The skin gets its color from melanin. Melanin is produced by melanocytes. Melanocytes are found in large numbers in the upper skin layer known as the epidermis. When melanocytes are absent or lose their ability to produce melanin, the skin appears pale but mostly milky-white. This disease is called vitiligo.
Vitiligo doesn’t cause serious complications. However, it makes affected areas particularly sensitive and prone to sunburns. The other common complication is cosmetic concern. In fact, vitiligo is more mentally than physically challenging. Is vitiligo hereditary? About 30% of all cases are hereditary but autoimmune activities are responsible for the largest percentage.
There are a variety of treatment methods available. Most seek to even skin tone or restore skin pigment. This article discusses micropigmentation and laser therapy options. They are among the commonly considered treatments for vitiligo.
Micropigmentation for vitiligo
Micropigmentation for vitiligo works best for vitiligo that is not spreading or has been in remission for two to three years.
How it works:
In simple terms, micropigmentation involves implanting pigment in vitiligo affected areas. The process is in several ways similar to tattooing.
The pigment used during micropigmentation is metabolically inert. This means that it doesn’t break down during body process, some of which may be causing vitiligo. Patients can therefore enjoy longer lasting effects compared to most other treatments.
Before the process, consult with the specialist who will carry out the procedure as required. The patient’s skin coloring will be carefully analyzed. In some cases, sample pigments will be implanted and monitored in the course of a month. This ensures that the right skin tone is achieved.
During the process, an electronic device will be used to implant the pigment in affected areas. For best results, thin layers are implanted to ensure that the skin looks completely natural. This means that more than one treatment will be required, 2-4 in most cases. The whole process can be done in two hours by a specialist. Patients may be put under local anesthesia or numbing agents.
How effective is it?
Results are noticeable immediately after the process. However, it may take up to 3 weeks for the desired results to fully kick in. Patients will be required to go for follow-up appointments. This is because side effects such as swelling are common. Most patients will have recovered by the sixth week after treatment. Side effects of micropigmentation are usually tolerable.
What is the cost?
Most insurance providers do not cover for micropigmentation fees. It is considered a cosmetic procedure. For this reason, the process can prove quite expensive, reaching a couple of hundred dollars in most cases.
Possible risks of micropigmentation for vitiligo
Before and after micropigmentation, patients risk the following.
One of the known potential causes of vitiligo is cuts. Cuts may produce enough skin trauma to trigger vitiligo cycles. This can be repeated during and after micropigmentation. The process of manually implanting pigment can be quite cruel especially to people with a history of allergic reactions and conditions such as atopic dermatitis.
Infections are common complications of surgical operations. In fact, outpatient treatment is sometimes preferred when circumstances allow. This is because hospitals are good breeding places for bacteria and other infectious pathogens. One way to avoid this complication is getting the operation done by a professional.
It is almost assured that trauma will always result in swelling. It is a natural reaction the body uses to protect itself from more damage. The good thing is that the swelling that results from micropigmentation improves gradually and disappears in about a month or less. It also is rarely intolerable.
When a wound is healing, scar tissue forms on top of the injured area. Normal scar tissue regresses over time. When keloids form in scar tissue, an irregular, pink or purple colored lump with a smooth top develops. Keloids are usually unsightly and don’t regress.
Removing pigment implanted during micropigmentation is way harder than implanting it. This can pose a major problem if in the future you decide to get rid of the pigment. It would be more like what happens with reverse vitiligo.
Other than risks, there are several identifiable limitations of micropigmentation. Herpes and HIV patients for example are not good candidates for the process. This also goes for people with a history of skin problems such as psoriasis. As it can be seen, micropigmentation is not applicable for widespread vitiligo. It works better for cases such as vitiligo on the lips or segmental vitiligo.
PUVA phototherapy for vitiligo
Phototherapy for vitiligo mainly relies on light to bring about repigmentation. While it perhaps is the most practical and effective treatment method for vitiligo, complete repigmentation is not guaranteed. Regained pigment may also disappear in a few years time. PUVA therapy is a commonly used type of phototherapy for serious skin diseases including vitiligo. Although it works for most types of vitiligo, best results are achieved when the disease covers less than 20% of body area.
What is PUVA?
PUVA therapy is a combination of psoralen and UVA. Psoralen is a compound derived in plants. It makes the skin more sensitive to UVA light. UVA light is a type of ultraviolet radiation that causes skin tanning. These two substances are used together to restore skin pigment in vitiligo skin disorder patients.
How it works:
Psoralen can be taken by mouth or be applied directly. In some cases, it is added to bathwater in which patients soak.
UVA light is shone on targeted areas depending on severity of the disease. If it has spread through most of the body, the patient is required to stand in a cabinet where UVA fluorescent bulbs are fixed. Clothes and goggles are used to protect unaffected areas. The exposure duration varies from a minute to half an hour.
How effective is it?
About 75% of all patients will notice improvements with PUVA therapy after 4-6 months. It is not however guaranteed that complete repigmentation will occur. In fact, chances are that some of the regained pigment will disappear after about 4 years. Best results are achieved for vitiligo on face and in darker skinned individuals.
Side effects of PUVA therapy may include:
- Burns – most of sunlight that reaches us is UVA radiation. Although UVB radiation is largely responsible for sunburns, UVA can also produce a burning effect. The effect is worst after the first treatments.
- Eye damage – psoralen is harmful to eyes. UV radiation can also damage unprotected eyes. Patients should always wear protective goggles during treatment.
- Itchiness – patients often experience mild itchiness after PUVA therapy. This can be managed with medications and skin moisturizers.
- Skin damage – excessive exposure to UVA leads to loss of collagen. This results in premature skin aging, which among other things increases the chances of skin cancer.
Narrowband UVB for vitiligo
More effective treatments for vitiligo are introduced now and then. Some like narrowband UVB are improvements on preexisting methods.
How it works:
As the name suggests, UVB is used in this case, radiation in the range of 311-312 nm to be specific. It has been noted that this radiation stimulates production of melanocytes before it can cause the burning effect associated with UVB.
This treatment is considered for vitiligo covering more than 20% of the body. It can be done in a hospital or at home with an artificial UVB lamp for vitiligo. The former is more convenient for widespread vitiligo, where patients stand in cabinets to receive UVB doses. It is very important that instructions given by a doctor be followed to the letter when using UVB lamp. This is partly because such devices are associated with skin cancer, including melanoma.
This type of light therapy can be used for vitiligo baby treatments. That is as long as they are old enough to keep protective goggles on when instructed to do so.
Topical medications and other treatments can be used with UVB therapy. Regardless, the treatment works just fine on its own for most patients. In a period of one to one and half years, 60% repigmentation will have occurred in a majority of patients.
Skin burning is the main potential side effect. This can be avoided by staying exposed only for the instructed duration of time. Since UV radiation is associated with cancer of the skin, care should be taken when using UVB lamp for vitiligo in long term. Other side effects may include itchiness and eye damage.
Excimer laser vitiligo treatment
Excimer vitiligo laser treatment is a new treatment option which promises faster and better results with very few side effects.
What is it?
Excimer laser vitiligo cure is a type of light therapy. It relies on UVB light, much like narrowband UVB. The main difference is the fact that with excimer laser, fiber optic technology is used to focus a beam of light to specific areas. This prevents unnecessary exposure of UV radiation.
UVB light works on the same principle of stimulating production of melanocytes. Since more light is able to be focused within a short period of time, the risk of suffering from skin damage is minimized. This treatment should be done by a doctor.
With other therapies, it is usually necessary that other forms of treatments such as medications and creams be also used. It is not the same with the excimer laser. While your doctor may suggest use of sunscreens and maybe cover lotion, the excimer laser is able to restore pigment on its own. Surgery is perhaps the only other treatment method that may produce better results than the excimer laser under the same period of time. Its precision allows it to be applicable even in cases such as vitiligo scrotum, rectal or genital treatments.
Other advantages include prevention of other skin conditions such as eczema and psoriasis as well as providing desirable effects painlessly. This is not to mention that the excimer laser is not associated with side effects such as skin damage.
Vitiligo patients face a cruel challenge of being the centre of attention, or even being accused of bleaching. Tamar Braxton vitiligo saga is a good example. While completely getting rid of vitiligo still remains a challenge, micropigmentation and light therapies can really help.
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