TREATING UNIVERSAL VITILIGO
Dr Anil Ganjoo, Sr. Consultant Dermatologist and Laser Surgeon, and Director, Skinnovation Clinics, presents a case study on how depigmentation therapy treats universal vitiligo.
A
45-year-old female patient with universal vitiligo, involving almost 90 per cent of the body surface area, had been on treatment for several years. She had partial relief and a history of waxing and vanning of the disease.
She was particularly bothered about the left-over spots on the face that gave her a cosmetically disfigured look.
After explaining to the patient about the severity of her disease and the possibility of the disease not responding to the conventional treatment, she was given the option of depigmentation of the left-over areas.
The patient was prescribed topical 20 per cent monobenzyl ether of hydroquinone (MBEH), to be applied twice a day along with strictly using sun protection. The patient developed a severe contact irritant dermatitis because of MBEH, following which its application was discontinued. It had the same results when the treatment was reintroduced.
The patient was then put on Q switched laser treatment using 532 nm wave length, spot size of 3.3 mm and fluence of 1.5 joules/cm2. Two sessions, done at three weeks interval, resulted in to complete clearance of the lesions. The patient has been on follow-up with us for the last eight years and has not experienced any recurrence.
Note the irritated skin because of the MBEH treatment and the complete clearance after two sessions of QS Nd:YAG Laser.
Discussion
Universal vitiligo is a skin disorder wherein more than 90 per cent of the body is covered in white patches. These patients are poor responders to repigmentation therapies and have the option of depigmenting the left-over spots of pigmentation with various therapies. This gives a uniform colour to the skin although depigmented. Presently, there are no ideal depigmenting agents for this purpose because of their shortcomings. While MBEH is a popular drug that is USFDA approved for the condition, it is associated with a number of side effects like contact allergies and irritation. Moreover, it may take a long time to act and may not act in some patients at all. Other agents used include 88 per cent phenol, 4-methoxyphenol. The physical modalities used include the Q switched lasers and cryotherapy, which can be associated with scarring.
The Q switched lasers are a useful modality under these circumstances. Our patient did well with only two sessions of the laser and did not re-pigment until eight years after the treatment. QS Nd:YAG laser is an effective tool to treat residual pigmentation in universal vitiligo. Following depigmentation, strict sun protection should be advised to prevent sun damage and re-pigmentation. However, if repigmentation occurs, repeat QS laser session can be performed.