Tips for Treating Vitiligo from Dermatology Specialist Dr. Alicia Cool

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Dermatology specialist Dr. Alicia Cool with Advanced Dermatology PC Answers Questions about Vitiligo, Loss of Skin Pigmentation

Dr. Alicia Cool

Vitiligo isn't contagious and it isn't medically harmful but it can have serious consequences for emotional and psychological well-being.

One to two million Americans suffer with a blotchy loss of skin color that is characteristic of the condition called vitiligo. It can affect anyone but is more noticeable in those with darker skin. “Vitiligo isn't contagious and it isn't medically harmful but it can have serious consequences for emotional and psychological well-being,” says dermatology specialist Dr. Alicia Cool with Advanced Dermatology, P.C. “And while we cannot cure it, we can treat it in ways that minimize or camouflage its cosmetic effects.”

What are the symptoms of vitiligo?
Vitiligo typically starts with small areas of light or white skin, often in areas exposed to the sun such as the hands, feet, arms, legs and face, and while it doesn't always spread further, the white areas may get larger or appear on other parts of the body over time. Other symptoms may include premature whitening or graying of the hair and loss or change of color of the retina of the eye and the mucous membranes that line the mouth and nose.

There are three types of vitiligo, reflecting the pattern in which pigment is lost. In generalized vitiligo, the most common type, the white patches are all over the body, usually in a symmetrical pattern; in the segmental type, de-pigmentation occurs only on one side of the body; and in focal vitiligo, patches appear in only one or a few isolated areas.

What causes vitiligo?
The loss of skin pigment that characterizes vitiligo occurs when melanocytes – the cells that produce melanin – die or stop producing melanin. It isn't known precisely what causes the destruction of these cells but it is thought to be an autoimmune response in which the immune system identifies the melanocytes as dangerous and attacks them. Some cases of vitiligo seem to be triggered or made worse by a single event, such as a severe sunburn or stress. Vitiligo sometimes runs in families, indicating that a genetic predisposition makes people susceptible to de-pigmentation.

How is vitiligo treated?
Treatments for vitiligo aim to even out skin tone. “The most effective option for each patient depends on the size, location and number of white patches,” says Dr. Cool, “as well as each person's tolerance of possible side effects, which you should discuss thoroughly with your doctor when deciding on treatment.”

  •     Topical steroid creams can return color to the skin over several months and are most effective when used early in the progression of the disorder.
  •     Topical immuno-suppressant ointments are most effective on small area of de-pigmentation, especially on the face and neck and may be used in combination with ultraviolet B (UVB) light.
  •     Ultraviolet A (UVA) therapy (photochemotherapy) uses UVA rays in combination with an oral or topical form of a medication called psoralen, which helps absorb the light. After exposure to the light, the skin turns pink and then changes to a more natural color. It is generally used when the areas of de-pigmentation cover 20% of the body.
  •     Narrow-band ultraviolet B (UVB) light uses a more specific wave length of light than UVA and does not require use of psoralen before treatment.
  •     Excimer laser therapy returns pigment to the skin by focusing light of a specific wave length directly on the affected skin and works best on small areas.
  •     De-pigmentation doesn't treat the affected skin but lightens the healthy skin to even out skin tone. It is used only when vitiligo is very widespread or if other treatments haven't worked. Medication is applied to the skin daily for an extended period, often a year or more, gradually lightening the skin.

There are also surgical treatments for vitiligo, including skin grafts and tattooing, in which pigment is implanted into the skin. Some people may also elect not to treat the condition; depending on how widespread the loss of pigment is and where it occurs, self-tanning lotions and cosmetics can provide effective cover.

Dr. Cool concludes: “Given the wide range of ways in which vitiligo affects appearance and the number of therapies available, it is important for each individual to learn about the condition and consult with an experienced dermatologist to determine the best course of action.”

Advanced Dermatology P.C. and the Center for Laser and Cosmetic Surgery (New York & New Jersey) is one of the leading dermatology centers in the nation with 13 locations in New York and New Jersey, offering highly experienced physicians in the fields of cosmetic and laser dermatology as well as plastic surgery and state-of-the-art medical technologies. http://www.advanceddermatologypc.com.

Bio: Alicia Cool, M.D., F.A.A.D., is a board-certified dermatologist, specializing in all areas of medical dermatology, skin cancer prevention and treatment and cosmetic dermatology.

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