Vitiligo is an autoimmune disease characterized by the destruction of melanin-producing cells (melanocytes) by immune cells (cytotoxic T lymphocytes). It manifests itself with the presence of white spots on the skin: these are hypochromic / achromic patches due to the absence of the melanic pigment at the level of the affected skin areas.
Like all autoimmune diseases, vitiligo has an unpredictable course and its therapeutic management is very complex. Vitiligo patients suffer greatly from this condition in which aesthetic impairment can have harmful consequences on a psychological and social level.
The patient considers this pathology disfiguring, a reason for a reduction in their self-esteem and quality of life, especially when the most visible areas are affected, such as the face.
Vitiligo therapy aims to restore the original appearance of the skin, stabilizing the depigmentation process and promoting the repigmentation of the patches. Considering that melanocytes respond slowly to therapies, it is necessary to allow for a time of 6-12 months to obtain satisfactory results.
Local therapy for vitiligo
Local therapy of vitiligo makes use of the application of cortisone-based creams (topical corticosteroids) to the patches for 1-2 times a day for a variable period of 2-4 months or calcineurin inhibitors (tacrolimus and pimecrolimus).
Treatment with topical corticosteroids is only recommended in cases of localized vitiligo involving the
In children, it is recommended to use lower potency corticosteroids or to apply calcineurin inhibitors, particularly in more sensitive areas where the use of corticosteroids is contraindicated.
Encouraging results were also obtained with the excimer laser, capable of emitting a monochromatic light similar to the UVB used in phototherapy with the difference of greater selectivity for the patches of vitiligo. It is therefore particularly indicated in patients with localized forms, also in association with local topical therapy.
UV phototherapy and heliotherapy for the treatment of vitiligo
In the presence of a more widespread form of vitiligo, the treatment of first choice is phototherapy with narrow band UV, a therapy that makes use of the use of lamps through which the beneficial effects of UV rays on stimulation are exploited . of melanocytes to favor the repigmentation of the patches.
Micro-phototherapy is based on exposure to UV light only in the affected areas, with a reduction in the total exposure dose and the advantage of not increasing the color contrast between healthy skin and patches. It is only recommended if the affected area does not exceed 20% of the body surface. Phototherapy is often associated with topical therapy and the intake of supplements based on vitamins and a pool of antioxidants (alpha lipoic acid, Polypodium leucomotos extract, vitamin C, vitamin E) which favor the repigmentation process.
