NON‐PSORALEN TREATMENT OF VITILIGO. PART I. COSMETICS, SYSTEMIC COLORING AGENTS, AND CORTICOSTEROIDS

Vitiligo is a common disorder of pigmentation characterized by loss of melanocytes resulting in macules and patches of depigmented skin in varying distributions. It has an unknown etiology and occurs in approximately 1.5% of the population. Historically, topical and/or systemic plant extracts (usually containing psoralen) had been used in conjunction with natural sunlight. Currently accepted standard therapy has been topical or systemic psoralens witb natural or artificial ligbt sources; however, not only can this therapy be time consuming, but only approximately one-third of patients achieve excellent results. It is important, therefore, to have other therapies as first line therapy or for patients who either have failed or are unsuitable for topical and/or systemic psoralen therapy. This report will deal only with other methods of treatment. We have reviewed most major studies on the therapy of vitiligo, published in English in the last 27 years. Therapies include expectant management (i.e., no therapy), patient education, psychotherapy (supportive and active), and active therapies: medical, surgical, or cosmetic camouflage. In this paper, the first of two papers on the therapy of vitiligo, we will review the literature concerning cosmetic camouflage and topical, intralesional, and systemic steroids in vitiligo. The second paper will deal with other modalities of treatment. There are several approaches to therapy. Obviously, it is not necessary to actively treat every patient with vitiligo; however, vitiligo can have profound effects on a patient's psyche and lifestyle. Studies by Porter et al.' showed that vitiligo patients can experience despair and depression as result of their disease. Individual responses vary considerably, ranging from considering oneself a social outcast, to an acceptance of the disease without any loss of individual or social functioning.