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Drugs for vitiligo for complex treatment. Herbal products. Ointments and creams

Vitiligo is a skin disease that occurs infrequently, but causes a lot of trouble for its owner. The essence of the disease is that depigmented spots appear on the skin caused by insufficient melanin production.

The reason for its appearance is not fully understood, but there are effective methods, allowing you to get rid of this defect and even out your skin tone. Several groups of drugs are used for this.

Corticosteroid-based products

The first of these is corticosteroids, which have an anti-inflammatory effect. The fact is that for several years now American and European scientists have been studying the inflammatory nature of vitiligo. Therefore, this group of drugs is often prescribed to patients.

Here are the most popular ones:

As an alternative to this drug, you can use effective ointments for vitiligo Lokoid or Sulfodecortem.

These products are used in complex therapy of skin diseases. They should be applied to problem areas of the skin 2-3 times a day.

As a rule, Hydrocortisone is prescribed for vitiligo in both children from 2 years of age and adults, however, before using it, you should consult a dermatologist, since the dosage and order of use may vary depending on the case. Such treatment should be abandoned if the integrity of the skin in the area of depigmentation is compromised, in the presence of acute acne, as well as when localizing spots near the mouth;

Prednisolone is a hormonal drug with the main ingredient of the same name. The ointment is produced with a dosage of 0.5% of the main substance. Prednisolone is intended to relieve inflammation, eliminate allergic reactions.

It should be used 1-2 times a day, applying a thin layer to problem areas of the face and body. The drug is prescribed for vitiligo by a doctor for adults and children from 2 years of age, but for young patients it is prescribed only in case of emergency. Like many hormonal drugs, Prednisolone ointment can cause swelling and excess weight. It should not be used during pregnancy, inflammatory and viral skin diseases, as well as in the presence of tumors;

Advantan - this drug is available in the form of an ointment, cream or emulsion. The main ingredient is methylprednisolone aceponate. It also has anti-inflammatory, anti-edematous and antipruritic effects, so it is usually used to treat dermatitis. However, even with skin pigmentation disorders, this medicine shows good results. This remedy is used once a day, and it is considered quite safe, therefore it is allowed for small children and nursing mothers. Treatment of vitiligo with Advantan is prohibited if the patient has syphilis, viral infections, skin tuberculosis and individual intolerance to its components;
Elokom-S. This ointment is characterized by a dense, uniform consistency and is based on mometasone furoate at a concentration of 0.1%. It deserves positive feedback from patients because it not only eliminates unpleasant symptoms, but also promotes tissue renewal. Treatment of vitiligo involves using the drug 1-2 times a day. Apply the product to small areas of depigmented skin. Vitiligo can be treated with this remedy for adults and children over 2 years of age. The drug is contraindicated if there are acute infections, especially viral skin diseases, in the first days after vaccination, during pregnancy and while breastfeeding, as well as in the presence of acute acne on the face and body.

These drugs are especially effective in treating skin defects caused by pigmentation disorders.

Herbal products

However, other means are also used in complex therapy.

And the next group is represented by ointments plant based:

Vitasan - cream based on extracts from medicinal plants: St. John's wort, nettle seeds, kernel walnut, carrot seeds, pine nut kernel. This composition increases the skin's sensitivity to sun rays, stimulates the growth of malanocytes and pigment formation. Vitasan should be used 2 times a day for 2 weeks, and it is advisable to periodically be in the open sun. Treatment of vitiligo with this remedy is contraindicated if there is an individual intolerance to the ingredients that make up the cream;
Psoralen is an ointment based on psoralea drupes. This drug is designed to enhance melanin production and sensitivity to ultraviolet radiation. This medicine should be used under the strict supervision of a doctor; it is sold by prescription. Every day you need to rub it into problem areas 2-3 times a day. Treatment for vitiligo lasts for 3-3.5 months. Despite the fact that this drug is herbal, it has many contraindications: kidney disease, thyroid gland, liver, as well as pregnancy, lactation and children under 5 years of age.

Products based on vitamin-mineral complexes

In addition to these herbal preparations, I also use other medications based on vitamins and minerals:

These products are used to treat vitiligo, but many who suffer from it need cosmetic products that quickly mask imperfections. Viticolor gel is suitable for this. This is a non-toxic, water-resistant product that is applied to white spots. No contraindications were identified when testing this cream.

The choice of the optimal remedy for vitiligo depends on individual characteristics organism and the degree of manifestation of the disease. Severe symptoms require the use of corticosteroids. Hydrocortisone is the most accessible domestic drug that shows good results. In this regard, many dermatologists and their patients prefer it.

To increase local immunity and skin sensitivity to sunlight, it is recommended to use plant-based ointments or creams. Vitasan is safer and can therefore be used at any age and condition. Vitiskin hydrogel is also suitable for these purposes.

Vitiligo is a skin disease that is of keen interest to modern scientists, since the mechanism of the appearance of depigmented spots is not fully understood. Conclusions are being drawn about the inflammatory, genetic or autoimmune nature of the pathology, but there is no consensus yet.

For this reason, external remedies are not enough to eliminate defects on the face and body, and you should consult a doctor to prescribe a more complete course of treatment.

The development of vitiligo is preceded by the following factors:

Vitiligo is not a congenital pathology, it is a disease that begins to manifest itself under a number of external and (or) internal factors:

1. Malfunctions of the immune system, when tissue metabolism is disrupted and the body mistakenly begins to destroy its cells, mistaking them for hostile.

2. Heredity. Research by American scientists has identified a common genetic defect in several generations of families with cases of vitiligo.

Their discovery also confirms that dark-eyed people experience the disease much more often than people with light-colored irises (blue, gray, green).

3. Hormonal disorders. Malfunctions in the body and metabolic pathologies cause achromia due to a surge or decrease in vital substances.

4. Injuries. Extensive wounds, bruises, frostbite and burns can provoke the death of the epidermis, as a result of which the affected area loses normal functions (heat regulation and protection) and changes color.

5. Liver diseases and digestive tract. Stagnation and slow absorption nutrients negatively affect the condition of the skin and contribute to the development of skin diseases.

6. Impact chemical substances(medicines, cosmetics, hygiene products, perfumes, household chemicals). In these cases, vitiligo develops in response to irritating substances and their harmful (or inappropriate for the skin) components.

Provoking factors for the manifestation of achromia include:

physical injuries;
infectious and (or) chronic diseases;
psycho-emotional shocks and severe stress.

The disease has a complex development mechanism, so its causes and treatment are strictly within the competence of doctors (dermatologists, immunologists, endocrinologists, etc.).

We can talk about the causes of vitiligo only approximately, at the level of assumptions, which are more or less confirmed. Changes in the skin occur from a decrease in the rate of enzymatic reactions that determine the production of melanin.

Melanogenesis is disrupted and tyrosinan activity decreases. A negative DOPA reaction is noted.

At the same time, the norm in the number of melanocytes is maintained.

vitiligo photo in a child (discoloration of eyelashes in the spot area is visible)

Dermatologists around the world are trying to understand the cause of this disease. Special cases that lead to this process have been studied, but it has not yet been possible to strictly prove it, and it has not yet been possible to “sort everything out.”

It is known for certain that there is a genetic autosomal recessive factor and vitiligo can be inherited, since a tyrosinase defect is inherited. This is proven by the fact that people with gray or blue eyes Vitiligo is less common than brown-eyed people.

To date, the causes of vitiligo have not been reliably established, which means there is no need to talk about effective and complete treatment. Basically, the treatment method includes photochemotherapy, as well as taking vitamin E and acupuncture methods in complex therapy.

Classification

Clinicians distinguish several types of the disease, depending on the color of the spots formed, as well as their distribution throughout the body.

By prevalence:

localized form. It is divided into three subtypes: segmental location (spots are localized only on one half of the body), focal (only a couple of depigmented areas are observed), mucous (spots appear only on the mucous membranes);
universal form. In this case, the pigment loses up to 80% of the entire surface skin;
generalized form. It has three subtypes: vulgar location (symmetrical manifestation of areas of depigmentation), acrocephalic (on the skin of the limbs and face), mixed.

By color of depigmented areas:

blue. The depigmented area of the skin acquires a blue tint;
inflamed. Along the edges of the spot you can notice the appearance of an inflamed border;
tricolor. In this case, the depigmented area is limited by a transition zone, which has a slightly lighter shade than healthy skin;
four-color. The above three colors are complemented by an area that has more intense pigmentation than healthy skin.

Depending on the nature of the spots, the disease is divided into two types: type A and type B.

Type A includes the following forms:

vulgar – present on 2 or more parts of the body;
mixed - combines different forms;
acrofascial – pathology is present only on the hands or feet;
universal – more than 80% of the body surface is affected.

Type B includes:

focal - appears only on one side of the body, does not progress further;
mucous membrane – only the mucous membranes (genital organs, oral cavity) are affected;
zosteriform - characterized by small clusters of lesions in one place;
segmental – associated with damage spinal cord and nerve endings.

Read about the symptoms and treatment of alopecia in children here.

The disease is classified according to the prevalence of the process of formation of spots and their color. Depending on the location of the lesions, the disease takes the following forms:

localized, which in turn can be focal (one spot is present in one area), segmental (the lesions are located along the nerve), mucous (the spots affect the mucous membranes);
generalized, which can be acrofascial (failure in melanin synthesis occurs only on the distal parts of the feet, hands and face), vulgar (depigmented areas are scattered throughout the body), mixed;
universal form - depigmentation of the skin throughout the body.

Depending on the color of the spot, the following forms of vitiligo are distinguished:

tricolor – the depigmented area has one transition zone;
four-color – two transition zones within one lesion;
inflamed - an inflamed outline forms around the lesion;
blue – lesions acquire a bluish tint.

Vitiligo: photo initial stage

Clinicians distinguish several stages in the progression of this disease:

To understand what vitiligo looks like, we suggest that you familiarize yourself with the photos in the initial stage and more.

initial stage of vitiligo photo - first spot

The initial stage of vitiligo, the first signs

The onset of the disease is unnoticed. Sometimes tingling, slight itching, and possibly primary erythema appear.

Vitiligo disease appears as clearly defined spots with smooth or scalloped edges from white to milky white. Apart from coloration, no other skin abnormalities are observed.

Subsequently, the spots grow and merge. The areas most often affected are the face, neck, arms and legs, folds of the external genitalia and anus.

If there is hair in the lesion, then it also undergoes a process of depigmentation.

Depending on the distribution of depigmentation, vitiligo is classified as follows:

general pattern (spots evenly distributed over the body);
local pattern (spots in the form of one or several limited zones);
segmental pattern (individual spots located on one side of the body);
total stage (damage to almost all skin).

However, depigmentation is not the only sign of vitiligo. In some cases, the disease is accompanied by irritation and inflammation of the skin.

Sometimes the disease is combined with others skin diseases: psoriasis, lichen planus, superficial scleroderma, baldness and others. In addition, in patients suffering from vitiligo, there is a decrease in the antitoxic function of the liver and the development of chronic diseases gastrointestinal tract.

Symptoms

The main sign is the appearance of characteristic spots on the skin. This process takes a long period of time. At the initial stage, the spots have a pink tint, then they become milky.

In children, spots are oval or round in shape. As the child grows and develops, they change their shape and color.

Vitiligo in children - photo:

On open areas When exposed to sunlight, other symptoms appear:

peeling of the skin;
redness;
compaction of stains;
local increase in body temperature;
lightening of spots against tanned skin;
appearance of cracks.

Otherwise, the disease is asymptomatic, that is, the patient does not feel unwell or other painful symptoms.

The onset of the disease most often occurs unnoticed (rarely the appearance of depigmentation is preceded by slight itching or slight redness of the skin).

The main symptoms of vitiligo include the appearance of small white spots on the skin that have clearly defined (ragged or smooth) edges. There are no signs of atrophy or lichen in the lesions.

Diagnostics

In addition to the presence of characteristic spots on the skin that form with vitiligo in children and adults, diagnosis is also based on indicators laboratory research. To accurately confirm the preliminary diagnosis, the patient is referred for the following tests:

Differential diagnosis is carried out with the following pathologies:

lichen of three types - white, simple and multi-colored;
secondary leukoderma, which began to progress against the background of lupus, dermatitis, syphilis.

If you notice noticeable depigmented spots on the body, you should contact a dermatologist for examination. The examination consists of determining the nature of the skin pigmentation disorder using a special lamp and collecting material for laboratory tests.

These manipulations will help eliminate other skin diseases.

For a confirmed diagnosis, various types of drugs are used:

Glucocorticoids. You need to start using the least concentrated drugs for local application: Fluorocort, Hydrocortisone, Triacort. If the result does not improve after 3 months of therapy, then adjust the dosage - prescribe drugs with a higher amount active substance: Beloderm, Dermovate, Elokom. In the generalized form, drugs of this group are used in tablet form, but in combination with pulse therapy to avoid the risk of developing side effects such as diabetes. Prednisolone, Dexamethasone, Methylprednisolone are prescribed for oral administration.
Photocoumarins in combination with an ultraviolet lamp. Herbal remedies increase the sensitivity of melanocytes to UV radiation: Beroxan, Psoberan, Puvalen, Methoxalen.
Systemic therapy concomitant diseases. Depending on the current situation and existing pathologies, antidepressants, sedatives (for depression and nervous disorders), vitamins and mineral complexes, immunomodulators and antioxidants.

Innovative methods for solving the problem:

Melanocyte transplantation - autologous cell transplantation healthy skin to the discolored area. Used on small areas of cover.
Melagenin Plus is an alcohol preparation based on human placenta.
Laser therapy - vitiligo spots are exposed to laser beams of varying lengths. The technique will be effective if the pathology develops less than 5 years and with segmental, vulgar and focal forms of leukoderma.
Cosmetic skin whitening is the introduction of lightening injections to even out the tone of the skin surface.

New methods are being developed to combat vitiligo, in particular, a vaccine against the disease is being invented.

In order to make this diagnosis, you need to see a dermatologist. Based on an examination and some laboratory tests, he will be able to diagnose a person with vitiligo.

Typically, depigmented areas are so characteristic appearance, which seems to be quite easy to diagnose. However, there are a number of similar pathologies: leprosy, syphilitic leukoderma, lichen versicolor. Only a qualified specialist can distinguish them from vitiligo.

Making a diagnosis is usually not difficult, since white pigment spots on the skin are considered characteristic features of this disease. Diagnosis is carried out by a dermatologist, who must be able to distinguish vitiligo from leucoderma ( secondary symptom syphilis), leprosy (leprosy), versicolor, albinism and depigmented areas of the skin after papules, pustules or blisters.

Modern medicine cannot offer one universal method of treating vitiligo, but there are methods that will help significantly improve the appearance of the skin, namely:

PUVA therapy - treatment of affected areas with ultraviolet light;
corticosteroid therapy (creams, ointments, tablets);
use of helium-neon laser;
diet therapy;
phytotherapy;
vitamin therapy;
folk remedies;
surgical method (transplantation of micro areas of healthy skin into lesions).

How to cure

Modern treatment of the disease includes conservative and surgical techniques.

The main directions in the treatment of vitiligo are:

taking or local use of drugs based on glucocorticosteroids (Hydrocortisone, Prednisolone);
laser or phototherapy;
restorative treatment, diet and lifestyle correction.

The newest methods of treating vitiligo include:

cosmetic procedures for skin whitening using special preparations (Eloquin, Monobenzone and Hydroquinone), which allow you to visually even out skin color;
autoskin grafting;
introduction of one’s own pigment cells from a healthy area to a diseased one;
the drug Melagenin plus, the use of this solution based on placenta extract allows you to compensate for the melanin deficiency in problem skin. Reviews from recovered patients confirm the lasting effect and the absence of remissions (return of symptoms of the disease).

All innovative techniques are used only after consultation with a doctor; therapy is not carried out during pregnancy and lactation.

Methods traditional medicine They offer various remedies to combat vitiligo:

1. Infusion for oral administration. Getting ready similar medicine from herbs that have the ability to improve metabolic processes in tissues (St. John's wort, thyme, calendula, duckweed, etc.).

2. Ointments, compresses. In order to receive homemade ointment from vitiligo to olive or sea buckthorn oil a squeeze from medicinal herbs. Compresses are prepared from wine vinegar or vodka with the addition of honey.

3. Baths. These procedures can be carried out using infusions and decoctions medicinal plants, with the addition of sea salt.4. Mud. Mud wraps rich in microelements help improve blood circulation and nourish the skin.

All methods traditional treatment Use only after consultation with a doctor!

Currently in medicine there are a number of methods to cure vitiligo. Forever or temporarily - only practice can show.

There are cases of complete recovery or stopping the development of the disease. In any case, to achieve a lasting effect, it is necessary to combine the efforts of doctors and patients.

The disease is very difficult to treat. Complex therapy is intended mainly to only stop pathological process. Removing depigmented areas is a very difficult task.

First, it is necessary to identify the cause of the disease and treat it. Usually this is a hidden or obvious pathology of the liver and/or gallbladder, bile ducts. Then the therapy will include drugs such as Essentiale, Gepabene, and Holagogum.

In case of dysfunction of the thyroid gland, a diagnosis is carried out and appropriate treatment is prescribed (if increased function– “Mercazolil” or other drugs, if decreased – hormone replacement therapy).

There is no ideal treatment method; each organism works differently. There are very rare cases where spots simply disappear over time. Treatment of vitiligo is a long process that requires constant monitoring, otherwise you can return to the initial stage of the disease. It is not always possible to completely get rid of the disease; you can stop the spread of spots and make them smaller. Most effective options how to cure vitiligo:

the most important thing is to resume the patient’s normal metabolism; for this, various drugs are used that improve the metabolic process. Preparations containing melanin pigment are prescribed;
the affected areas are treated with alcohol;
It is most effective to carry out ultraviolet irradiation of the affected tissues along with the procedures; before this, they are treated with a special preparation;
PUVA therapy uses ultraviolet light to inject various drugs, hormones and medications under the skin. They provide rapid local treatment;
If local treatment is used, do not lubricate the eye area and eyelids with special solutions.

Children under 5 years of age are more difficult to treat; most drugs are contraindicated for them. For people with weak immunity and complex chronic diseases, as well as the elderly, most drugs can be harmful.

See photos before and after treatment.

Treatment of vitiligo using traditional methods is quite possible; natural-based tinctures and creams are used. The following methods are the most effective, although they do not guarantee 100% results:

You can use several methods at once, the main thing is to find out what helps best and use them only after consulting a doctor.

People who have completed courses of treatment and those who have just started left their reviews about the treatment of vitiligo on various medical forums. This practice is very important: those who have been struggling with the disease for years tell what helped them most effectively and what was just a waste of time.

It is very informative and useful for those who have recently become ill to read such reviews. If we talk about a disease like vitiligo, everyone’s recovery stories are very important for people who are just starting to fight the disease.

Getting rid of foci of vitiligo is not easy, since this pathology has not been fully studied. Today is the most effective way combating discoloration of skin areas can be considered PUVA therapy: pigment spots on the patient’s body cover special drugs and then irradiate them with ultraviolet light.

Under the influence of UV radiation, melanin begins to form on the areas of the skin affected by vitiligo, as a result of which the foci of the disease become less noticeable.

This technique is not safe, and recently it has been somewhat modified: the medicine itself is exposed to ultraviolet irradiation, which is then applied to pigmented areas.

This treatment is considered more gentle and no less effective.

In addition to PUVA therapy, white spots on the arms and other parts of the body can be treated using other methods. If the causes of vitiligo are stress and nervous tension, to pacify the disease, you should take soothing baths twice a week with the addition of valerian and pine needles (for 1 full bath, take 25 ml of alcohol tincture of valerian and 2-3 tablespoons of pine needle extract).

In patients with vitiligo, there is a lack of T-lymphocytes in the body. To increase their amount, you should drink echinacea tincture, vitamins C and B6.

And here is a description of the treatment of the disease according to the Indian method: white spots on the skin of the hands can be made less noticeable if problem areas are treated with a 4% solution twice a day for 3 months salicylic acid, and then apply clobetasol ointment to them.

With prolonged use, the ointment can cause changes in skin pigmentation, which is necessary to get rid of vitiligo. However, you should be careful, as this method has many side effects, including allergic reactions and skin atrophy.

In order for vitiligo treatment to be effective, it is necessary to constantly take care of the condition of your skin.

Experts prescribe groups of drugs responsible for improving metabolic processes. They should not only have a beneficial effect on the internal functioning of the body, but also directly on the metabolism of melanin and stimulate its production.

Therefore, it is advisable to use all kinds of alcohol solutions that should be used to treat the affected areas of the skin.

Basically, treatment for vitiligo comes down to taking medications in the form of tablets, as well as ointments and solutions that increase the sensitivity of the skin to ultraviolet rays.

The ointment is rubbed into those areas of the skin that have lost pigment. The most effective drugs in this sense are ammifurin, psoberan, beroxan, psoralen and meladinin.

Treatment for vitiligo is aimed at helping the body produce melanin on its own.

Ultraviolet irradiation and photochemotherapy are also used for treatment, but with these methods one course of treatment is not enough; several courses of treatment are required with minimal pauses between them.

As symptoms of vitiligo are increasingly seen in young people, last years Treatment is practiced using photosensitizing agents, as well as laser irradiation.

This is much more effective than photochemotherapy, and also cures faster and does not cause adverse reactions. The therapy includes vitamin C and copper, since with vitiligo the patient has a deficiency of these components.

In the West, vitiligo is treated surgically - skin transplantation from donor sites. This method is painless and quick, but is expensive.

The treatment complex also includes immunomodulatory drugs, such as Immunal, Activin or Echinacea tincture. In addition, widespread traditional methods treatment of vitiligo, and namely traditional methods turn out to be the most effective in a number of cases.

Here are some of the most famous recipes used by people to treat vitiligo.

Getting rid of vitiligo is difficult. There are cases of spontaneous healing, but this is very rare, especially with extensive spots. A visit to a dermatologist is required. Modern medicine has by various means, including ultraviolet irradiation with a special wavelength, laser therapy.

In special cases, if the patient persists, whitening options for adjacent skin can even be used to even out the tone and smooth out shade transitions. They are even used surgical methods skin transplants (melanotransplantation). But all these methods are determined by the doctor.

How to treat vitiligo at home?

1) At home, you can wipe the skin with a weak solution copper sulfate, since the enzyme tyrosinase is activated by copper salts.

2) To suppress autoimmune inflammation in the skin, they are used various ointments containing corticosteroid hormones. But this can only be used in the progression stage, and as prescribed by a doctor. After all, even local use hormones may lead to systemic effects.

The most commonly used are Elokom, Dermovate, and Beloderm.

3) In some cases, Elidel and Protopic help with vitiligo. They are new anti-inflammatory drugs that reduce the cellular response of T-lymphocytes, suppressing the synthesis of interleukins - inflammatory mediators, as well as other components of inflammation.

In conclusion, it should be noted that if vitiligo appears, you should immediately go to a dermatologist. If the diagnosis is confirmed, then you need to undergo a complete examination, and you need to start with a doctor - an endocrinologist and rheumatologist, then start checking the functioning of the liver and gastrointestinal tract.

If any pathology is detected and treated in a timely manner - big chance that vitiligo will be cured in its infancy.

How to treat vitiligo in children? Therapy for the disease is aimed at normalizing metabolic processes in the body and returning normal color skin.

For this purpose, medications, physical and other procedures, and folk remedies are used. Typically, therapy is complex, that is, it includes all methods at the same time, which increases the effectiveness of treatment.

Medicines

Treatment medicines involves the use the following types medicines:

corticosteroids (Hydrocortisone, Dexamethasone, Alclomethasone, Fluocinolone, Prednisolone);
hormonal and photosensitizing drugs (Methoxalen, Meladinin, Beroxan, Lamadin);
immunomodulators (Interferon, Dekaris, Likopid, Arbidol);
antioxidants (Panangin, Glutargin, Actovegin);
vitamin and mineral complexes.

You can reduce the manifestations of pigmentation using traditional medicine recipes. White spots on the skin can be removed with red currant juice: you need to wipe the vitiligo lesions with a cotton swab generously soaked in the juice in the morning and evening time.

Instead of juice, you can use red currants themselves: apply the pulp directly to the stains for a quarter of an hour, and then wash off with water. If the patient’s skin is prone to peeling, then after the procedure a thin layer of rich sour cream should be applied to it and washed off with warm water after 10 minutes.

Lemon juice has proven itself well in the treatment of local manifestations of vitiligo. It is necessary to mix 1 part of freshly squeezed juice with 2 parts of kombucha infusion and wipe the affected areas of the body with the resulting solution until the spots become less noticeable.

You can prepare another treatment based on lemon juice. age spots: whipped egg white add 2 tablespoons of juice, place the mixture over low heat and stir until it thickens.

Cool the lemon-egg mixture and add 4 drops of lavender or rosemary essential oil. Apply the product to white spots until a noticeable result is obtained.

You can get rid of skin pigmentation with the help of celandine: it is recommended to regularly wipe problem areas with a tincture of this plant. If vitiligo is present only on the hands, you can make a bath for them 2-3 times a week with the addition of celandine infusion.

It is believed that you can make white spots less noticeable using fresh cabbage juice, sour milk or parsley. Any traditional medicine for vitiligo is effective only on initial stages disease or in combination with the main treatment.

In cases where the disease progresses significantly, the patient must stop self-medicating and consult a doctor as soon as possible.

Prevention and prognosis

To prevent the disease, you should follow the recommendations of specialists:

adhere to a balanced diet;
monitor dental health;
strengthen immunity;
treat any infectious diseases in a timely manner;
avoid stress and psychological stress;
get rid of worms in children;
seek medical help in a timely manner.

The disease vitiligo is still a mystery among doctors. Preventing the disease is difficult, but treating it is even more difficult.

At the first symptoms, it is better to immediately take the child to the doctor and begin therapy.

In the early stages, the symptoms of the disease can be eliminated in a short time by normalizing metabolism and physiotherapy. At later stages, this process may be irreversible.

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Vitiligo is a skin pigmentation disorder. Flat white spots with uneven borders appear on it. They are different sizes, are located on one side of the body or cover fairly large areas. The disease is not contagious, does not cause pain and is not dangerous to health. It can be treated, but cannot be cured completely. Doctors usually associate vitiligo with thyroid dysfunction and other autoimmune disorders. Since the disease is more likely to be considered a cosmetic defect, the medicine for vitiligo is designed to restore pigment in discolored areas of the body.

General principles of vitiligo treatment

There are many treatment options for the disease. The goal of most procedures is to restore lost pigment. The remedy for vitiligo can mask the spots cosmetically, using special tinting creams, the ointment can temporarily restore the color of the affected skin and improve its appearance.

The best treatment option that's right for you will depend on your preference for hormonal ointments or tattooing, phototherapy, or melanocyte transplants to the affected areas. Yours general state health, age, localization of depigmented spots will be decisive in developing a treatment regimen:

Skin camouflage. This is the fastest and safe way make vitiligo less noticeable. With the right shade of cream, its effectiveness lasts from 12 to 18 hours on the face and up to 96 hours on the rest of the body. Most of them are waterproof. Due to its safety, camouflage is often recommended for children.
Drug therapy. These include strong corticosteroids, which restore skin color after 4-6 months of use of these drugs. Some of these ointments should not be applied to the face. This group uses ointments, creams, lotions, and tablets.
PUVA therapy. This method involves the use of ultraviolet rays and a medicine called Psoralen, which is applied to the white areas on the body to increase their photosensitivity or taken orally. The method is effective for large areas of vitiligo, especially on the face, torso and shoulders. Less suitable for restoring pigment on arms and legs.
Depigmentation. If the repigmentation measures taken do not produce results, and more than half of the body area is covered with white spots, then depigmentation is recommended. Skin that has not yet been affected by the disease is bleached to the same color as the affected areas, so that the entire body is given the most uniform shade possible.
Transplantation is the transplantation of melanocytes to depigmented areas, which leads to the gradual restoration of pigment in the affected area.
A tattoo is the introduction of carefully selected pigment into skin discolored with white spots.

Despite its safety, vitiligo changes a person’s life forever.

Many people experience low self-esteem, develop depression, and try to avoid social contacts. Therefore, the strategy to overcome it is not only to treat with ointments and tablets, but also to provide psychological assistance, support from family and friends. Some people prefer not to undergo treatment at all.

Review of effective pharmaceutical drugs

Since it is impossible to completely get rid of vitiligo, the main goal of therapy is to restrain its development, at least partially restore the production of melanin in the affected areas and remove cosmetic imperfections. An integrated approach to the treatment of vitiligo involves the use of hormonal ointments, herbal preparations, vitamin complexes and sun protection. Particular care should be taken when choosing hormonal drugs, since most of them have significant side effects. The course of treatment is individual in nature, so the dosage and duration of administration should be selected only by a doctor.

Hormone-based drugs

Corticosteroids are medications that have an anti-inflammatory effect. If the patient has a disease inflammatory nature, then ointment for vitiligo on hormonal basis helps stop its further spread and temporarily restore the original color of the skin.

Steroid ointment for the treatment of vitiligo should not be applied to the face.

If after a month of using the steroid drug there is improvement, then you need to take a break for a couple of weeks before continuing treatment. If after monthly use If there is no improvement in the affected area or side effects occur, you should stop using the ointment. Patients taking hormonal medications should be closely monitored for the possibility of steroid-induced skin atrophy, that is, thinning of the skin.

Hydrocortisone in ointments and tablets

This medicine is widely used in the treatment of most skin pathologies due to its anti-inflammatory and antiallergic properties. Discolored areas are lubricated no more than 3 times a day. Can be used to treat vitiligo in children over 2 years of age.

Prednisolone ointment

The medicine with the active ingredient of the same name should be used no more than 2 times a day, applying a thin layer to white spots on the skin. The drug has serious side effects - headache, swelling and excess weight. It is prohibited to use it during pregnancy, viral and oncological diseases.

Ointment Elokom-S

Belgian drug, the main active ingredient is mometasone. Dispensed in pharmacies without a doctor's prescription. It can be applied to children no earlier than 2 years of age. White spots from vitiligo are smeared no more than 2 times a day. The ointment is contraindicated for viral infections skin pathologies, pregnancy and breastfeeding, as well as various types rash.

Herbal medicines

Many ointments and tablets against vitiligo contain extracts of medicinal herbs. One such natural compound is furocoumarin, which accelerates the production of melanin by melanocytes. It is extracted from herbs and plants such as St. John's wort, string, calendula and others. It increases photosensitivity of the skin, so the use of drugs containing furocoumarins for vitiligo restores pigment on discolored skin.

Cream Vitasan

One of the drugs for vitiligo based on furocoumarin. It must be applied at least 2 times a day. It has virtually no contraindications, with the exception of individual intolerance to any component.

Cream Amadin

Another cream for vitiligo. A distinctive feature of this drug is that it contains components that enhance the effect active substance. In addition, the ointment replenishes vitamin and mineral deficiency, accelerates blood circulation and metabolism.

Gel Vitaskin

Due to its rich composition, it is effectively used in ultraviolet therapy for vitiligo. The gel enhances the tanning effect. You can treat stains about 2 times a day; you can even use it on your face. It is usually well tolerated by patients, but if you have hypersensitivity to any component, you should consult your doctor.

Nuclea ointment

This anti-vitiligo ointment is based on St. John's wort oil, calendula and avocado extract, and is enriched with a wide range of amino acids. The manufacturer guarantees effective recovery pigmentation on white spots if you use the ointment for a long time.

Medicines from other pharmacological groups

Drugs for the treatment of vitiligo Elidel and Protopic are made using tacrolimus and pimecrolimus, calcineurin inhibitors. They oppress increased activity immune system, reduce inflammation and the appearance of spots with vitiligo. These are not corticosteroid drugs, therefore they do not thin the skin and can be used long time. However, some studies warn of a link between these drugs and skin cancer.

If attempts to restore skin pigmentation in vitiligo do not give satisfactory results, then depigmentation is recommended to patients. To carry out this procedure, the drug Hydroquinone is used. It must be applied 2 times a day for 3 to 12 months. During treatment, the patient may feel burning and itching, and an allergic reaction may occur. contact dermatitis. The drug should be used on areas that bother the patient the most, such as spots on the face and hands, as there are no studies on the long-term effects of using it on large areas of skin.

The long-term social and emotional consequences of this procedure for the patient should be considered. Therefore, depigmentation should not be attempted unless the person is fully aware that the treatment results in permanent loss of natural skin pigment.

Used for photochemotherapy

During phototherapy, the skin is exposed to ultraviolet light from PUVA therapy. Before starting the procedure, the skin is treated with Psoralen in the form of an ointment or taken orally in tablets to enhance its photosensitivity. The course of treatment is agreed with the doctor. This method combating vitiligo is not recommended during pregnancy, breastfeeding, diseases of the gastrointestinal tract, as well as for children under 10 years of age and those over 60 years of age.

Before you start self-treatment We recommend that you consult your doctor first!

Successful treatment of vitiligo requires suppressing the autoimmune response to restore melanocyte production in the white patches of the skin. Research is currently underway on the use of the drug Afamelanotide for phototherapy for vitiligo. Afamelanotide is a hormone that is naturally produced by our skin and stimulates the growth of melanocytes and the production of melanin.

Preliminary research results show that patients who received this hormone regained skin pigmentation 20 days earlier than those who did not receive it. This therapy is best suited for people with dark skin. Further research should investigate the feasibility of using higher dosages, frequency and duration of use to achieve the best results.

People who experience vitiligo most often experience embarrassment, anxiety, and depression. This is especially true for those with dark skin, since the contrast is more noticeable. In India, vitiligo is called “white leprosy.” Therefore, raising awareness about vitiligo, communicating in a support group, discussing this problem with your doctor will help overcome these difficulties.

Among skin diseases, perhaps the most complex is vitiligo, which is characterized by the appearance of discolored spots on the skin. Hormonal ointments are most often used to treat vitiligo.

Brief information about vitiligo

The disease belongs to the group of chronic diseases. Characteristic manifestations Vitiligo is the presence of white spots on the skin, which can be isolated, or can merge together, forming a large affected area. Patients do not experience painful symptoms or discomfort, except for cosmetic skin defects that bring significant psychological discomfort.

The loss of skin pigment can occur gradually or quickly. The exact causes of vitiligo are not fully known. The disease manifests itself mainly at a young age, up to 30 years. An increase in vitiligo occurs in the spring and summer, when sun activity is greatest.

There is practically no complete cure for the disease, with the exception of spontaneous recovery from this disease in approximately 7% of patients. Treatment of the disease is based on curbing its progression, restoring melanin production and reducing cosmetic defects. As a rule, a complex technique is used, including local and general treatment, physiotherapy and vitamin supplements, and diet. At local treatment Hormonal ointments are most often used for vitiligo.

Treatment of vitiligo with hormonal ointments

When starting treatment for vitiligo with hormonal ointments, you should remember that you cannot make such a decision on your own, but only after the recommendation of a specialist.

To the main ointments hormonal group for the treatment of vitiligo include the following.

Prednisolone

The ointment belongs to the group of hormonal corticosteroids. Its local application consists of an anti-inflammatory, anti-allergic effect, the ointment also reduces vascular permeability. Despite many side effects, prednisolone is quite effective for vitiligo.

Apply the ointment according to the instructions. Apply a thin layer to areas affected by vitiligo once a day. The duration of treatment depends on the degree of damage and the nature and duration of the disease.

Betamethasone dipropionate

Belongs to the category of synthetic corticosteroids. Has an anti-inflammatory effect. The ointment contains 0.64 g of the main active ingredient. For vitiligo, it is used once a day in the form of an application.

Beramethasone dipropionate can cause dermatological reactions, burning, itching, dryness and thinning of the skin.

Clobetasol propionate

Ointment of the glucocorticoid group. It has anti-allergic and anti-inflammatory effects, helps relieve swelling and eliminate itching. Used for skin diseases. Apply a thin layer for vitiligo once a day. Local reactions, thinning of the skin, and dilation of blood vessels are possible.

Hormonal ointments for vitiligo should be used for 2 to 6 months. It is advisable to avoid applying medications to the area around the eyes. Hormone therapy ointments for vitiligo can be carried out in several ways:

Continuous, in which the ointment is prescribed once daily for 90 days for children, for adults - from 4 to 6 months.
Intermittent. With this treatment regimen, 1 application is prescribed every day for 15-20 days, repeating courses after a 7-14 day break. In total, 4 to 6 courses of treatment are required.

If the ointments have a positive effect, results may appear 2-6 weeks after the start of treatment. Discolored spots may shrink in size and their edges may become jagged. An uneven change in the color of pathological lesions appears.

Modern view on the treatment of vitiligo

Modern views on complex therapy of vitiligo reflect a commitment to theories of the development of depigmentation. A number of authors argue that systemic use corticosteroids can inhibit the spread of depigmentation, especially in generalized forms. It is proposed to use prednisolone at a dose of 10-15 mg/day 2 times a week for 6 months. This author, summing up the results of the study, showed that none of the patients had complications after 6 months of treatment, but only 32% of patients had active repigmentation of the lesions. S. Radakovic-Fijan (2001) prescribed prednisolone at a dose of 0.3 mg/kg daily for 2 months. A pronounced effect in the form of complete repigmentation of lesions was noted in 65% of patients with vitiligo, in whom the disease lasted no more than 2 years. As a result of the use of prednisolone 5 mg/day for 6 months, the progression of the disease was stopped in 90% of patients, and restoration of pigmentation was observed in 67% of patients. The results of these studies demonstrate the high effectiveness of systemic steroid therapy, but a number of contraindications and a high risk of side effects and complications do not allow this method to be widely used, especially in pediatric practice.

In 2004, Indian researchers published the results of an open-label, multicenter study of the clinical effectiveness of levamisole for the treatment of vitiligo. Levamisole was considered as a drug with antihelminthic activity and influencing certain parts of immune reactions. Levamisole was used in patients aged 14 to 55 years at 150 mg/day twice a week for 12 weeks. As a result, it was concluded that levamisole is ineffective in this disease, since only 15% of patients had partial repigmentation in the lesions, and in a parallel placebo-controlled study, partial repigmentation of individual lesions was also observed in 12.5% of patients taking placebo.

Cyclosporine is widely used for the treatment of immunomediated dermatological diseases. Some authors used its immunosuppressive properties for vitiligo, but the results of treatment were very doubtful. Complete repigmentation was not observed in any patient; partial repigmentation of individual lesions was observed in only 8% of patients. Considering possible complications and side effects, this method has not yet found wider application.

A positive clinical effect was observed when drugs with immunomodulatory effects were included in complex therapy. Thus, the use of polyoxidonium caused the restoration of normal skin color in patients with widespread and limited forms of vitiligo. THEM. Korsunskaya (2004) successfully used the domestic drug glutoxim, which belongs to the class of thymopetins and has an antioxidant effect that modulates the intracellular processes of thiol metabolism. It has been used for several decades and in some cases is still used today. complex therapy with B vitamins, folic acid in combination with microelements (zinc, copper) and ultraviolet irradiation. During the therapy, no pronounced clinical changes were detected. The pathogenetic justification for the patient's use of vitamins is also questionable; partial repigmentation of individual lesions was observed in only 8% of patients. Given the possible complications and side effects, this method has not yet found wider application.

For several decades, complex therapy with B vitamins, folic acid in combination with microelements (zinc, copper) and ultraviolet irradiation has been used and in some cases is still used. During the therapy, no pronounced clinical changes were detected. The pathogenetic justifications for the use of vitamins are also questionable.

Therapeutic algorithms Muscalu A.S. et al. (2008) recommend using it taking into account clinical form vitiligo, duration of the disease and the severity of psycho-emotional changes that developed against the background of the disease. In children integrated approaches Treatments for vitiligo include topical steroids, psoralen, Vitix (an antioxidant) and ultraviolet B irradiation and antidepressants. The choice of duration and dose depends on the clinical form of vitiligo.

The use of topical steroids for vitiligo is common in Europe and the USA, however, the use of these drugs for a long time (at least 3 months) is recommended for small areas of damage and there are restrictions for certain areas of the skin (eyelids, large folds, genital area), on which develop skin atrophy most quickly and frequently. Long-term use topical steroids in the periorbital area increases the risk of glaucoma and cataracts. In research by scientists, it was found that 0.1% hydrocortisone butyrate cream, 0.05% clobetasol propionate cream, a cream containing 50 mg/g calcium potriol, have a photoprotective effect, but even with prolonged external use in combination with sunlight do not cause carcinogenic effects. effect, therefore they can be used in combination with phototherapy in patients with vitiligo.

Some authors propose various topical therapy regimens, including clobetasol 0.05% or a combination of clobetasol 0.05% and estrogen cream 0.625%. Results of the clinical trial indicate that with combined use it is possible to reduce the risk of side effects such as skin atrophy and the appearance of telangiectasias.

The method is called innovative topical use analogues of prostaglandin E2 involved in the proliferation of melanocytes. In an experiment on mice, it was found that applying PgE2 to the skin leads to an increase in the number of melanocytes. As a result, the appearance of pronounced repigmentation was noted in 62% of patients, moderately pronounced repigmentation was observed in 25% of patients, and mild changes were observed in 12% of patients. The study of the clinical effectiveness of topical PgE2 is ongoing, since the positive effect obtained is considered significant.

Currently, a large number of publications are appearing on the results of the use of pimecrolimus and tacrolimus, nonsteroidal inhibitors of proinflammatory cytokines in various forms of vitiligo. 35 patients with vitiligo under the age of 30 years were included in a study to study the clinical effectiveness of 0.1% tacrolimus ointment, which was applied to the lesions twice a day for 3-6 months. In 7 patients, brilliant results were observed and complete repigmentation was noted in the lesions, in 24 patients there was partial repigmentation of large lesions (pigmentation was restored by 50-75%) and complete restoration of normal skin color in small lesions, in three patients no positive changes were found, however, the sharp boundary between depigmented and normally colored skin disappeared, and only one patient did not respond to treatment. The authors also noted that lesions repigmented most quickly on the face, chest, and labia.

Win Z., Costigan J., Bhat J., Abdullah A. (2009) conducted a retrospective analysis of the results of treatment of vitiligo in children with tacrolimus ointment (Protopic) in 2007-2008. 100% repigmentation of all lesions was observed in 19 out of 24 patients, partial repigmentation was noted in 4 children, and only in 1 child no positive results were obtained. The authors emphasize that tacrolimus therapy should be long-term, at least 4 months. This treatment method did not involve additional medications or UV irradiation.

In 2009, M.D. Rooseleer N. published his own observations of a 35-year-old patient suffering from vitiligo for more than 2 years, who used a combination of calcium potriol/betamethasone dipropionate ointment with ultraviolet irradiation for 23 months. Partial repigmentation was noted in lesions on the face and hands, at the same time clinical signs no skin atrophy was observed. External therapy of vitiligo with a combination ointment calciumpotriol/betamethasone dipropionate has shown high effectiveness in the treatment of facial skin lesions with vitiligo.

Currently, a combination of calcipotriol cream and sunbathing can be used. 38 patients with vitiligo, whose affected area was no more than 20% of the skin surface, were treated with calciumpotriol cream once a day in the evening, and the next day the patients took sunbathing for 10 minutes before 10 am for 6 weeks. In 12 patients, complete repigmentation was observed in the lesions, in 13 patients - partial repigmentation, and in 13 - no results of combined treatment.

Phototherapy. Experimental studies in the field of photobiology demonstrate the various effects of UV irradiation in combination with various substances, as well as their participation in melanogenesis and the advisability of their use. The experiment found that procyteine is a potential tyrosinase inhibitor and potential antioxidant, and vitamin C reduces the transport of melanin into keratinocytes.

Phototherapy is a very common treatment for vitiligo. It is used in children and adults, with limited and generalized forms of vitiligo with varying duration of the disease. The feasibility of using phototherapy is due to possible stimulation pigment formation and some ability to reduce the activity of skin immune system cells. The search for the most effective method of UV irradiation continues. For this purpose, a comparative study of the influence of UV with different wavelengths is carried out, as well as the possibility of using combined approaches, including topical agents used in the treatment of vitiligo. Scientists emphasize that phototherapy should be long-term, and in some cases indefinitely long, and the duration of treatment can be significantly reduced through pre-treatment with topical steroids, calcineurin blockers or other known methods. However, the authors point out that with stable vitiligo (with a disease duration of 2 years or more), the best results are achieved using surgical techniques.

Summarizing the results of the long clinical study effectiveness of various modifications of phototherapy (UVA and UVB) M.E. Whitton et al. (2008) conclude that the effectiveness of the selected phototherapy methods is approximately the same. Hartmann A. et al. (2002) conducted a comparative analysis of the effectiveness of UV-B with a wavelength of 311 nm and polychromatic UVB rays. The authors showed that UVB with a wavelength of 311 nm has a pronounced effect in the treatment of patients with vitiligo, while polychromatic rays of this spectrum turned out to be completely ineffective. The same author believes that when ultraviolet irradiation is combined with local application calcipotriol can reduce the radiation power.

PUVA therapy is still widely used to treat vitiligo. Various photosensitizers are used: puvalen, methoxalen, oxorolene, ammifurin. In their studies, scientists have shown that during PUVA therapy, repigmentation is observed due to increased mitosis in melanocytes through the release of endothelin-1 into the bloodstream. When using PUVA therapy, scientists observed rapid (1-2 months) repigmentation in 50-75% of patients.

On the other hand, comparing UV irradiation with PUVA therapy, scientists note that the effectiveness of these methods is reliably comparable. Repigmentation of more than 70% was observed in 30% of patients receiving UVR and in 24% of patients receiving PUVA, and the absence of effect from UVR was shown in 4.5% and in 7% with PUVA therapy. However, the author emphasizes that when using any method of phototherapy, the quality of life of patients with vitiligo increases and their mood improves. IN various studies the immunosuppressive effect of PUVA therapy on activated tissue macrophages, cytotoxic T lymphocytes and Langerhans cells. The inducing effect of UV on apoptosis of T lymphocytes in depigmented lesions has been demonstrated.

Despite the wide popularity of PUVA therapy in various modifications, side effects and contraindications are well known, limiting the use of UFO and PUVA. The most common side effects of UVR include itching, persistent erythema, severe dry skin, as well as cataracts and carcinogenic effects. With PUVA therapy, headaches, dyspepsia, palpitations, dry skin, photodermatitis and long-term side effects are observed - uneven skin pigmentation, lentigo, hypertrichosis, epidermal dystrophy, onychodystrophy, up to onycholysis, keratoses, skin cancer, cataracts, liver dysfunction and kidneys, induction of autoimmune processes, manifestations of immunosuppressive effects. At the same time, attention is drawn to clear limitations for PUVA therapy - individual intolerance to photosensitizers, acute gastrointestinal diseases, diabetes mellitus, thyrotoxicosis, hypertension, acute and chronic diseases liver, kidneys, blood, heart, central nervous system, various neoplasms, tuberculosis, HIV infection, pregnancy and lactation, cataracts, increased photosensitivity.

In modern practice, laser radiation from various sources with different powers and effects on the skin and underlying tissues is increasingly used. IN modern therapy Vitiligo patients use an excimer laser to study its stimulating effect on melanogenesis and its corrective effect on cells of the immune system. A large number of foreign publications note fairly high efficiency and fewer side effects compared to PUVA. This method is used for segmental vitiligo, since it is possible to selectively irradiate without affecting normally pigmented skin. According to various authors, the effectiveness of this method is different and varies from repigmentation in 95% of patients to complete absence effect in almost 20% of patients. Against the background of the noted clinical effectiveness, the appearance of persistent erythema in the foci of depigmentation is noted in a significant number of patients.

Other authors are more reserved about the high clinical results of using the excimer laser. S.V. Mulekar et al. (2005) observed repigmentation of more than 75% in only 15% of observed patients and in 19% there were no positive changes during excimer laser therapy. During the same period of time, M. Esposito (2005) observed complete or partial repigmentation in 29% of patients after laser therapy. Subsequent studies demonstrate better results - repigmentation was observed in 55-78% of patients when combined with tacrolimus or calcipotriol.

Subsequently, the excimer laser was used less frequently as monotherapy. A new combined method was developed by K. Fitz and T. Hunziker (2009), who propose, for stable vitiligo, to transplant uncultured melanocytes (source - hair follicles in the anagen phase) and then stimulate melanogenesis using an excimer laser. Although these authors in their work noted high efficiency (repigmentation more than 50%) when using pimecrolimus or tacrolimus and further phototherapy. I.M. Sheikh (2009) showed that in stable vitiligo, any transplantation of autologous (both cultured and uncultured) melanocytes followed by irradiation leads to complete repigmentation in 90% of patients. The author emphasizes that in this way it is possible to reduce the time and power of radiation without affecting the final results.

Korean researchers demonstrate positive results with both UVB and excimer laser (perifollicular repigmentation observed in 42.2% and 51.3%, respectively) after 12 weeks of treatment. In conclusion, they conclude that successful treatment to a certain extent depends on the location of the rash, the age of the patient, the duration of the disease, the speed of response to radiation, i.e. if in early dates phototherapy, signs of repigmentation appear,then we can expect a complete restoration of normal skin color in irradiated areas of depigmentation. A group of other researchers used an excimer laser twice a week, with a total of 30 procedures per course, irradiating depigmented lesions on the head and chest in patients from 0 to 60 years old. The authors believe that the best results were obtained in younger patients, and other than hyperpigmentation around the radiation zones, no other side effects were noted. Laser phototherapy, and in particular the excimer laser with a wavelength of 308 nm, has a number of advantages over other methods. The possibility of precise dosing and fewer contraindications open up prospects and require further study.

The high effectiveness of combined phototherapy has been noted by many researchers. When choosing a method of phototherapy and combined modifications, an individual approach is required, taking into account the prevalence, duration of the disease, age and possible side effects. In all cases, long-term, expensive treatment is expected - more than 3-6 months.

Surgical methods for treating vitiligo. At the end of the 50s of the 20th century, the results were first published surgical treatment vitiligo. Back in 1947, N. Haxthausen used full-thickness flaps of healthy skin to replace depigmented skin. It seemed that this method would gain acceptance. But later, in addition to the rejection of autografts, other complications were observed in the form of scar changes, infection, uneven pigmentation, and the occurrence of the Koebner phenomenon. The search and development of various techniques and modifications continued and the next step was the technique of thin epidermal flaps using the Thiersch method. R. Falabella (1971) proposed using thin covers of the epidermal bladder as an autograft (epidermal transplantation with a suction effect). Available methods obtaining thin epidermal flaps are: forming a bubble using a vacuum extractor or liquid nitrogen. On the one hand, these techniques are performed without much difficulty, on the other hand, they are traumatic and leave scar changes of varying severity after exposure. Some researchers have transplanted pigmented hair into areas of depigmentation, since melanocytes are a reserve source of autologous melanocytes hair follicles. Currently, when methods are known and developed that allow transplantation of single hair follicles with pigmented hair, it is possible to avoid scar changes both in the donor area and in the focus of depigmentation.

The search continues for possible surgical treatments for vitiligo with minimal complications. Observations show that surgical methods have the highest success rates compared to others, reaching 92% of restoration of normal skin color. It is recommended to resort to surgical methods in cases of stable vitiligo, including segmental, vulgar, generalized, acrofacial, refractory to traditional methods of treatment. It is proposed to evaluate the stability of the process according to the following criteria:

1) the absence of the appearance of new foci of depigmentation or an increase in the area of existing foci over a period of time from one to 3 years;

2) absence of the Koebner phenomenon;

3) trial transplantation is the gold standard for determining the stability of the process and the effectiveness of treatment: the test is considered positive if repigmentation extends beyond the autograft by 1 mm or more over a period of 3 months.

However, in a number of cases when positive test There is no stability of the process, therefore its reliability and universality are questionable.

A new and promising direction of surgical treatment is autotransplantation of cultured melanocytes. When using “blister” transplantation, a culture of melanocytes grown from the patient’s own pigment cells is transferred to a special carrier, after which it is applied to a previously macerated area of depigmented skin. A. Andreassi et al. (2001) noted the restoration of normal skin color in 40-100% of cases using this technique. The disadvantages of this method are maceration of the skin, marbling of the area, uneven repigmentation of the affected areas. During the same period, other scientists proposed applying a melanocyte culture suspension to pre-dermabraded depigmented skin and showed the highest efficiency of the developed technique - repigmentation was observed in 84-100% of cases, especially in combination with PUVA therapy to restore pigmentation in large areas of depigmentation. However, the authors warn about the possibility of the Koebner phenomenon. In order to reduce the risk of developing S.V. Mulekar et al. (2004) suggested using prednisolone at a dose of 0.5 mg/kg 1 week before transplantation and 1 week after it. The authors emphasize that the immunosuppressive effect of prednisolone not only prevents the development of the Koebner phenomenon and the rejection reaction, but has a pathogenetic basis for its use in vitiligo.

Until now, transplantation of a suspension of cultured melanocytes and keratinocytes has not been used in Russia, although this surgical method is the most promising and effective. The suspension obtained after co-cultivation of keratinocytes and melanocytes is injected into the areas of depigmentation. The advantage of the culture approach is that in vitro cell expansion can significantly reduce the area of skin graft used to prepare the graft.

There are still some options that make the life of a vitiligo patient easier - these are decorative camouflage cosmetics and micropigmentation (tattooing). The complexity of these methods lies in selecting the required pigment tone, constantly using cosmetics, and experiencing anxiety when it runs out. cosmetic product and seek, try and experience innovative developments in this area. Micropigmentation invasive method introducing pigment, the tone of which can also be difficult to choose. In addition, the pigment fades after some time and there is a need to correct/defective areas.

Thus, studying the literature data, it becomes clear why there are still no clear algorithms for the treatment of various forms of vitiligo and many of the proposed methods are aimed only at eliminating a cosmetic defect, that there are a large number of treatment options for vitiligo, many of which have serious limitations for use, high risk of complications and side effects.

Despite the emerging new opportunities for studying impaired pigment formation, a unified view on the causes and mechanisms of the development of depigmentation has not yet been formed. Why do some patients have 1-2 stable foci of depigmentation for decades, while others have fresh depigmented areas appear against the background of apparent well-being and well-being?