Can vitiligo on the lips be cured

Vitiligo (White spot disease)

Vitiligo or white spot disease cannot be cured. However, in addition to general measures and cosmetic measures to cover the white spots, various therapy options are available to bring the progression of the disease under control and to promote the restoration of the skin color, i.e. repigmentation. A distinction is made between medicinal measures, phototherapy or light therapy and surgical measures.

Repigmentation is achieved by stimulating melanocytes. In most Vitiligo patients there are still remaining pigment cells in the hair root area, which can be stimulated to growth and immigration into the skin. Individual melanocytes remaining in the Vitiligo spots or located in the edge of the spots serve as additional sources.

There is no standard therapy that will work for every Vitiligo patient. The response to different treatments can vary from case to case and is unpredictable in each case. Some therapeutic measures have serious side effects, others have not yet been approved. In any case, the therapy is time-consuming and requires a lot of patience (the melanocytes need several months to regenerate melanin).

General measures

Sun protection is one of the most important measures for Vitiligo. With the loss of pigment, the natural protection of the skin has also been lost. With adequate sunscreen and covering clothing, you protect the unpigmented skin areas from sunburn and normal skin from excessive tanning (so the color difference to the white spots is not greater). Severe sunburns can also worsen the condition of Vitiligo.

Cosmetic measures

The white Vitiligo spots represent a serious aesthetic problem for many sufferers. The following are available for cosmetic coverage:

  • Camouflage: i.e. waterproof, special highly covering make-up products can cover up the skin changes. Instruction by trained cosmetic staff is recommended.
  • Self-tanner: However, this cannot be washed off (the effect lasts 3 to 5 days) and a regular result is more difficult to achieve.
  • Cosmetic tattoos: can be used e.g. in the area of ​​the lips (especially for dark-skinned people) or nipples, but caution is advised in other areas due to the unpredictability of Vitiligo.

Depending on the extent of the disease and the level of suffering of those affected, cosmetic measures may be sufficient for Vitiligo patients.

Medicinal measures

Medicines for external use

Corticosteroids as a cream or ointment:
  • Medium-strength corticosteroids are recommended as first-line therapy for use in children and adults with limited vitiligo (less than 2-3% of the body surface) outside the face. Duration: 3 to 6 months, depending on the therapy scheme.
  • Not applicable in the long term due to side effects. Possible side effects are thinning of the skin (atrophy), permanently enlarged superficial blood vessels (telangiectasia), increased hairiness (hypertrichosis) or acne-like skin changes.
  • Most effective when used on sun-exposed skin, dark skin, and fresh skin changes.
  • When used over a longer period, on a large area, on thin skin or in children, newer corticosteroids with negligible systemic side effects should be used due to (systemic) side effects affecting the entire organism.
Calcineurin inhibitors as a cream or ointment:
  • These are so-called immunomodulators, i.e. they influence processes in the immune system.
  • Studies have proven its effectiveness in terms of repigmentation, particularly in the head and neck area.
  • Are better tolerated than corticosteroids.
  • Can be used as an alternative to corticosteroids in children and adults for new vitiligo spots on thin skin. Due to the lack of data for other areas of the body, the use of calcineurin inhibitors should be restricted to the head area and neck area.
  • Duration of therapy: 6 months, extension possible if successful.
  • During the therapy, the treated skin areas should be exposed to sunlight in a moderate but daily manner.
  • So far only as an off-label use, as the authorities currently only approved for neurodermatitis.

Other active ingredients that affect the immune system are still being researched.

Medicines for internal (systemic) use

Corticosteroids
  • Use as oral minipulse therapy (OMP), i.e. taking medium doses at certain intervals, in the case of rapidly progressing (progressive) Vitiligo or lack of stabilization after light therapy: stabilizes the disease and promotes repigmentation.
  • Not suitable for stable Vitiligo.

Other drugs that affect the immune system are still being researched. However, the currently insufficient data and side effects do not justify their use in Vitiligo.


Phototherapy

During phototherapy or light treatment, areas of the skin affected by vitiligo are irradiated with ultraviolet light (UV). This can stimulate remaining melanocytes to grow and form new pigment. Skin areas on the face or trunk usually respond well to this treatment.

Phototherapy can be combined with medication (corticosteroids, cacineurin inhibitors). Various combinations with other substances such as antioxidant gels (pseudocatalase) or antioxidant food supplements have shown some positive results. However, these must be confirmed in further studies.

Narrowband UVB light therapy

  • Currently considered the treatment of first choice for generalized vitiligo.
  • Irradiation with a certain narrow spectrum of UVB rays in radiation cabins or by means of partial body devices.
  • Whole-body irradiation if more than 15-20% of the body surface is affected.

Targeted UVB light therapy

  • Excimer laser, excimer lamp: irradiation with UVB light of a certain wavelength (monochromatic light).
  • Micro-phototherapy: Narrow band UVB with a focused light beam
  • High-energy flash lamp
  • Affected areas can be irradiated in a targeted manner without affecting the surrounding healthy skin. Particularly advantageous for areas that are otherwise difficult to access, e.g. skin folds.
  • Indicated for localized forms of Vitiligo, especially for small new spots and in childhood.

There is still no agreement on what the optimal duration of treatment for targeted or narrowband UVB light therapy is. The light therapy is usually used for at least 3 months and, if successful, continued as long as repigmentation can be detected, for a maximum of 1 to 2 years.

Photochemotherapy

Combination of special active ingredients that increase the skin's sensitivity to light with irradiation of the skin with UVA light:
  • PUVA: As a light-sensitizing agent, psoralen is applied topically (cream, ointment or as a bath) or internally before radiation. Particularly effective for dark skin types. Has been replaced by the better tolerated and more efficient narrowband UVB light therapy as the treatment of first choice for generalized vitiligo. As a long-term side effect, there is an increased risk of skin cancer.
  • KUVA: Khellin as a light sensitizing agent prior to UVA radiation. Internal ingestion is no longer used because of its liver-damaging effect. Topical application as a cream or gel can be used in certain cases. However, there is largely a lack of data to prove the effectiveness of this application.

Surgical measures

Pieces of skin or pigment cells are taken from healthy areas of the affected person's skin and transplanted into pathologically altered skin areas after the upper layer of skin has been removed there. Various surgical procedures are available that can be performed under local anesthesia or, under certain circumstances, under general anesthesia.

  • Surgical procedures are primarily used for segmental vitiligo and other localized forms when medicinal and physical measures have not shown any success.
  • The prerequisite is a disease that has become stable. The segmental Vitiligo and localized Vitiligo forms are therefore best suited.
  • In certain circumstances, patients with stable nonsegmental vitiligo can also be treated surgically, but the risk of relapse is increased.

Depigmentation

  • During depigmentation, remaining healthy skin islands are bleached with chemical substances and / or laser treatment in order to achieve an adaptation to the affected skin.
  • Only in the case of extensive (more than 50% of the body surface), disfiguring Vitiligo that does not respond to other treatment options.
  • Irreversible.
  • Subsequently, there is an extreme sensitivity to sunlight.