Oral PUVA may increase the risk of skin cancer, so patients should apply sunscreen and avoid direct sunlight for 24-48 hours after each treatment and wear protective UVA sunglasses for 18 to 24 hours after each treatment to avoid eye damage, particularly cataracts.
Patients in whom the condition affects more than 50 per cent of their body surface sometimes opt for medical depigmentation by applying a drug to the normal skin until its colour matches the areas affected with vitiligo.
The results are permanent and irreversible. In addition, by undergoing depigmentation the individual will always be abnormally sensitive to sunlight.
All surgical therapies, e.g. skin grafting, should be looked upon as experimental because their effectiveness and side effects remain to be fully defined.
In 1963, scientists at the National Institute of Mental Health, USA, discovered that tetrahydrobiopterin, a naturally occurring small molecule, is an essential coenzyme.
This means that it participates in chemical reactions inside the body to increase the rate of the reaction. Within the last ten years, other scientists have developed a treatment that could possibly permit skin pigmentation to be changed naturally.
They identified tetrahydrobiopterin as the controlling factor in depigmentation and developed a cream, pseudocatalase, based on their discovery.
In a pilot study during the early 1990s, 33 patients with vitiligo were successfully treated with a topical application of pseudocatalase, calcium, and short-term exposure to UVB light.
Initial repigmentation occurred in the majority of cases after 2-4 months. Complete repigmentation was achieved with a 90 per cent success rate on affected faces and hands. In all patients, active depigmentation was arrested.
None of them developed new lesions during treatment. No recurrence of the disease was observed during a two-year follow-up.
I am not aware of any studies performed comparing this against other treatments and cannot vouch for its safety, efficacy or availability in the UK.
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