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Ask the Experts

The National Vitiligo Foundation answers many different questions daily from patients and family members. If you have a specific question that you do not find answered here, please email it to the NVF and address it to "Ask the Experts". We will ask our Medical Advisory Board for their opinions and recommendations.

>> Click here to view the "Ask the Physician" page

Q. Is vitiligo contagious?

A. Vitiligo is not contagious. If it were, I would have had it years ago.

Q. Why can't we find a cure for vitiligo?

A. Many investigators have looked for a cure to vitiligo. We need to find some medication that will stop its spread first. Then we could cure vitiligo. But despite many studies, the mechanism for destruction of the skin pigment cells remain an elusive goal. The cause will be discovered in the coming 25 years or less.

Q. Do we know what causes vitiligo?

A. We know that the white spot of vitiligo are caused by destruction of melanocytes in the epidermis. But we do not know why they die and disappear. That is the key problem. Everyone agrees that there probably are many causes.

Q. What are the chances of my children and grandchildren inheriting vitiligo?

A. About 1 in 200 individuals in the U.S. and Europe get vitiligo. In families, that increases to about 1 in 20 for children, siblings, or parents and about 2-3% for grandparents. That means there is about a 7% chance that one relative could manifest vitiligo. In other words, there is a 93% chance that no one else will get vitiligo in that family.

Q. Should people with vitiligo stay out of the sun?

A. It is my opinion that those with vitiligo should get some direct exposure to the sun. The sun is the best stimulus for growth of melanocytes and can assist the individual in getting color back. But the exposure should not lead to sunburn which is not helpful. It can slow down repigmentation. Those who are depigmented or using Benoquin should not get sun exposure lest they gain some color back.

Q. What type of sunscreen do you recommend?

A. The patient should use routine sunscreens with an SPF of 15 to 25. They should get one they like so they will use it.

Q. Is there any safe treatment for children under the age of twelve?

A. Children under the age of twelve years who have vitiligo can be treated. We use a combination of topical steroids and exposure to natural sunlight. Children can also be treated with Protopic or Elidel. We suggest not using a sunscreen during the morning hours from breakfast to lunch provided they do not burn. In the afternoon we have them apply a sunscreen with the usual protective factor, about SPF 15 to 25. Many children do very well with this combination but not all are improved or cured.

Q. Should children and adults change their diets?

A. There are no known factors in foods that cause individuals to get vitiligo. We don't recommend any routine changes in the diet.

Q. How soon should a patient using Benoquin see results?

A. Benoquin used correctly will cause depigmentation in about 75% of those with vitiligo. It can take as few as six weeks and as long as a year to get the desired results.

Q. Is there any dangerous side effects in Benoquin?

A. The only known side effect of Benoquin is an allergy. The allergy produces a rash like poison ivy but is limited to the pigmented skin and does not affect the white skin. Why this happens is a mystery. It does mean that the person must stop the applications of Benoquin. There are no substitutions for Benoquin and so the person cannot depigment.

Q. Why do dermatologists discourage the use of Benoquin?

A. I think that dermatologists discourage the use of Benoquin because they don't know how to use it, have never seen it used, and have not seen patients who have been depigmented. They do know about individuals who have used Benoquin for improper reasons and had bad results. So maybe dermatologists shy away from lack of knowledge and experience.

Q. Do birth control pills trigger vitiligo in women predisposed to the disease.?

A. We are not aware that birth control pills or pregnancy affect the course of vitiligo.

Q. Does skin that is injured or stressed have a greater tendency to develop vitiligo?

A. The normal appearing skin of a person is in truth not really normal. With special microscopes investigators have shown that all skin in a person with vitiligo is altered. So any injury -- an abrasion, a cat scratch, a surgical procedure -- can spread the vitiligo.

Q. Besides the loss of pigment, what other health problems might vitiligo patients experience?

A. There is no good data to indicate that a person with vitiligo will develop other problems. Of course all people, even those with vitiligo, are susceptible to high blood pressure, diabetes, or other common problems.

Q. Can stress be linked to vitiligo?

A. Currently there are no hard data to link psychological stress to vitiligo, however, stress imposed to the skin by chemicals, trauma or sunlight can induce a Koebner phenomenon and start a new lesion in the majority of patients.

Q. Is there a good cosmetic or stain that you recommend?

A. We find that no one cosmetic has filled the needs of individuals. (See Penpals, Vitadye, Cosmetics and Psuedocatalase Information for a listing of cosmetic concealers)

Q. What are the cortisone or steroid creams that the dermatologist prescribed for my child? And will this stop spreading?

A. Cortisone creams, also called steroid creams, are topical medications containing a natural or synthetic form of cortisone. Cortisone is a hormone made in the adrenal gland and is essential for life. Within our bodies we all make some daily. Cortisone creams have been used for a multiplicity of disorders and they work sometimes for those with vitiligo. If the cream is too strong, it will damage the skin. So the dermatologist must pick the proper cortisone cream to be applied. There are at least 25 such products available in the U.S.

Q. Is there a specialist anywhere in the world that understands vitiligo?

A. There are many individuals in the U.S., Europe, the Orient, and the Middle East who understand vitiligo and its manifestations. But there is no one who understands the mechanism for destruction of vitiligo.

Q. Can chemotherapy or other treatments be harmful to vitiligo patients.?

A. There are many treatments that can be harmful to patients with vitiligo. PUVA used improperly can be harmful. Topical or oral steroids used incorrectly are harmful. If used properly the risk is very small although no treatment is completely risk free. Other treatments, especially those involving herbs or other uncontrolled agents, might carry some risk but since they are not carefully studied, the risks are unknown.

Q. Are there any foreign treatments that you would recommend?

A. The treatments currently used in the U.S. are identical to those used around the world. Communications are so easy that any treatment used in the U.S. is quickly used in other countries or vice versa. There are treatments such as Ratokderm ultraviolet light that is available only in Milan, Italy. But individuals can get similar results with sunlight.

Q. Does the psoralen treatment (PUVA) cause liver and kidney damage?

A. PUVA is not known to cause any kidney damage. There has been concern about liver dysfunction and abnormal liver test but these events must be few. I personally know of no serious liver problems related to the use of psoralen.

Q. Does the psoralen treatment (PUVA) cause cataracts?

A. There are reports that PUVA causes cataracts in rabbits and that those who abuse the use of PUVA have developed cataracts. But there is no substantial data that PUVA causes any eye problems. Rather the data from a large number of individuals on PUVA for psoriasis who have been examined frequently over 25 years have indicated that the eyes suffer no ill effects at all from PUVA.

Q. Does the psoralen treatment (PUVA) cause cancer?

A. There is good data that PUVA does cause squamous cell carcinoma in those with psoriasis. These individuals are not identical to patients with vitiligo. Those with psoriasis have been treated with tars, ultraviolet B and other agents that might contribute to or be the cause of the squamous carcinomas. In addition, I recommend that patients with vitiligo restrict the number of treatments to less than 200, the threshold number of doses that seem to be needed for cancers to occur. But those on PUVA should be apprised that there is some risk of squamous cell carcinomas.

Of more concern is the recent report of melanoma. In the group of patients with psoriasis followed for 25 years there is an increased incidence of melanoma. There might be a chance of occurrence and we won't know if the melanoma is more frequent for a few years. But there are dangerous cancers and patients on PUVA should be alert for changing moles and should be apprised of the risk if they continue PUVA too long or have too many treatments (more than 200).

Q. How long does it take for the vitiligo patient to see results after beginning treatment of PUVA?

A. It takes a minimum of three months to see the effects of any treatment for vitiligo. Often the patient will see results even later, at four months.

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