Vitiligo Vulgaris best treatment is
The best treatment in vitiligo vulgaris is topical coicosteroids. Vitiligo vulgaris is a localized depigmentation. It is an acquired condition resulting from progressive loss of melanocytes characterized by milky white sharply demarcated macules. First line treatment is topical coicosteroids and topical calcineurin inhibitors Second line-phototherapy: There is no cure for vitiligo but several treatment options are available.The best evidence is for applied steroids and the combination of ultraviolet light in combination with creams.. Lesions located on the hands, feet, and joints are the most difficult to repigment; those on the face are easiest to return to the natural skin color as the skin is thinner in nature. Immune mediators: Topical preparations of immune suppressing medications including glucocoicoids (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: *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 repoed that a combination of UVB phototherapy with other topical treatments improves re-pigmentation. *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. Longer treatment is often recommended, and at least 6 months may be required for effects to phototherapy. NBUVB phototherapy appears better than PUVA therapy with the most effective response on the face and neck. With respect to improved repigmentation: topical calcineurin inhibitors plus phototherapy are better than phototherapy alone, hydrocoisone plus laser light is better than laser light alone, gingko biloba is better than placebo, and oral mini-pulse of prednisolone (OMP) plus NB-UVB is better than OMP alone. *Skin camouflage 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. De-pigmenting 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 sunburn and melanomas. Depigmentation takes about a year to complete Ref Harrison 20th edition pg 1290
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