Pigmentation Disorders
Pigmentation disorders are often traumatic to those who suffer from them and effective treatments are not widely practiced. The Vitiligo and Pigmentation Institute of Southern California is the only practice of its kind in the Western United States.
The Institute specializes in the treatment of vitiligo, melasma and also in depigmentation caused by laser resurfacing, in addition to treatment of other pigmentary disorders.
Vitiligo
Vitiligo is a psychologically devastating disease. Recent major strides have been made in our understanding of the pathogenesis of vitiligo. Commensurate with these studies, there have been significant therapeutic advances. Treatments are most often based on age, severity and progression of disease.
Topical steroids are a mainstay for patients with limited disease. Recent studies now document the beneficial effects of low dose and pulse dose oral steroids for stabilization and repigmentation.
A rationale for the use of antioxidant therapy has been well established. Calcipotriol has been reported to be effective in combination with PUVA as well as natural sunlight.
Immunomodulators have shown efficacy for some patients with vitiligo. Preliminary data suggest that tacrolimus ointment can induce significant repigmentation in children and adults. Maximum repigmentation is seen on sun exposed areas. Dr. Grimes has pioneered the use of tacrolimus ointment (Protopic, Fujisawa Healthcare) and pimecrolimus cream (Elidel, Novartis Pharmaceuticals) for treatment of vitiligo. An article discussing her preliminary research with tacrolimus ointment was recently published in Dermatology Times. Expanded data was presented in 2002 at the Society of Investigative Dermatology Conference and at the World Congress of Dermatology in Paris, France. As the data continues to be compiled, topical immunomodulators show promise as an exciting new therapy for the treatment of vitiligo.
Other studies have documented the efficacy of the 308nm Excimer laser for repigmentation of vitiliginous lesions.
Advances have also been made in surgical therapies for vitiligo. These include newer or modified methods for culturing melanocytes, harvesting punch, sheet and suction blister grafts and preparation of donor sites. In summary, there has been significant growth in the repertoire of effective treatments for this therapeutically challenging disease.
Melasma
Melasma is characterized by dark or gray/brown patches on the face. Post infammatory hyperpigmentation is caused by a trauma to the skin, and is characterized by an excess of pigment at the sit of the trauma. Bleaching, chemical peels, and microdermabrasion have all proven beneficial for patients with melasma and post inflammatory hyperpigmentation.
Laser-Induced Hypopigmentation
With the recent popularity of laser resurfacing procedures, the Institute has seen an increase in patients who have suffered a loss of pigmentation as a result of the laser procedure. Repigmentation therapies for laser-induced pigment loss are often similar to therapies for vitiligo.
Procedures for laser-induced pigment loss include topical psoralen photochemotherapy, targeted phototherapy using the excimer laser or TheraLight, and autologous grafting.
