National Vitiligo Foundation, Inc.

Wright State University School of Medicine, Dayton, OH, and
Group Health Associates of Cincinnati, Ohio

James J. Nordlund, MD

GENERAL WORKUP

Patient history and complete skin examination.
Discussion about pathogenesis and treatment.
Ophthalmologic examination is optional and indicated only for those with signs or symptoms of chorioretinitis.
Thyroid studies only for those with family history of thyroiditis or symptoms of thyroid disorder.
Photographs (selected cases).
Make patients aware of National Vitiligo Foundation and local chapter.

OPTIONS FOR TREATMENT

Stains such as Dyoderm and VitiGone.
Makeup with sunscreen such as CoverFX, Dermablend, and Couvrance.
Immunomodulators such as topical steroids (used cautiously on face and intertriginous areas), tacrolimus or pimecrolimus.
Natural sunlight in sub-erythemal doses.
Narrow band ultraviolet light or excimer laser.
Tanning parlors with assistance of dermatologist.
UV light phototherapy using topical or oral 8-MOP (indoor only) is indicated for the more complex cases where repigmentation is desired and all other therapy has been unsuccessful.
Surgical therapies are available for carefully selected patients, especially those with focal or segmental vitiligo.
Depigmentation using monobenzylether of hydroquinone is usually permanent and irreversible, but some repigmentation can occur following sun exposure (note that it takes several years to depigment the face, neck, hands and arms).

FOLLOW-UP OBJECTIVES