Update on skin repigmentation therapies in vitiligo

Abstract

SummaryTreatment for vitiligo is difficult and prolonged. Nevertheless, at present considerable knowledge accumulated during several decades on the pathogenic mechanisms, revealed important clues for designing new strategies to improve vitiligo depigmentation. With available medical therapies, high repigmentation percentages mostly on facial and neck lesions are achieved, although they are less effective on trunk and limbs and poor on the acral parts of the extremities. Narrow band UVB and psoralens and UVA are the two most important treatments for generalized vitiligo affecting more than 10-20% of the cutaneous surface, and topical corticosteroids, or calcineurin inhibitors are the most valuable treatments for localized vitiligo. Persistence of achieved regimentation is variable and an undefined percentage of patients may have variable recurrence.When vitiligo becomes refractory, surgical methods may improve depigmentation as effectively as with medical therapy; in segmental (unilateral) or long standing, non-segmental (bilateral) stable vitiligo, repigmentation with surgical methods is usually permanent.

Optimising size and depth of punch grafts in autologous transplantation of vitiligo and piebaldism: a randomised controlled trial

“…Large grafts (>2 mm) have high risks on side effects like cobblestone formation (3,4,7,9). Hence, the current technique involves 1-to 1.5-mm superficial punch grafts, depending on anatomical location (10). Superficial punch grafts are the method of choice, since it is suggested that in thinner grafts, the superficial capillary network allows an earlier process of vascularisation, preventing side effects and the loss of grafts (11,12).…”

Why are there so few effective treatments for pigmentary disorders of the skin?

“…The follicular repigmentation of the interfollicular epidermis in depigmented disorders, such as vitiligo, is supported by the observation that anatomic locations devoid of follicular units, Editorial such as glabrous skin, are significantly less responsive to phototherapy [23]. The areas that respond most favorably are the face and trunk, which contain numerous follicles [24].…”

“…However, surgical methods can be used in refractory vitiligo, piebaldism or to obtain repigmentation in cases of thermal burns and trauma. The presence of melanocytes in grafts is crucial for repigmentation induced by surgical methods, which is most effective in completely depigmented skin versus hypopigmented lesions [23,25]. Patients can require several sessions for optimal recovery, which may result in decreased patient compliance.…”

Herbal Remedies and New Approaches in Vitiligo Treatment

“…Tedavi çeşitleri, topikal steroidler, kalsinörin inhibitörleri, D vitamini analogları, fototerapi, lazer terapisi, cerrahi yöntemler olarak sayılabilmekte-dir. 7,25,26 Vitiligo tedavisinde yeni gelişmeler özetlene-cek olursa; vitiligoyu stabil hâle getirmek ya da repigmentasyon amaçlı uygulanan tedavilere devam etmektedir. Bununla birlikte, sadece monobenzon ile olan tedavi Amerikan Gıda ve İlaç Dairesi tarafından onay almış bulunmaktadır.…”