Vitiligo

What is Vitiligo?
Vitiligo is a acquired skin disorder. It is a skin condition of white patches resulting from loss of pigment. Any part of the body may be affected. Melanin, the pigment that determines color of skin, hair, and eyes, is produced in cells called melanocytes. If these cells die or cannot form melanin, the skin becomes lighter or completely white. Affected skin is particularly sensitive to sunlight.

A common idiopathic acquired depigmentation disorder, occurs mostly among young people.

Vitiligo affects at least 1% of the population, and occurs in all races. In half of sufferers, pigment loss begins before the age of 20. In one fifth, other family members also have vitiligo.

General Measures
Protection against sun exposure
The white skin needs sun protection because it can only burn, it cannot tan. The normal skin also needs protecting to prevent sunburn, and to reduce the contrast between the normal and the white skin.
Wear protective clothing. 
Stay out of the sun at peak periods. 
Apply sunscreen (Sun Protection Factor 30+). 

Use of cosmetics
Cosmetics are helpful to disguise the vitiligo. Dyes, stains and make-ups can be applied and with specialist help the results can be very satisfactory. 
Dihydroxyacetone-containing "tan without sun" products; take care not to apply to the normally tanned skin because this will also look darker. 
Water-resistant concealing make-up. 

Topical Treatments
Topical steroid cream
A potent anti-inflammatory cortisone cream may reverse the process if applied to the affected areas for a few weeks in their early stages.
Initial treatment with certain topical corticosteroid creams is practical, simple, and safe. If there is no response in 2 months, it is unlikely to be effective. A Physician monitoring every 2 months for signs of early steroid atrophy (thinning of the skin) is required.

Topical Oxsoralen
Much more complicated is the use of topical Oxsoralen (8-MOP). Oxsoralen is highly phototoxic (likely to cause a sunburn), and the phototoxicity lasts for 3 days or more. This should be performed only as an office procedure, only for small spots, and only by experienced physicians on well-informed patients. As with oral psoralens, 15 or more treatments may be required to initiate a response, and 100 or more to finish.

Ultraviolet Radiation
PUVA
This form of light treatment requires the patient to take a psoralen medicine and then be exposed to ultraviolet light (UVA). Gradual but partial repigmentation may results. Hands and feet respond poorly, faces and trunks do better. When the treatment is stopped, some of the pigment disappears again. PUVA takes less than five minutes twice weekly, and is continued for up to two years. PUVA is unsuitable for children or very fair skinned people. The pigment loss should have been present for less than 5 years.

Narrowband UVB phototherapy has also been effective, particularly in combination with calcipotriol cream.

Surgical treatment 
Mini grafting, which involves transplanting the patient's normal skin to vitiligo affected areas, may be a useful technique for refractory segmental vitiligo macules. PUVA may be required following the procedure to unify the color between the graft sites. Good results are seen, especially if the vitiligo is stable

Depigmentation therapy
If a dark skinned person has vitiligo affecting a large part of the exposed areas, he or she may wish to undergo depigmentation. A cream containing monobenzyl ether of hydroquinone is applied to the skin. This causes all the skin to lose its pigment. Its effect is usually permanent.