Vitiligo is a chronic pigmentation disorder of the skin. In the affected areas of the skin, the pigment cells are absent or their function is impaired. This results in white skin patches, which often appear on sun-exposed areas such as the hands and face. The disease can start in childhood as well as in advanced age. The likelihood of occurrence is independent of gender, skin type or any ethnic origin.
Vitiligo may be associated with other autoimmune diseases, but in itself does not initially represent a health-threatening disease. Nevertheless, the cosmetic disorders can lead to a considerable psychological burden. The spontaneous onset and localized vitiligo can cause as much suffering as larger and longer persisting skin areas.
UV-B 311nm narrow-band phototherapy has a positive effect on the immune system by reducing or even preventing the body's own breakdown of pigment cells (melanocytes). Progression of the disease is thus prevented. In addition, the melanocytes are stimulated to migrate from the hair follicles to the upper layer of the skin, where they release pigments (melanin) again. In this way, the affected skin areas re-pigment and regain their original skin coloration.
Due to the mechanism of action, the onset of repigmentation is delayed, so that UV phototherapy must be applied over a longer period of time. Furthermore, the process is linked to the presence of hair follicles, so that some skin areas tend to repigment better (face and neck) and other skin areas (hands, feet) worse.
UV phototherapy is applied 3 times a week. The dosage is based on the erythema threshold. Compared to other indications, the initial dose should be chosen much more cautiously, because for the determination of the skin type, not the healthy but the pigment-free skin is decisive. Healthy skin areas must be provided with suitable UV protection in each case to prevent hyperpigmentation.
UV phototherapy requires patience, because an incipient repigmentation is only visible after a few weeks and the total duration of therapy can extend over 9 months. If no repigmentation can be detected after 3 months, the further course of therapy should be agreed with the physician.
Vitiligo is primarily a cosmetic skin disorder. The goal of any treatment is to prevent disease progression and repigment the affected areas. Given the relatively low medical severity, any treatment option should be accompanied by as few risks or side effects as possible. The form of treatment also depends on whether the vitiligo is stable or rapidly progressing.
Treatment usually begins with topically applied anti-inflammatory creams. Systemic medications with additional immunosuppressive effects are more effective, but are also accompanied by more severe side effects. Compared to UV phototherapy, clinical experience with systemic drugs is limited. In addition to classical UV phototherapy with fluorescent tubes, UV excimer devices are also used, which allow "targeted" UV phototherapy, but can only be operated by specialists due to the surgical effort involved. Classical UV therapy, on the other hand, can take place in the home environment. Finally, surgical procedures should be mentioned, which are particularly effective but are only used to a limited extent due to their invasiveness.
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