Topical preparations of immune suppressing medications including glucocorticoids (such as 0.05% clobetasol or 0.10% betamethasone) and calcineurin inhibitors (such as tacrolimus or pimecrolimus) are considered to be first-line vitiligo treatments
Phototherapy Both UVA/Narrowband UVB
Phototherapy is considered a second-line treatment for vitiligo.Exposing the skin to light from UVB lamps is the most common treatment for vitiligo. The treatments can be done at home with an UVB lamp or in a clinic. The exposure time is managed so that the skin does not suffer overexposure. Treatment can take a few weeks if the spots are on the neck and face and if they existed not more than 3 years. If the spots are on the hands and legs and have been there more than 3 years, it can take a few months. Phototherapy sessions are done 2–3 times a week. Spots on a large area of the body may require full body treatment in a clinic or hospital. UVB broadband and narrowband lamps can be used,but narrowband ultraviolet picked around 311 nm is the choice. It has been constitutively reported that combination of UVB phototherapy with other topical treatments improves repigmentation.
Ultraviolet light (UVA) treatments are normally carried out in a hospital clinic. Psoralen and ultraviolet A light (PUVA) treatment involves taking a drug that increases the skin’s sensitivity to ultraviolet light, then exposing the skin to high doses of UVA light. Treatment is required twice a week for 6–12 months or longer. Because of the high doses of UVA and psoralen, PUVA may cause side effects such as sunburn-type reactions or skin freckling.
Narrowband ultraviolet B (NBUVB) phototherapy lacks the side-effects caused by psoralens and is as effective as PUVA.As with PUVA, treatment is carried out twice weekly in a clinic or every day at home, and there is no need to use psoralen.
Micropigmentation specially for Lips & Tips of fingers.
Depigmenting Approach :
In cases of extensive vitiligo the option to de-pigment the unaffected skin with topical drugs like monobenzone, mequinol, or hydroquinone may be considered to render the skin an even colour. The removal of all the skin pigment with monobenzone is permanent and vigorous. Sun-safety must be adhered to for life to avoid severe sun burn and melanomas. Depigmentation takes about a year to complete
Skin grafting :
Both mini skin grafting as well as split skin grafting are performed
Camouflage solutions :
In mild cases, vitiligo patches can be hidden with makeup or other cosmetic camouflage solutions. If the affected person is pale-skinned, the patches can be made less visible by avoiding tanning of unaffected skin
Melanocyte Transplantation :
Melanocyte transplantation Also known as Non-cultured Melanocyte-Keratinocyte Transplantation Procedure (MKTP) is the latest modification in the surgical management of Vitiligo/Leukoderma. It involves separating skin cells from normal skin and transplanting on white spots as a cell suspension after removal of upper layer of skin superficially. It can be performed in 1 to 3 hours as a day care procedure
The Procedure step-by-step
In a clean procedure room, a thin shave biopsy is taken. The most common site is anterior, upper third of thigh.
The biopsy is processed using an enzyme to separate the layers of skin and to make a skin cell suspension. This suspension contains melanocytes-keratinocytes (epidermal cells).
The area to be treated is abraded with diamond fraize wheel and the cell suspension is applied. It is covered with collagen sheet, which helps to keep cells in place and promotes healing.
The final dressing consists of a micropore or tegaderm depending on sites involved.