What is the commonly used treatment for vitiligo?

(1) ultraviolet (including sunlight) irradiation method. Ultraviolet light is located outside the purple light in the spectrum, also called ultraviolet light. Sunlight contains a lot of ultraviolet rays. Theoretically, ultraviolet radiation can increase the photosensitive reaction of pigment cells and promote them to produce more melanin, which is a traditional treatment. There are still books and periodicals. According to our clinical observation, this method is not conducive to the treatment of this disease for two reasons: too much ultraviolet light will cause damage to the human body; After illness, the human body's ability to resist ultraviolet rays decreases. Therefore, we believe that patients with vitiligo should reduce or avoid ultraviolet radiation.

The human body receives more or less a certain amount of solar ultraviolet radiation every day, which has no harm to normal tissues of the human body. This is because the human body surface has a complete protection mechanism, in which pigment cells produce and secrete melanin to resist ultraviolet radiation and protect the body from harm is an important self-protection function. When the illumination time is prolonged and the illumination is enhanced, the pigment cells appear compensatory physiological response. According to the time and intensity of light, the production of melanin increases correspondingly, and the skin darkens obviously, thus blocking and weakening the ultraviolet radiation on the body surface and protecting the body tissue (and also protecting the pigment cells themselves) from damage. The sick body is completely different from the normal body. Most of the pigment cells on the body surface are damaged to varying degrees, their functions are weakened or even lost, and their protective functions are destroyed. However, ultraviolet therapy will not reduce but increase the amount of light, which will inevitably increase the workload of pigment cells, thus aggravating the damage of pigment cells and causing serious damage to other tissues and cells. Clinically, after ultraviolet irradiation, local skin redness and blistering reaction are the manifestations of serious damage to skin and subcutaneous tissue. Clinically, sometimes we can see that the skin around the white spot becomes darker after brightening, or a small number of pigment islands appear in the center of the white spot. This is because some pigment cells still have a certain compensatory function, showing a temporary compensatory reaction. However, with the extension of light time and intensity, the damage of pigment cells is aggravated and the function of producing melanin is lost. The melanin around and in the center of leukoplakia gradually subsided, the area of leukoplakia expanded, the whiteness deepened, and even the disease spread rapidly. Some people think that "the fading of black spots and the exposure of white spots are the manifestations of the improvement of the disease", which is debatable. The discoloration of pigment and the expansion of skin lesions indicate that more and more pigment cells are lost and less pigment is produced after injury, which is a manifestation of the aggravation of the disease. In addition, the treatment of vitiligo is a long-term process, and long-term ultraviolet irradiation may also induce cell aberration, leading to the occurrence of tumors. Therefore, we think that ultraviolet therapy is not suitable for the treatment of vitiligo.

The use of ultraviolet rays with special wavelengths avoids these shortcomings and has a good curative effect. See the introduction below.

(2) Immunomodulatory therapy. Medical research and clinical observation have proved that the occurrence and development of the disease are related to immune dysfunction, but clinical treatment with immunomodulators has no obvious effect. Immune dysfunction is a very complicated physiological and pathological process, and immune deficiency, low immune function and strong immune response will all lead to the occurrence of corresponding diseases. It is not clear which immune factors are related to this disease. At present, the commonly used immunomodulators (such as transfer factors and calf thymosin) are usually used for infectious diseases caused by low immunity, and the curative effect is remarkable. The treatment of this disease is still in the stage of observation and research. Although oral steroid hormones have a certain curative effect, they have great side effects after long-term use. Rebound phenomenon is easy to appear after drug withdrawal, which accelerates the development of the disease and is generally not used for routine treatment in clinic.

(3) supplement trace elements. Some researchers believe that the lack or imbalance of trace elements is the cause of the disease. The physiological activities of human body need the participation of various trace elements, and it is not completely clear which element is lacking or which element is disproportionate to this disease.

Therefore, there is no exact theoretical basis for the supplementary treatment of trace elements, and the clinical trials of supplementary treatment of copper, zinc and other elements have no obvious effect. However, according to our clinical observation, the incidence of children with partial eclipse is high, and the treatment effect is poor compared with children with the same condition. Correcting the partial eclipse can improve the curative effect, indicating that the disease is related to nutrient deficiency (including trace element deficiency).

(4) Psoralen and Psoralen tincture therapy. Psoralen injection is extracted from Psoralea corylifolia and used for intramuscular injection. The cure rate of patients with early onset is about 1% ~ 2%, and the effective rate is above 30%. Psoralea corylifolia tincture is made by soaking Psoralea corylifolia in alcohol, which has a certain curative effect for external use, but it rarely heals when used alone.

(5) Acupuncture therapy. Theoretically speaking, acupuncture can regulate endocrine function and enhance immunity. However, the clinical observation is not completely in line with the theory, and some patients have promoted the development of the disease after acupuncture treatment. The reason may be that patients have a fear of acupuncture, which leads to mental tension. Therefore, acupuncture treatment can not be the same, but should be used according to the patient's situation. Patients who are afraid of acupuncture, especially children, should not choose acupuncture treatment.

In addition, you must not use some therapies that directly damage the skin, such as plum blossom needles, fire needles or direct burns with firearms. Because the skin of this disease is damaged, "isomorphic reaction" will occur, which will lead to the development of the disease. In severe cases, scar tissue is formed locally and becomes permanent injury.

(6) Autologous epidermal cell transplantation. This method is aimed at the pathological changes that the number of pigment cells in vitiligo lesions is reduced or even completely lost. The epidermal layer of normal skin was removed by instruments, and then transplanted to the lesion (leukoplakia) to increase the number of melanocytes in the lesion and promote the recovery of melanocytes in the lesion. This method was first reported by Kiistala in the United States in 1964, and the transplantation method is simply negative pressure suction foaming. In 1980s, China began clinical trials in Shanghai Medical University and China Medical University. Simple negative pressure suction foaming takes a long time and the peeling area is small, which is not conducive to the popularization of this method. From 65438 to 0995, vitiligo research institute of Shandong University and Shandong Polytechnic University jointly developed PFJ- 1A autologous epidermal cell transplantation therapeutic instrument, and later improved PFJ-I and BLY-II were developed by Shandong Polytechnic University. This machine is characterized by applying negative pressure to the transplanted epidermis to attract foam and heat at the same time, and separating the epidermis under the dual biophysical effects of negative pressure and heating. Self-control of pressure and temperature, good stability, fast separation speed (60-90 minutes), accurate separation level, uniform foam skin, no scar, large separation area, maximum total separation skin 15.7cm2, simple operation and easy popularization. So far, the application of autologous epidermal cell transplantation in China has been popularized, and the autologous epidermal cell transplantation in China has reached the world leading level. On the basis of traditional Chinese medicine treatment and autologous epidermal cell transplantation, the total cure rate increased from 35.8% to 57%. Among the cured patients, the patient with the smallest lesion area only had 1 operation, and 5 blisters (0.5 cm2) were transplanted. Each). The largest operation was 22 times, and 602 blisters were transplanted, accounting for about110 of the body surface area. The maximum area of each transplant is 64 blisters. According to our clinical experience, drug therapy is effective, the survival rate of skin grafting is high, drug therapy is ineffective, and the transplantation effect is not significant. Patients with sporadic, systemic and acromegaly must be treated with drugs first, and surgery can only be performed after the condition improves and the area of skin lesions shrinks, otherwise the treatment will be ineffective and even "isomorphic reaction" will appear. Usually, 3 ~ 6 months of drug treatment is the best time to choose surgery. The survival rate of pigment cells in premature operation is low, and the treatment time is prolonged in late operation. Due to improper application of external drugs, the operation of "skin aging and fibrosis" is not effective and should not be operated. In addition, those who are located in the sternum, fingers, eyes or scars should be careful when grinding, so as not to damage scar tissue and physiological dysfunction.

(7) Other imported drugs.