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Ask a Dermatologist Free: Severe Vitiligo

Dear Doctor

Good day mam/Sir….I have. vitiligo all over my face and body how can I stop it and is there a possibility to regain my skin color?..thank you so much.

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Dear Patient

Your symptoms are suggestive of extensive/severe vitiligo. The treatment of severe vitiligo includes:

1. Sun Protection

Sun protection should include:

a. Applying a Broad Spectrum Sunscreen

The white patches of vitiligo tend to develop sunburns without tanning and this can increase the risk for developing skin cancer. Sunburns on normal skin can cause the Koebner phenomenon in which new vitiligo lesions develop as a result of the sunburn.

Therefore, apply a Broad spectrum sunscreen which offers protection from UVA and UVB rays each day and ensure that it has a sun protection factor (SPF) of 30 or above.


2. Camouflage Therapy

Temporary camouflage therapy for vitiligo includes the use of cover-up makeup and self-tanning lotions.

a. Cover-Up Makeup

Cover-up makeup is useful for masking vitiligo on the face and other exposed areas. It usually comes as sets which include concealing creams and setting powder. To use them, the skin is cleaned and the concealing cream foundation applied to the white patches. This cream foundation should be 1 or 2 shades darker than the surrounding skin. Loose powder is then dusted lightly over it to set it.

Examples include the Smart Cover Up Kit and Dermablend cover cream with SPF 30.


b. Self-Tanning Lotions

Self-Tanning Lotions are useful for darkening skin on legs and other parts of the body that have lost their normal pigmentation.  Self-tanning lotions contain Dihydroxyacetone (DHA) which is a 3-carbon sugar that gives the skin a fake, UV-free tan.

DHA self-tanning lotions are available in concentrations that range from 2.5 to 10%. The lower the concentration, the lighter the tan produced and vice versa. Beginners should start with a low concentration formulation since any uneven applications will be less noticeable.

These color changes begin to become apparent around 1 hour after application and they are fully developed after around 8-24 hours. Reapplication may be needed after around 3-7 days when the color begins to fade.

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3. Phototherapy

Phototherapy which is also known as light therapy, is the exposure of the skin to specific wavelengths of light to treat skin conditions like vitiligo. It includes:

a. Narrowband UVB Therapy

This form of light therapy involves exposing the skin to UVB light with a wavelength of 311- 312 nm. Home UVB lamps can be used to treat small patches on the hands and feet.

b. Oral PUVA

Oral PUVA involves swallowing a capsule containing a chemical that makes the skin more sensitive to light and then exposing it to UVA light. It is usually used to treat patients with vitiligo affecting more than 20% percent of their skin.


4. Lasers

Excimer lasers have been shown to be quite effective for the treatment of vitiligo patches on the face in persons with dark skin.

5. Skin Grafts

Skin grafts are usually considered for adults who have stable vitilgo which has not worsened or developed new white patches in the last 1 year. It can involve attaching healthy skin or blisters from healthy skin on the patches with vitiligo.


5. Depigmentation

De-pigmentation involves the application of a chemical known as the monobenzyl ether of hydroquinone to remove the remaining skin color and leave a uniform white color. It is used for patients with extensive vitiligo that affects more than 50% of their skin.


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