Some notes on vitilago and treatment options around Jacksonville, Florida

These notes are in chronological order. Some links may have broken. This is not a complete research. These are merely notes. Conclusions are towards the end

weblink

weblink

nvf

uf dermatology

http://www.pathology.ufl.edu/~mccormac/VIT-INFO.html

faq

What are elidel and protopic

Vitiligo is difficult to treat. Early treatment options include the following:

Exposure to intense ultraviolet light, such as narrow-band UVB therapy Oral medications, such as Trisoralen (trimethylpsoralen)

Topical medications

Repigmenting agents such as Oxsoralen (methoxsalen)

Immunosuppressants such as Elidel (pimecrolimus) and Protopic (tacrolimus)

Corticosteroid creams

Other..

Skin may be grafted, or removed from normal areas and placed into areas of pigment loss. In the future, skin pigment cells may be grown in the laboratory and used to treat areas of vitiligo.

Look up a doctor in Florida Department of health

Steroids applied to the skin sometimes have a dramatic effect in bringing about repigmentation. These agents do not act as mitogens as does ultraviolet light. Instead, they may reduce the microscopic level of mild, largely imperceptible inflammation present in the skin surrounding the patches of vitiligo. The combination of light acting as a mitogen and steroids suppressing inflammation can stop vitiligo from spreading and for new pigment cells to form. However, topically applied steroids have their own set of side effects. The most important one is thinning of skin, which in turn can lead to formation of stretch marks. Areas where the skin comes together, such as the axillae and the groin, are especially sensitive and in most cases should not be treated. Hydrocortisone, available as Lanacort or Cortaid in 0.5 to 1.0 percent strength, can be used. The superpotent steroids, Temovate and Diprolene, useful in the treatment of vitiligo in adults, must be avoided in children. The mid-potent steroids should be used with care. 

cortico steroids
topical psoralen
elidel
psoralen + sunlight

In summary, Class III cortcosteriods for localized vitiligo and UV-B therapy for generalized vitiligo are the most effective and safest of the therapies now available.

See the full article

what is psoralens and sunlight (puvasol) as opposed to puva?

read

http://web.mit.edu/dzshen/Public/mdconsultvtg.doc

Class 3 corticosteroids (and UVA); course, 6?9 mo

Treatment choice is guided by clinical type. Patients with localized vitiligo can be treated with class 3 corticosteroids combined with UVA therapy. If there is no response after 6 months, localized UVB or topical PUVA therapy can be given as an alternative. Narrowband UVB therapy is recommended as the most effective and safest therapy for generalized vitiligo. A minimum treatment duration of 6 months is recommended. Responsive patients can be given this treatment for a maximum of 24 months. After the first course of 1 year, a resting period of 3 months is recommended to minimize the annual cumulative dose of UVB.

Segmental and lip-tip vitiligo (lips and digits) is best treated with autologous transplantation.

In patients with extensive areas of depigmentation (80%) and/or disfiguring lesions on the face who do not respond to repigmentation therapies, depigmentation of the residual melanin should be considered. During and on completion of the therapy, patients should minimize sun exposure and apply broad-spectrum sunscreens. The use of a potent bleaching cream and/or laser therapy (e.g., the Q-switched ruby laser) is considered to be the cornerstone of depigmentation therapy for these patients.

In all cases, advice regarding the use of camouflage and sun-blocking agents should always be given. If necessary, psychologic counseling may be recommended.

southside dermatology

This is a demo for mugree

http://www.vitiligosupport.org/nbuvba.cfm 

Sanjiv Goyal
10:40, Thursday Aug 17th
904-567-1050

I have tried this combinatior for about a month. I see about 40% repigmentation in this time frame. I would have thought the repigmentation would start from the edges and move in.

But I have noticed in 2 weeks a very very tiny dot or two smack in the middle. Those and a few more grew in the same fashion.

Dr. Goyal has a uva/uvb treatment avaialble. He is quite hopeful this will help.

I am quite happy with Dr Goyal and his staff as they are quite receptive to ideas and possibilities.

Apparently this starts with a 3 min exposure and gradually builds up to a 10 minute exposure. I have gone through the first one today. I will report in a couple of days what the results are whether there are some or not.

This is an enclosure that is about 7 feet tall and about 3 feet in diameter studded with top to bottom uvb and uva lamps.

You will need an athletic support to go in and a goggles that they provide to cover the eyes completely. These look like swimming goggles.

And how is it different from uva? How come such a small exposure time seem to have an impact? Why ramp up? Why not use in conjunction with psoralen?

I went 3 days a week. It started at a 3 min exposure and went all the way to 7 or 8 minute exposure. From an energy perspective started at 200 millijoules and went upto 800 or so.

Prior to starting this treatment the protopic and the other ointment treatment seemed to have a very positive effect.

I have continued those medications as well during the uvb.

Not sure uvb helped much.

The area got repigmented with in a month or two. The doctor suggested to stop.

Perhaps I would have needed a stronger dosage. I would have expected a quicker pigmentation. but that didnt take place.

usually a pigmentation will preceed with a pink discoloration of the skin. I didnt see that happen as the dosage is probably small.

Around 10 years ago there was a quarter sized depigmentation on my forehead along with some stuff on my finger tips and my wrists. I went through a puva treatment with some psoralen tablets. Almost all of it got cleared up except the one on the forehead. It got uniformly but partially got repigmented. During the last 10 years it didnt get any worse at all. So I left it untreated.

I was hoping that the uvb will make a difference but it didnt. Again, perhaps a stronger dosage might help.

So in all i went through about 6 months of treatment.

It will probably cost 20 dollars per visit and 40 dollars per visit to the insurance

But the insurance doesnt seem to cover them for vitilago. Again it will take multiple treatments. I may try it next year to see if they are useful