For skin to be repigmented, new pigment cells must be recruited from those that exist nearby. That means that new pigment cells must come from the base of hair follicles, from the edge of the lesion, or from the patch of vitiligo itself if depigmentation is not complete. The maximum amount of repigmentation that can be expected in any one spot in a year of treatment is an eighth to a quarter of an inch. If, in a given area, most of the hair follicles provide pigment cells that radiate to one eighth to a quarter of an inch, there may be substantial repigmentation. However, if the hairs are white or if there are no hairs present, repigmentation must occur from the edge of the depigmented area.
Hydrocortisone-type compounds (immunomodulators and immunosuppressants), when applied to the skin, slow the process of depigmentation and sometimes enhance repigmentation. Cortisone ointments or creams sold over the counter, such as 0.5% hydrocortisone,are too weak to be effective. More potent cortisones are available by prescription. When potent cortisones are used daily for a long time, they may produce side effects such as thinning of the skin. Under the care of a dermatologist, it is usually possible to adjust the treatment with topical hydrocortisone such that side effects are minimized.
Phototherapy methods can also be used to induce repigmentation of the skin, either alone or in combination with hydrocortisone-type compounds. These forms of therapy consist of narrow-band ultraviolet B (UV-B) light, excimer laser, and PUVA (psoralen plus UV-A).
Narrow-band UVB (also referred to as narrowband and NB-UVB) is a relatively new vitiligo treatment option that helps to repigment cells with minimal to no side effects. It involves exposing the skin to a narrow-band UVB light source, which can be done in a doctor's office or using home phototherapy units. Typically treatment is done three times week for several months.
Excimer laser treatment involves exposing the skin to a beam of focused laser light. It is most commonly used for small areas of depigmentation. The majority of patients with head and neck depigmentation achieve substantial repigmentation in less than four months. Treatment must be done by a doctor; no home units are available at this time.
In PUVA, a patient is given a psoralen drug and is then exposed to UV-A light. When psoralen drugs are activated by the light, they stimulate repigmentation by increasing the movement of pigments cells into the vitiligo lesion. The response varies among patients and body sites. PUVA therapy is no longer the first choice of phototherapy given the availability and relative success of narrow-band UVB and excimer laser treatments.
About 75% of the patients who undergo PUVA therapy respond to some extent. Even for these individuals, complete repigmentation rarely occurs. After the initial two to three weeks of exposure to sunlight, patients will look worse since the contrast between their light and tanned skin increases. With time repigmentation will begin, and the appearance of the skin will improve. If therapy in stopped in winter, most people will retain at least half of the color they achieved during the summer months.
People with vitiligo should always protect their skin against excessive sun exposure by wearing protective clothing, staying out of the sun at peak periods (except during doctor-approved treatment times), and applying sunscreen lotions and creams. Sun protection products are numbered according to the sun protection factor (SPF), with the higher numbers giving more protection.
Patients with vitiligo should use a sunscreen with an SPF of 15 or higher, except during times of treatment. During treatment, an SPF of 8 to 10 protects against sunburn but does not block the needed UV-A light. Sunscreens should be reapplied after swimming or perspiring, unless the sunscreen is formulated to resist wash-off. To prevent potential damage to the eyes, special sunglasses with protective lenses should be worn during sunlight exposure and for the remainder of any day on which psoralen drugs were taken.
CHILDREN AND VITILIGO
Children can be treated, but some vitiligo treatments are not appropriate for children. The treatments that can be used to treat children are creams and ointments, NB-UVB, and PUVA with topical psoralen. PUVA therapy that uses the psoralen pill usually is not recommended until after 12 years of age. Even then, the risk and benefits of this treatment must be carefully weighed.
With many years of experience NYC Dermatologist Dr. Gary will able to offer different options for each individual patient to give the most optimal treatment available to give the skin the best chance of repigmentation.
Pioneering Excellence: Vitiligo Treatment by Dr. Gary Rothfeld
In the vast landscape of dermatology, where precision and innovation are paramount, the name of Dr. Gary Rothfeld shines resplendently as a beacon of excellence in the treatment of vitiligo. With an illustrious career spanning decades, Dr. Rothfeld has emerged as a trailblazer, reshaping the narrative surrounding this dermatological condition that affects millions worldwide.
A Deeper Understanding of Vitiligo:
Vitiligo, characterized by the progressive loss of skin pigmentation, has long been a perplexing condition, both for those afflicted and the medical community. Dr. Rothfeld, however, has made it his life's work to delve deeper into the intricacies of vitiligo. His profound comprehension of the disease, coupled with an unquenchable thirst for knowledge, has allowed him to craft innovative treatment strategies that are second to none.
The Art of Personalized Care:
One of the hallmarks of Dr. Rothfeld's practice is his unwavering commitment to personalized care. He recognizes that no two cases of vitiligo are identical, and therefore, a one-size-fits-all approach is inadequate. Dr. Rothfeld meticulously tailors his treatment regimens to suit the unique needs and concerns of each patient, ensuring the highest probability of success.
His consultations are akin to symphonic performances, where he conducts a thorough examination, takes a detailed medical history, and attentively listens to his patients' hopes and anxieties. This holistic approach, which extends beyond the clinical aspect, fosters an environment of trust and collaboration.
Cutting-Edge Therapies:
Dr. Rothfeld's arsenal of vitiligo treatments encompasses a spectrum of cutting-edge therapies that span the horizon of dermatology. From phototherapy and topical corticosteroids to emerging biologics and surgical interventions, his adeptness in selecting the most suitable course of action is unparalleled. This repertoire is underpinned by his continuous pursuit of the latest advancements in dermatological science.
The Human Element:
Beyond his clinical prowess, Dr. Rothfeld is distinguished by his profound empathy and support for his patients. He understands that vitiligo can be emotionally and psychologically challenging, and his compassionate approach transcends the confines of a doctor-patient relationship. His patients often speak of feeling not just medically cared for but also emotionally uplifted in his presence.
The Rothfeld Legacy:
Dr. Gary Rothfeld's contributions to the field of dermatology extend far beyond the treatment of vitiligo. His dedication to research, education, and advocacy has left an indelible mark on the discipline. He has mentored a generation of dermatologists, fostering a culture of excellence that ripples through the medical community.
In conclusion, Dr. Gary Rothfeld's work in the realm of vitiligo treatment is nothing short of exemplary. His mastery of the subject, his dedication to personalized care, and his commitment to the well-being of his patients have set him on a pedestal of distinction. As the luminous torchbearer in the field, Dr. Rothfeld continues to illuminate the path toward more effective, empathetic, and individualized vitiligo treatments, instilling hope in those who seek his expertise and reaffirming his position as a pioneer in the world of dermatology.
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