What is vitiligo?
Vitiligo (rhymes with little-I-go) is often referred to as leucoderma by patients. It is believed to be an auto-immune disease.
Vitiligo right side face before treatment
Vitiligo right side face after NBUVB treatment
What is an auto-immune disease?
In an auto-immune disease, a person’s immune system produces antibodies against his/her own organs/tissues. In vitiligo, antibodies attack and destroy specialized cells in the skin (melanocytes) , which are responsible for producing the skin pigment (melanin).
What are the distribution patterns of vitiligo?
There may be just one or a few white patches on the body. This is called focal vitiligo.
It may affect only one side of the body. This is termed segmental vitiligo.
When there are many white patches on the body, the condition is referred to as generalized vitiligo.
Sometimes the hair on the white patches also turns white. This is called leucotrichia.
In rare cases vitiligo can affect eye colour as well as the pigment in the retina.
Vitiligo left side face before treatment
Vitiligo left side face after NBUVB treatment
What are the treatment options for vitiligo?
Vitiligo is a difficult disease to treat. Traditional therapies include oral / local psoralens + UVA light (PUVA) and steroid creams. Newer treatments include Narrow-band UVB light, excimer lasers, topical tacrolimus, topical pimecrolimus, topical and oral JAK inhibitors and vitiligo surgery.
How long does it take to see improvement?
You should treat for at least 6 months before deciding that the method is not working. It may take 2 years or more to see good results.
Vitiligo forehead before treatment
Vitiligo forehead after NBUVB treatment
What is narrow-band UVB phototherapy?
Narrow-band UVB phototherapy is a relatively newer technology than UVA for treating vitiligo.
Can narrow band ultraviolet B be used to treat other skin diseases?
Apart from vitiligo, narrow band UVB is being used to treat psoriasis, atopic eczema, lichen planus, alopecia areata, persistent itching, pityriasis lichenoides and many other not so common skin diseases.
Vitiligo chin before treatment
Vitiligo chin after NBUVB treatment
What are the advantages of narrow band UVB over PUVA (psoralen + UVA)?
Oral psoralen cannot be given to children and pregnant ladies. It also needs to be withdrawn if there are troublesome side-effects like nausea and vertigo. If oral psoralen is given, patient needs sun-protection for the eyes for the next 24 hours. Narrow band UVB works well in most patients without psoralen. Therefore the problems linked to psoralen usage are not there with narrow band UVB. In addition exposure times are shorter and frequency (number of sessions per week) is also lower with narrow band UVB. NBUVB is today considered to be more effective in clearing the disease too.
However, we may sometimes choose PUVA over NBUVB.
What is khellin?
Khellin is a substance chemically related to psoralen. It has been used topically and systemically with sunlight and UVA (KUVA).
Vitiligo forearms before treatment
Vitiligo forearms after NBUVB treatment
What are JAK inhibitors?
JAK (Janus kinase) inhibitors are a relatively new class of drugs. A JAK inhibitor is a type of immune modulating medication which inhibits the activity of one or more of the Janus kinase family of enzymes (JAK1, JAK2, JAK3 and TYK2), thereby interfering with the JAK-STAT signalling pathway in lymphocytes.
Are JAK inhibitors safe?
As JAK inhibitors are a new class of drugs, it is perhaps wise to use them with caution.
Vitiligo legs before treatment
Vitiligo legs after NBUVB treatment
How do I treat vitiligo?
I treat vitiligo with Narrow Band UVB phototherapy, UVA phototherapy combined with oral and topical psoralens, topical corticosteroids, topical tacrolimus, topical pimecrolimus and also with topical and systemic JAK inhibitors.