Vitiligo is a common hypopigmented skin disease that manifests as limited or generalized pigment loss spots on the skin, which directly affects the appearance of the patient and thus affects the quality of life of the patient. The fact that vitiligo is stubborn and difficult to treat, and there is no ideal treatment method, has attracted more and more attention. This is the first time that a person has been able to get a job:
1, drug treatment
The first is the 1 % pimecrolimus cream (pimecrolimus) is a semi-synthetic product produced by Streptomyces cysticercin, which has a mild treatment for vitiligo, the side effects are mainly burning sensation. It can be used selectively on the face, trunk and elbows, etc.).
The 0.03% and 0.1% tacrolimus ointment (tacrolimus, also known as FK506) is a macrolide immunomodulator extracted from the culture of Streptomyces, the possible mechanism is that it stimulates tyrosinase activity and thus promotes melanin biosynthesis. The best results are obtained on the face and neck, and tacrolimus ointment and pimecrolimus cream encapsulation are more effective.
It can also increase the activity of tyrosinase and melanin production by improving the calcium transport in melanocytes.
The Chinese medicine has done a lot of work in the treatment of vitiligo and has played a huge role, and at the same time has achieved promising results. The main principle is still to nourish the liver and kidneys, dredge the liver and Qi, harmonize Qi and blood, activate blood circulation and remove blood stasis, etc. External treatment is mostly based on tinctures. The main principle is still to benefit the liver and kidneys, dredge the liver and qi, harmonize the blood and blood, activate blood stasis, etc. The external treatment is mainly tincture.
2, phototherapy and photochemotherapy
The most important thing is that it is not only the best way to treat the skin, but also the best way to treat the skin. The most widely used clinically is the medium-wave ultraviolet (UVB) and long-wave ultraviolet (PUVA).
Narrow-spectrum UVB ((311nm, NB-UVB) has the advantages of less phototoxicity, uniform pigment recovery and shorter treatment time than broad-spectrum UVB, and its efficacy is better than long-wave UVB (PUVA), with good efficacy on the face and neck, but poor efficacy on the lower extremities and hands, and can be used for the treatment of children and pregnant women. Combination therapy with topical tacrolimus, pimecrolimus and carboplatin is more effective.
Photochemotherapy is a method of treating skin diseases by applying PUVA irradiation plus photosensitizers (oral or topical photosensitizing drugs). The most commonly used clinical photosensitizing substances are psoralen and its derivatives.
(1) Topical 8-MOP, 30 min followed by PUVA irradiation, 2-3 times/week, is more effective for limited vitiligo lesions, and can avoid the side effects of oral drugs, and is not suitable for skin in the genital area.
(2) Oral 8-methoxypsoralen (8-MOP) 0.4 mg/kg, 1 to 2 h after irradiation PUVA, 2 to 3 times / week, continuous treatment for more than 3 months (treatment can produce a certain degree of phototoxic reaction, to avoid blistering reaction), can achieve maximum pigment regeneration. The most effective site is the face, followed by the trunk, the extremities are poor, and the hands and feet are almost ineffective.
(3) There is also the systematic use of hormones, azathioprine and other combined treatment with PUVA reported.
3.Excimer laser treatment
The 308 nm excimer laser (a kind of single-frequency excimer laser, i.e., xenon chloride (XeCL) excimer laser) has a pulse width of 30 ns, a single pulse energy density of 2-3 mJ/cm2, a spot size of 2 cm×2 cm, and a local dose of 25-2,100 mJ/cm2.
The 308 nm excimer laser has the characteristics of monochromaticity and coherence. Excimer laser is considered to be more effective than NB-UVB, and the recoloration speed is faster, which is a new treatment method.
4.Surgical treatment
It is suitable for patients with stable or segmental vitiligo who have failed to respond to phototherapy and medication. The previous surgical methods include autologous epidermis transplantation, thin layer chipping, full-thickness layer drilling, single hair transplantation, autologous melanocyte culture after transplantation, epidermal cell suspension transplantation and many other treatment methods. In recent years, phototherapy, photochemotherapy, drugs and other methods have been combined with surgery to improve the treatment effect.
①Autologous melanocyte transplantation combined with PUVA (is a safe and effective treatment for stable vitiligo of the mouth and lips).
②Borehole transplantation combined with NB-UVB (a simple, safe, inexpensive, and effective treatment for quiescent stubborn vitiligo).
The other: surgical treatment combined with laser or corticosteroids, allogeneic melanocyte transplantation is not far from clinical use, which will undoubtedly be a breakthrough for vitiligo treatment.
The above methods can treat vitiligo to some extent, but each method has shortcomings, the real complete solution to the treatment of vitiligo, to explore an easy to operate, effective treatment path is a serious challenge before us, we look forward to the near future to win this challenge!