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New Approach to a Discoloring Skin Disorder

New Approaches
Several treatment approaches often result in the repigmentation of the white skin patches in people with vitiligo. But many insurers consider vitiligo a cosmetic issue and do not cover treatment costs. If the affected area is small, application of creams containing corticosteroids may help restore pigment. Chronic use of steroids, however, can result in thinning of the skin and stretch marks in some areas.

More often, dermatologists use a remedy dubbed PUVA for those seeking to darken white skin patches, especially when the condition is extensive. PUVA involves taking a drug called psoralen, which makes the skin very sensitive to light, followed by exposure of the affected skin to a special lamp that generates only ultraviolet A radiation. Occasionally, when the vitiligo patches are very limited, psoralen can be applied directly to the skin before ultraviolet A treatment.

Usually at least a year of twice-weekly treatments is needed to restore melanin production. The treatments are 50 percent to 70 percent successful in restoring color on the face, trunk and upper arms and legs. But hands and feet respond poorly to this approach. PUVA should not be used in children under 12, in pregnant or nursing women, or in people with certain medical conditions. Long-term use of PUVA can cause freckling and, when used for years to treat psoriasis, PUVA increases the risk of skin cancer.

Better treatments may be on the way. In an encouraging preliminary report recently in The Journal of the American Academy of Dermatology, researchers from Henry Ford Hospital in Detroit described the successful repigmentation of five patients through a series of exposures to a limited spectrum (narrow band) of ultraviolet B radiation, the type that causes sunburn. Two dark-skinned blacks were among five patients who achieved better than 75 percent repigmentation after an average of 19 treatments administered three times a week. Two other patients, both light-skinned Caucasians, achieved 40 percent and 50 percent repigmentation after 48 and 46 treatments, respectively.

Another new approach under study involves the application to vitiligo patches of a synthetic enzyme, pseudocatalase, that results in repigmentation after exposure to narrow-band ultraviolet B, according to a report from Dr. Karin Schallreuter and her colleagues in Manchester, England.

Copyright 2001 The New York Times Company. Reprinted with permission.


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