sage, calendula, and nettle. Inside, take an alcohol tincture of ginseng, a decoction of chicory root, or a Chinese magnolia vine. A decoction with red pepper or from the leaves of Ginkgo biloba is suitable for compressing.

What vitamins should I take for vitiligo?

The relationship between the development of this disease and the deficiency of vitamins and trace elements has long been determined. First of all, it is vitamin D3, the lack of which plays an important role in the development of skin diseases of various origins (psoriasis, atopic dermatitis). With autoimmune disorders, their level decreases.

Therefore, synthetic analogs of vitamin D, calcipotriol, and tacalcitol began to be included in the treatment regimen for vitiligo. It has been proven that this allows you to control the activation of melanocyte cells and the formation of melanin pigment. It is believed that pigmentation disorders may be associated with a lack of B12 (cobalamin). Patients are also advised to take long-term folic acid (B9).

In addition to vitamins for vitiligo, complex therapy includes microelements necessary for health. Food products and nutritional supplements contain copper, iron, cobalt, iodine, zinc, and selenium. For example, analysis of bleached hair from patients showed a marked decrease in copper (in women) and zinc (in men). A lack of manganese and cobalt was also found.

Studies have been conducted that have shown that, in combination with cream for vitiligo, the intake of micro- and macroelements contributes to the stabilization of the skin-pathological process. Combining this effect with ultraviolet irradiation (phototherapy) can also enhance this effect. At the same time, this helps solve the problem of vitamin D3 deficiency. Under the influence of medium-wave UVB rays, its natural synthesis occurs in the skin.

Popular creams for vitiligo

Depending on the mechanism of action and composition, they can be divided into three groups:

✓ Cosmetic. These are tonal masking agents for external therapy that do not have a therapeutic effect. Allow to smooth out the difference between normal and depigmented skin. They are used mainly for the face and open areas of the body. These include, for example, Coverderm, which includes coloring pigments (10 shades). The reviews are not the most positive since achieving a uniform skin color is very difficult. Another means of disguise is viticolor gel. Suitable for people with dark skin because the light effect is unsatisfactory. A whitening agent, Achromin, with vitamin B3 and green tea extract, brightens healthy areas.

✓ Natural. Vitiligo creams with a natural composition have a certain therapeutic effect but are more supportive therapy. Designed for long-term use. Important: the effect can be achieved only in combination with drugs or with ultraviolet irradiation! A popular remedy is Vitilemna with duckweed extract. It has already been mentioned that this plant is used in folk medicine. Apply Egallohit cream with green tea extract and mineral oil or Vitix with melon extract and trace elements. Vitasan, with extracts of St. John’s wort and string, also belongs to natural remedies that enhance pigmentation.

✓Healing. Vitiligo creams from this category are basic for local therapy. They may contain natural ingredients but must have an active ingredient in their composition. Doctors usually prescribe the non-hormonal remedy Elidel with the active substance Pimecrolimus. It is a calcineurin inhibitor with immunosuppressive and dematotropic properties. A separate cream for vitiligo, Pimecrolimus, is also available.

Another calcineurin inhibitor, Tacrolimus, is part of Tacropic ointment with a similar effect. To enhance the effect, it is recommended to use them in combination with narrow-band phototherapy of 311 nanometers, whose effect we will consider later. Of the latest products, the Americans introduced Opzelura cream based on ruxolitinib, which is sold only abroad.

Medications for vitiligo

The choice has much in common with the schemes of external therapy. Moreover, the composition of therapeutic ointments and tablets for oral administration includes the same active substances.

• non-hormonal agents These include calcineurin inhibitors, which are topical immunomodulators. They interfere with the activity of cytokines and T lymphocytes that cause inflammation and atypical immune responses. They have already been mentioned in connection with creams. They are also available in the form of drugs: Protopic and Tacrolimus. They can be taken for up to 2 months. As with external applications, combining the reception with ultraviolet irradiation at 311 nm is recommended. Non-hormonal is also a synthetic analog of vitamin D3 (calcipotriol). Regulates local immunity and promotes the maturation of melanocytes.

• Hormonal agents These are drugs for vitiligo based on topical glucocorticosteroids (GCS) of medium and high activity. They are similar to natural steroid hormones and can normalize the immune response. They are included in the basic therapy for other autoimmune diseases (psoriasis, parapsoriasis). With depigmentation of the skin, they are advised to be used externally, but with the progression of the process, they are prescribed orally or as injections of triamcinolone acetonide. A synthetic analog of the hormone that stimulates the production of melanin pigment in the skin is afamelanotide (melanotan).

• New drugs for vitiligo In recent years, dermatologists worldwide have been actively interested in Janus kinase inhibitors. In short, these protein substances block the intracellular signaling system that activates the provocateurs of the inflammatory process (cytokines). Ruxolitinib and Tofacitinib are positioned as new drugs for vitiligo. They can be prescribed for a long time—more than a year. These drugs have also begun treating severe psoriasis, atopic dermatitis, eczema, and alopecia areata. But these drugs are unavailable for most patients because of their very high price.

Treatment of vitiligo with ultraviolet light

Since the middle of the last century, domestic medicine has successfully used sunbathing with vitamins. However, this must be done correctly so that the difference between normal and discolored skin does not become even more noticeable. Today, phototherapy courses use special lamps that generate ultraviolet light. These can be rays of the long UVA spectrum (320–400 nm) or the medium UVB spectrum (280–320 nm).

Vitiligo treatment with UVA is resorted to in its generalized form when depigmentation covers more than half of the body. This method is called PUVA therapy and is carried out along with taking photosensitizing drugs. It is dangerous because, with prolonged or repeated courses, it causes photoaging and pronounced pigmentation of healthy skin.

With segmental and non-segmental varieties with lesions up to 15-20% of the skin, the priority is the treatment of vitiligo with ultraviolet B (UVB) radiation. And narrow-band, with a wave emission peak of 311 nanometers (NB-UVB). No additional medications are required. The waves themselves are energetically strong and capable of exerting an immunosuppressive effect. They activate the natural synthesis of vitamin D3 in the skin and the production of melanin pigment. The method is suitable for all skin types and can be performed on children as young as seven.

Unlike PUVA, it does not cause phototoxic reactions! Perhaps the appearance of light pink erythema (redness), but after a day, it passes. Vitiligo treatment with ultraviolet light (311 nanometers) is carried out throughout 20 to 25 procedures. Most effective for fresh spots that have appeared over the past couple of years.

Where and how do you treat vitiligo?

To answer the question, we summarize and supplement the information provided. Today, there is a large selection of natural ointments and therapeutic creams for local effects. It is advisable to use them if depigmentation covers at most 20% of the skin because applying them all over the body is problematic. How do you treat vitiligo if the lesion progresses and approaches 50% of the area?

Medicines are here to help. This is the second line of therapy, usually resorted to in advanced and complicated stages. In addition to medicinal creams, ultraviolet irradiation of the skin also belongs to first-line therapy. It is used as an independent method (monomethod) or in combination with creams and preparations. To enhance the action, they must be combined with phototherapy. Otherwise, the cream will have no visible effect, which most patients confirm.

Regarding where to treat vitiligo, it depends on the chosen method. Medical institutions offer radical methods—for example, surgery. Young people undergo epidermal transplantation—their healthy tissues are transferred to depigmented areas. Doctors have found another way to treat vitiligo. This is a well-known method of plasmolifting used in various fields. Platelet-rich plasma is taken from the patient’s blood and injected into the lesions. But most patients adhere to the traditional scheme. And when answering where to treat vitiligo, they answer, “at home!

After consulting with a doctor, you can independently use folk remedies, pharmacy creams, and vitamins. Carrying out a course of phototherapy at home became possible after the appearance of UV irradiators with effective and safe radiation at the peak of 311 nm.

Vitiligo home treatment with 311 nanometers of ultraviolet light

Chronos LLC manufactures certified devices for the phototherapy of skin diseases at home. When localized on the body, a portable irradiator called Ultramig-311 is used. You need to put it on a flat surface and turn it on. Before the procedure, you must put on glasses (included) and apply a protective cream to healthy, non-pigmented skin.

Irradiation should only be exposed to lesions where recovery processes will occur. If they are single, then for the treatment of vitiligo with ultraviolet 311 nanometers at home, an irradiator comb called Ultramig-311R is used. It is held in hand and directed to discolored areas on the arms, legs, neck, and face. Suitable for restoring pigmentation on the scalp. The device is inexpensive and convenient to use. Khronos’s own-produced irradiators can be ordered with delivery to all regions of Russia. Not the first year they have been successfully used in the home treatment of psoriasis, parapsoriasis, eczema, seborrhea, atopic dermatitis,