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Studies Show Combination Therapy Best for Vitiligo

If you suffer from white patches on the skin, otherwise known as vitiligo, there are several treatment options available. Do you go medical, do you try natural? Choosing the right treatment can be difficult. However, new studies show vitiligo responds best to multiple forms of treatment- making the decision much easier. Learn more about the best treatment methods below.
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Vitiligo is a condition of the skin in which pigmentation slowly fades and leads to small to large patches of completely white skin in its place. Vitiligo was long thought to be untreatable, but recent medical research has shown that several treatment options can be effective- both natural and medical.

Studies examining the increase in vitiligo cases have uncovered a wide range of possible triggers for the development in the disease. However, a new study from 2014 has also found that combination therapy is the most effective when treating the disease. Read more about these two studies and the possible treatment methods for vitiligo below:

How Common is Vitiligo?

Vitiligo is characterized by depigmentation on the skin, and often affects the hands, feet, face, and the joints between torso and limbs. In rare cases, vitiligo can affect the entire body. Although vitiligo was at first thought to be extremely rare, cases seem to be increasing worldwide. An estimation from the Journal of the American Medical Association-Dermatology states that approximately 1 out of every 100 people in the United States suffer from mild to severe vitiligo.

Other studies support the idea that vitiligo cases are increassing. A 1999 study published in the Indian Journal of Dermatology, Venereology, and Leprology found that globally, cases of vitiligo have increased between 4 and 5 percent over previous decades.

The study examined 5000 individuals with vitiligo to try and identify why vitiligo cases may be on the rise.

What Causes Vitiligo?

Vitiligo is thought to be caused by a variety of factors-none of which point to a clear cause for the disease. Commonly, vitiligo is thought to be a genetic, autoimmune, or stress-triggered disease. Other possible causes include neurologic problems, or melanocyte self-destruction.

However, the Indian study listed above offers an additional possible explanation- environmental factors. The study found that just over 68 percent of the vitiligo patients in the 5000 patient study had the same precipitating factors. According to the study researchers, 68 percent of patients had dealt with a major illness, severe emotional stress, surgical or physical trauma, or pregnancy.

Other significant factors included consumption of stale preserved foods, water contaminated with industrial waste, and old medicines. There were even some incidences of air contaminated with industrial waste leading to cases of vitiligo. Repeated drug intake also triggered vitiligo in just over 26 percent of cases, including antibiotics.

The study researchers theorized that these precipitating factors worked to disturb the immunological balance in the body, which triggered the autoimmune response to produce symptoms of vitiligo. Upon further research, the study researchers found evidence to support the theory that the entire melanocyte system is defective in patients with vitiligo.

This study, and other similar studies, can help identify how to prevent vitiligo, rather than simply treat the symptoms after they occur.

The Most Effective Treatment for Vitiligo

Although there are many treatment options for vitiligo, not all of them are effective. In fact, most medical treatments for vitiligo are rather ineffective. However, a new study has discovered a treatment method that may provide the biggest improvement in vitiligo symptoms.

The study was published in September 2014 in JAMA Dermatology. The study found that a combination of phototherapy and implantation of afamelanotide provided more benefit than either of those treatments alone.

The Multicultural Dermatology Center at Henry Ford Hospital in Detroit, Michigan conducted a clinical trial on 55 adult patients with vitiligo. These patients were assigned to receive monotherapy or combination therapy. All patients were suffering from slow progression of the disease from the three months leading up to the study.

The monotherapy group acted as a control group for the combination group which received afamelanotide combined with ultraviolet B (NB-UV-B) phototherapy. Afamelanotide is a synthetic version of the naturally occurring α-melanocyte-stimulating hormone, which is what stimulates pigment production in the skin. Each patient received afamelanotide injections once a month for four months.

Both groups underwent NB-UV-B phototherapy 2-3 times a week for 6 months. Both groups saw improvement in their symptoms, but the combination group improved the most. The combination group showed a 48 percent improvement versus a 33 percent improvement in the control group. The combination group also saw faster results than the monotherapy group. The greatest improvement was seen on the face and upper extremities. However, since this clinical trial was so small, further studies are necessary to identify the limitations and benefits of combination therapy.

Despite the problems with the study, this research supports the idea that a multi-faceted approach is best for reversing vitiligo symptoms.

Other Medical Treatment Options for Vitiligo

Although none of the medical treatment options for vitiligo are completely effective, many patients do show some recover and repigmentation after trying medical treatment. The most common medical treatments for vitiligo include:

Topical Corticosteroid Creams

These steroid creams stimulate the immune response which is sometimes effective at repigmenting the skin. Usually, these creams are most effective on smaller spots. If the treatment does not work within two months, then the patient is unlikely to respond to this treatment option.

Topical Oxsoralen

Small spots can also be treated with topical Oxsoralen (8-MOP). This cream encourages the skin to turn brown when exposed to the sun. The trouble with this treatment is that it encourages sunburn, which can increase a person’s chances of developing skin cancer. Patients often undergo between 15 and 100 cycles of treatment before results are seen or completed.

Mini Grafting

In small cases, vitiligo patients can undergo skin grafting to replace unpigmented skin with pigmented skin from other areas of the body. This treatment is not without risks and is impossible for large sections of vitiligo.

PUVA Photochemotherapy

The most common treatment for large areas of vitiligo is PUVA photochemotherapy. Patients are given oral psoralen combined with UVA treatment (synthetic or from sunlight). Patients are given the medication then instructed to spend time outdoors or under UVA light for gradually increasing periods. This treatment is up to 85 percent effective in about 70 percent of vitiligo patients, but only if the vitiligo is on the trunk, head, neck, upper arms, and legs. In some cases, after therapy, the vitiligo will return in areas that have not fully pigmented after the conclusion of treatment.

Bleaching

For patients who do not respond to other treatments, or do not want to do other treatments, some doctors prescribe topical creams to remove pigment from elsewhere on the body. Often, monobenzylether of hydroquinone cream is used to whiten the skin.

Non-Medical Treatment Options

As stated in the studies above, there are a variety of factors that are implicated in the development of vitiligo, and addressing these conditions at the source could help the skin repigment without the need for medical intervention.

Eliminate Toxins

The Indian study found that individuals who lived in toxic environments were more likely to develop vitiligo than individuals living in clean environments. Industrial waste products in drinking water dramatically increased a person’s chances of developing the disease. One of the easiest ways to improve the quality of water is to drink bottled mineral water or to filter water using a high-quality water distiller or carbon block filter. These filters can remove a vast array of chemical contaminants in any water source.

Although residents in the United States are less likely to have severely contaminated water, groundwater is still poisoned by factories daily. For example, in West Virginia and Ohio, Industrial giant DuPont was sued by nearly 3,000 people in 2014 due to the company’s practice of dumping perfluorooctanoic acid (C8) (used in the production of Teflon products) into the Ohio river. The results of a 2005 study conducted on the side effects C8 found that the chemical can cause kidney cancer, testicular cancer, high cholesterol, ulcerative colitis, pregnancy-induced high blood pressure, and thyroid disease.

Just because water comes from a U.S.-based water source does not mean it is not contaminated with waste chemicals.

Repair Stress Damage

Damage from medical procedures, illnesses, and even emotional stress can all contribute to an increased risk of developing vitiligo. Removing stress from the body can help the body recover and improve the immune system. A properly-working immune system is less likely to trigger an autoimmune response like the one responsible for the spread and development of vitiligo. Concentrated de-stressing efforts, such as stepping down from stressful roles, spending time each night relaxing, and engaging in de-stressing activities like meditation and massage can help repair stress damage.

Improve the Diet

The foods that you eat can play a role in the progression or development of vitiligo. As the Indian study uncovered, an unhealthy diet full of processed and stale foods led to the further progression and development of the disease. Certain vitamins are known to improve the quality and health of the skin, which may also be helpful in reducing vitiligo symptoms. These nutrients include:

Important Nutrients for Skin Health
  • Vitamin B12
  • Folic Acid
  • Vitamin C
  • Vitamin D
  • Vitamin A
  • Copper, iron and zinc

One of the richest sources of minerals, B vitamins, and vitamin D in the diet is seafood. Fatty fish like sardines, salmon, and shellfish have large concentrations of these vitamins. Vitamin A can be found in orange foods, as well as red meat products, particularly liver and other organ meats.

Supplement for Immune Health

Since vitiligo is an autoimmune disorder, improving the immune system could help prevent the spread of the disease. According to WebMD, carotenoids, antioxidants, zinc, selenium, vitamin E, vitamin C, and vitamin D are all essential nutrients that support immune system health. Adding foods that contain these nutrients and supplementing with any missing nutrients could help control symptoms of vitiligo.

Reduce Drug Exposure

Another potential trigger for vitiligo is extended drug use. The Indian study even found that widespread antibiotic use was implicated in some cases of vitiligo. According to the researchers, patients with a family history of vitiligo should carefully consider the potential side effects of medication before starting any treatment in case the development of vitiligo is a side effect. Patients on long-term medication who also have symptoms of vitiligo should discuss the potential link with their doctor. Never cease the use of a medication without the approval of a qualified health professional.

Vitiligo: Multiple Causes, Multiple Treatments

According to the studies outlined above, vitiligo can be caused by a variety of factors and responds best to a variety of treatment options. Individuals suffering from vitiligo should see best results when combination therapies are used-both medical and non-medical. Depigmentation of the skin is an autoimmune response that likely points to several potential causes in the body’s systems. Addressing these problems from the inside out is likely to produce better long-term results than simply treating the condition from the outside alone.

Sources


http://www.sciencedaily.com/releases/2014/09/140917172741.

htm http://www.ijdvl.com/article.asp?issn=0378-6323;year=1999;volume=65;issue=4;spage=161;epage=167;aulast=Behl

http://www.mayoclinic.org/diseases-conditions/vitiligo/basics/causes/con-20032007

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