Vitiligo, a challenge for the dermatologist

Vitiligo is an acquired pigmentary disease characterized by the appearance of acromic, milky-white spots on the skin and mucous membranes. This is due to the destruction of melanocytes, which are the cells that synthesize and secrete melanin, the main pigment that colors the skin.

Multifactorial causes of vitiligo

The cause of vitiligo is unknown, but it is considered multifactorial, involving genetic factors, alterations in immunity, cytotoxic phenomena within the melanocyte and even neurological factors. On the other hand, there are triggering factors, the main one being stress.

White spots on the skin, the first symptom of vitiligo

White spots can appear in any location of the skin integument and are the main symptom of vitiligo. The size of the spots varies from a few millimeters to several centimeters, and they may converge, causing large areas of depigmentation. The hair may also be affected, bleaching it. The spots are asymptomatic and are located mainly around the eyes and mouth, back of the hands, forearms, scalp and genital area.

Vitiligo can have a stable character, in which there is no change in the number or size of spots for months or years or, on the contrary, the patient can present an active vitiligo with continuous appearance of spots.

Treatment for vitiligo according to degree of involvement

Vitiligo has always been a therapeutic challenge for the dermatology specialist. When vitiligo is localized or not very extensive, topical treatments are used: corticosteroid cream, calcineurin inhibitors. They are generally prolonged treatments and are most effective on the head and neck. Phototherapy is another treatment option, either with PUVA (psoralens plus ultraviolet A light) or narrow band ultraviolet B, but they are more used in extensive lesions. Other therapeutic possibilities are 308nm excimer laser or autologous skin mini-grafts.

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In the case of active or unstable vitiligo, patients can be treated with oral corticosteroids with similar results. Recently, it has been observed that adding oral corticosteroids to treatment with narrow-band UVB achieves better results than with corticosteroids alone.