Пожалуйста помогите советом. С 1989 года у меня Белые пятна в разных местах...

[Svetlana]

Пожалуйста помогите советом. С 1989 года у меня Белые пятна в разных местах. Поставили диагноз витилиго. Подскажите как избавиться от этой болезни?

 

[Nurse-Practitioner]

following are helpful hints to assist you with your patients.
I. ADULTS AND YOUNG PEOPLE; AGES 12 YEARS OR OLDER


Topical steroids such as tramcinolone acetonide 0. 1% cream applied once daily.


Useful for smaller areas.
Easy, quick, cheap; avoids tanning contrasts.
About 50% response — partial or total if continued for 4 months to 6 months longer.
Oral steroids are contraindicated because of the long duration of treatment needed and the high toxicity.
See patient at reasonable intervals to avoid steroid- induced atrophy.

NOTE: The reservoir of melanocytes is in the hair follicles. Those areas without follicles such as the dorsum of the hands from metacarpal joints distally, the feet from the ankles distally, the genitalia, the lips, or the skin containing white terminal hair cannot repigment with any medical (vs. surgical transplant) therapy.

PUVA.


Oxsoralen- ultra, 10- 20 mg. 1. 5 hours before UVA is the best medication.
Trisolaren is poorly absorbed from the intestine.
Must use UVA (not UVB).
Sunlight — treat all exposed skin with UVB sunscreen, SPF 8- 10.
Medical UVA box.
Light exposure and dose of psoralens should produce mild erythema. This is the optimal dose. It can vary from 10 mg Oxsoralen 5 joules UVA to 30 mg + 10 joules. Each patient must be carefully titrated and individualized. Excessive erythema is harmful to melanocytes in the epidermis.
Start with 10 mg Oxsoralen and 3 joules. Increase the UVA 2 joules per treatment until erythema is reached or 15 joules (an arbitrary endpoint because of time constraints). Then give the patient 20 mg Oxsoralen and 2 joules UVA. Increase 1 joule per treatment until a pinkness is noted in the white skin.
Treatments should be given 2- 3 times per week, never on consecutive days.
Patient wears Noir glasses on day of treatment until the next day.
Sunlight — begin at 10 minutes front and back. Increase 5- 10 minutes per treatment until pink. Always use SPF 8- 10 sunscreen.
Treatment requires 6- 18 months.
Success rates approximately 60- 70% if done properly.
Topical psoralen is EXTREMELY photosensitizing. Follow directions in the PDR with ABSOLUTE and TOTAL care. Expect all patients to blister occasionally and forewarn them.