General measures
- If necessary, camouflage (corrective cosmetics) or permanent makeup (cosmetic treatment that uses micropigmentation to simulate waterproof, smudge-proof makeup that lasts for a long time).
- Avoid mechanical stimuli / injuries.
- Avoiding psychosocial stresses:
- Stress
Conventional non-surgical therapy methods
- Microdermabrasion followed by topical (topical) tacrolism treatment (see “Drug Therapy” below) is more successful than ointment treatment alone. This therapy resulted in very good repigmentation in 11.4% of the white patches. Repigmentation was dependent on the anatomical region of the lesions: Patches located on the neck and trunk showed greater than 50% repigmentation more often (75%) than those on the extremities (41%); hands and feet were repigmented to greater than half in only 7% of cases.
- Xenon-chloride excimer laser (308-nm excimer laser; monochromatic light); indication: localized vitiligo; three applications per week – The laser is suitable only for small areas, but it is well effective. There is a better and faster repigmentation, than with conventional UV therapies due to the higher dose that can be applied locally.
Physical therapy (including physiotherapy)
The following forms of phototherapy are used:
- Narrow-spectrum UV-B therapy (311-nm UVB); narrow-spectrum UV-B appears to be more effective than other phototherapies.Indications: extensive vitiligo; if >15-20% of the body is affected, whole-body irradiation is recommended; aim for just visible erythema (skin redness) during therapy; if treatment proves effective, continue for at least 9 months and a maximum of 2 years.
- Patients with narrow-spectrum UV-B therapy have no increased risk of developing melanoma (“black skin cancer“), nonmelanocytic skin cancer, or Bowen disease (in situ squamous cell carcinoma of the skin and transitional mucous membranes), according to one study. Patients with vitiligo with greater than or equal to 200 sessions had a significantly increased risk of actinic keratosis (chronic damage to the keratinized epidermis caused by long-term intense exposure to sunlight, which after years can lead to squamous cell carcinoma of the skin).
- Narrow spectrum UV-B therapy (311-nm UVB) if necessary in combination with oral supplementation of specific micronutrients; see “Therapy with micronutrients (vital substances)” – if necessary, taking a suitable dietary supplement.
- PUVA therapy (psoralen-ultraviolet-A: combined use of psoralen and UVA light), topical (“topical”) or systemicNote: Oral PUVA is currently used as second-line therapy in adult patients with generalized vitiligo. Compared with narrow-spectrum UV-B therapy, it has the disadvantage of lower efficacy and higher short- and long-term risk.RESULT: Repigmentation is seen in 70-80% of PUVA patients, but complete repigmentation is seen in only 20% of patients.
