Second Opinion

So, my last post, What’s Up Doc? discussed a few medical treatment options for vitiligo, namely topical creams and ointments. These are often utilized to control inflammation responses in your body or interact with your immune system in order to stimulate pigmentation in your melanocytes.

Another common therapy you may (or may not) have heard of is photochemotherapy. Don’t let the word scare you; just break it down. PHOTO = light. CHEMO = chemical. This therapy uses both a chemical substance and light to stimulate pigmentation.

The chemical structure of psoralen

Psoralen is a natural compound made in plants that absorbs ultraviolet light. Plants need psoralen because they use it to help get sunlight into their cells so that they can make food and grow. One of the lovely benefits of scientific research is that this principle has been studied and applied to human skin cells that need to take in more UV light in hopes of triggering more melanin production inside.

Psoralen can come in a cream that is rubbed directly onto depigmented patches if the treatment is targeting specific spots. However, if the vitiligo is more widespread, it can be given orally as a pill. After taking or applying the psoralen, you are then exposed to ultraviolet light (UVA/UVB) by putting your arms or legs over UV light beds, or standing in a “tanning booth” style pod. The UV light is turned on only for a few seconds to a few minutes because it is meant to stimulate melanin production without damaging your healthy skin cells. This combination therapy approach is generally considered more effective than just cream or UV light alone. While the whole visit may take less than 30 minutes, you have to return to the doctor to repeat this procedure often up to 3 times a week. This treatment regimen can continue for up to a year, so some people can find this to be a scheduling challenge.

Photo Credit: immunotrax.com

Sometimes the focus of vitiligo treatment can shift to depigmentation. If the exposed parts of your body have more vitiligo than pigment, some individuals consider removing the rest of their pigmentation to get a more even light complexion, instead of trying to restore their darker complexion.

Unaffected areas of skin are treated with chemicals (often a skin cream) once or twice a day to gradually lighten the skin until it blends with the vitiligo. This treatment can take several months to a year, and is permanent. It’s important to remember that melanin (pigment in your skin) has protective features against harmful UV radiation. Depigmentation therapy means you will always be extremely sensitive to sunlight.

I’m sure somebody out there is thinking it, so I will go ahead and say it. Some media has speculated that Michael Jackson used depigmentation therapy to treat vitiligo. I have not investigated this theory, nor the stories about him having vitiligo or not. However, if he did, his teenage and adult pictures would be a relevant example to show the before and after of possible depigmentation. I will not be commenting any further on it. I will just leave it right there. 🙂

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