Vitiligo therapy

Vitiligo  is an inflammatory skin disease, characterized by continuous local or disseminated depigmentation (loss of pigment) in the skin. Approximately 0.38-0.46% of the general population are affected by vitiligo; in some areas of the world up to 10%. Treatment goal for vitiligo is to stop further depigmentation while inducing a long-lasting and complete repigmentation. Various therapeutic approaches exist; especially phototherapy (treatment with UV-light) is one of the most widely employed and most effective treatment options: among those are narrow-band UVB_311nm- phototherapy or photochemotherapy (PUVA, KUVA) often in combination with topical steroids and vitamin-D-analoga.

We believe that you are already informed about the standard treatment alternatives. For further information, we suggest that you contact the German Vitiligo Foundation (Deutscher Vitiligoverein): www.vitiligo-verein.de

The following new therapeutic modalities are employed for the application of narrow-band UV-B radiation:

• Excimer-laser (Xenon-chloride excimer-laser, monochromatic light, 308nm). This laser is effective and useful for treatment of small areas (Baltas et al, 2002). Due to the high doses that can be applied locally, a faster and more effective repigmentation than with ordinary UV-B phototherapy can be achieved (Spencer et al, 2002).
• BIOSKIN Micro-phototherapy (focused beam of narrow-band UV-B radiation). Suitable for treatment of vitiligo affecting less than 30% of the body surface (Menchini et al, 2003).
• B-Clear: A flash-lamp with a wavelength of 290-320nm. Due to its wavelength, this gadget is effective and useful for treatment of small areas, similar to the excimer laser.
• Helium neon laser (low energy laser, 632,8nm). The alleged effect (as shown in vitro) is due to a stimulation of proliferation and enhanced migration of melanocytes through the release of mitogenic factors and thus alteration of the local environment which results in an amelioration of repigmentation (Yu et al, 2003). Clinical studies remain to demonstrate this effect in vivo.

During therapy only the affected skin is exposed to radiation. Treatments are carried out 3x/week and effects can be observed after 15-20 treatment sessions. The advantage of these new treatment modalities is the exposure of affected skin only, while sparing the healthy skin. Especially in vitiligo this approach is of great advantage as a contrast enhancement between lesional depigmented skin and healthy surrounding skin can be prevented.

Unwanted side-effects are the same as in other UV-B phototherapies: erythema of the skin, sunburn reaction with blister formation in case of overdosing and uneven pigmentation in the treated areas. Rarely, a vitiligo can be initiated/ exacerbated by this therapy when chosen UV-doses are too high (Köbner-Effekt).