Brief Answer:
NB-UVB phototherapy
Detailed Answer:
Hello and Welcome to healthcaremagic
I am Dr. Kakkar. I have gone through your concern and understood it.
Vitiligo is a condition characterized by the autoimmune destruction of melanocytes, resulting in loss of pigmentation. In vitiligo, there is a partial or total destruction of melanocytes, initially only of the
epidermis and later even of the hair follicle, which acts as a reservoir for providing melanocytes during repigmentation.
Vitiligo can be of various types depending on the distribution of lesions: 3 types commonly seen are:
-Focal Vitiligo
-Segmental Vitiligo
-Generalised Vitiligo
Judging from the distribution of the lesions, you seem to be having a generalised type of vitiligo, where patches are widespread and symmterical involvement is common (e.g Bilateral arms, bilateral legs etc)
Medical therapies are the primary treatment for vitiligo. To enumerate them, they can be divided into topical and oral.
--Topicals e.g Topical
steroids, Topical immunomodulators like Tacrolimus, Topical
PUVA (Melanocyl lotion)etc
--Oral e.g Oral PUVA(Melanocyl tablets), NB-UVB phototherapy, Oral steroids etc.
For generalised vitiligo, as seems the case here, Phototherapy remains the mainstay of treatment e.g NB-UVB and PUVA. NB-UVB is the most preferred form of therapy for patients with generalised vitiligo since it is safe, effective, well tolerable and gives long lasting results/re-pigmentation. It can also be given in children and even pregnant ladies because of its safety profile.
Disadvantages with NB-UVB Phototherapy are:
-It requires to be adnministered 3 times in a week for several weeks.
-It is expensive in private set up though in government hospitals it is free of charge.
Topical are an adjuvant to systemic treatment and include topical steroids and topical immunomodulators like tacrolimus. They accelerate the response to systemic therapy.
At last, I would want to say that Vitiligo is a remitting and relapsing condition and no one can predict the future course of the disease. Treatment is directed at repigmenting the already existing patches with the most appropriate modality suitable for the particular type of vitiligo.
Sometimes it responds very well at certain body sites like trunk,
limbs and face but remains resistant at certain body areas like lips(perioral), fingers, palms, soles and
scalp etc
Since you have already tried PUVA (melanocyl tabs and lotion and pigmento tabs), though you did'nt mention about the response to this form of therapy, I would advice that you talk to your
dermatologist and explore the feasibility of NB-UVB Phototherapy in your case.
Hope this answers your query
regards