Drugs For: Vitiligo & Warts

A persistent or chronic skin pigmentation Autoimmune disorder characterized by white patches surrounded by heavily pigmented borders.

Genetic link / blood relatives (not always) It occurs when melanocytes die or unable to function. It is common, affecting 1-2% of the world's population

irrespective of sex and race. It can start at any age after birth, but in more than half of the

people affected it before 20 years of age. There is no medical evidence of any link between diet or

smoking and vitiligo.

Repeated trauma such as rubbing or scratching the skin may trigger vitiligo.

Sunlight may cause sunburn to exposed areas. These patches may start progression or re-pigment on

their own In most people, it tends to change slowly, with periods

of stability often lasting several years. The pigment may return in some patients, but is not

guaranteed (Difficult to cure).

Irregularly shaped patches on the skin which may vary in size and shape (no fixed pattern) of pale, pink or white color.

The extent of the condition is unpredictable, varying from single small patches to total loss of skin color.

These patches may appear on different parts of the body. The most common sites are the hands, face and around body

openings (the eyes, nostrils, mouth, umbilicus and genital regions), and within body folds such as the underarms.

Usually not itchy or sore, but some people experience some irritation of the skin before a new vitiligo patch appears.

Premature on scalp, eyelashes, eyebrows or beared . When hair-bearing skin is involved, the hair may lose its

pigment and appear white or gray.

Generalized vitiligo :- Many vitiligo cases are found to be bilateral as if it is in one hand, it tends to appear and can be on other hand also.

Segmental vitiligo :- Generally Vitiligo starts from a particular area like one hand, face or from waist line area. If vitiligo is spread to few limited area then it can be termed as segmental vitiligo.

Acrofacial vitiligo:- The most common. Spread of white patches away from the center of the body.

Long and difficult process, rarely 100% effective on individual Always involves sunlight or ultraviolet light Chemical methods Topical steroid therapy Psoralens photochemotherapy (PUVA) Depigmentation

Physical methods Tattooing (micro-pigmentation) Autologous skin grafts Autologous melanocyte transplantation Sunscreen and cosmetics

Psychological counseling

Topical steroid therapy: Steroid creams or ointments may be helpful in repigmenting white patches, particularly if they are applied in the initial stages of the disease. Short courses of oral steroids can sometimes be considered but may be associated with side effects such as weight gain, skin thinning, stretch marks and mood changes. E.g. Hydrocortisone, Triamcenolone

Psoralens photochemotherapy (PUVA): this is probably the most effective treatment for vitiligo (re-pigmentation of the white patches)

Depigmentation: Fading the rest of the skin on the body to match the areas that are already white. Monobenzone twice a day until pigmented areas match the

already-depigmented areas Phenylalanine: This essential amino acid is the precursor for the skin

pigment melanin.

Tattooing (micro-pigmentation): Implanting pigment into the skin with a special surgical instrument

Autologous skin grafts: skin is removed from one area of the body and attached to another area

Autologous melanocyte transplantation: a sample of the normal pigmented skin is taken and placed it in a laboratory dish containing a special cell-culture solution to grow melanocytes. When the melanocytes in the culture solution have multiplied, they are transplanted on depigmented skin patches

Sunscreen and cosmetics: Areas of vitiligo will burn easily in the sun. The use of a sunscreen to all exposed areas helps to protect skin affected by vitiligo. Other standard sun protection measures, such as appropriate protective clothing and sun avoidance should also be employed.

Advice from experts about skin camouflage is now widely available. There are good quality camouflage products in a range of colors that are water resistant and less likely to rub off. Your GP or dermatologist can advise or refer you to a camouflage service for this. Careful use of fake suntans can be effective to make areas of vitiligo less noticeable.

Warts are small harmless, painless fleshy growth of the skin caused by a DNA-containing human papilloma virus (HPV).

The appearance of warts can differ based on the type of wart and where it is located on the body.

Warts are common in children. Most cases between 12-16 yrs.

Up to 30% of warts disappear by themselves within 6 months. Most will disappear without any treatment within 3 years.

The virus enters the skin after direct contact with recently shed viruses kept alive in warm, moist environments such as a locker room, or by direct contact with an infected person.

The entry site is often an area of recent injury.

The incubation time: 1-8 months.

Contrary to popular mythology, touching a frog will not give you warts.

Common warts (Verrucae vulgaris): Typically develop on the hand, especially around the nail.

They are gray to flesh colored, raised from the skin surface, and covered with rough, hornlike projections.

Plantar warts (Verrucae plantaris): Occur on the plantar surface, or bottom, of the foot.

They usually occur in high pressure areas such as the heel and the metatarsal heads (just behind the toes).

They usually grow into the skin, not outward like common warts.

This growing into the skin makes them more difficult to treat.

Flat warts (Verrucae plana): Most commonly seen on the face, the back of the hands, and lower legs.

They usually appear as small individual bumps about 1/4 inch across.

Flat warts may spread rapidly on the face, neck, forearms, hands and lower legs from the activities involved in shaving.

Home care is effective in making the wart or warts go away.

No matter what technique you use, warts will disappear 60-70% of the time.

Techniques may be done with and without medication.

The ultimate goal of the medical therapies (not the surgical treatments) is to get your body to recognize the wart as something foreign and to destroy it, much like the body destroys a cold virus.

Place several layers of waterproof adhesive tape over the wart region (even duct tape).

Do not remove the tape for 6-12 days. Then take off the tape and open the area to the air for 12 hours.

Re-apply tape for another 6-12 days.

The tape works best in the region around the fingernail.

Tape works because the air-tight, moist environment under the tape does not allow the virus to grow and reproduce

Salicylic acid is available by many different trade names at the drug store. Dual Film Wart-Off Dr. Scholl’s Wart Medication Medi-Plast

It comes either as a liquid to paint on the wart or as a plaster to be cut out and placed on the wart tissue.

slowly destroys virus-infected epidermis and may cause an immune response from the mild irritation caused by the salicylic acid

The area with the wart should be soaked in warm water for 5-10 minutes.

The wart should then be pared down with a razor. A simple razor works fine for this, then throw it away.

Do not shave far enough to make the wart bleed. Apply the salicylic acid preparation to the wart tissue. Do not apply it to other skin because of salicylic acid's potential to

injure normal tissue. Follow directions on the package for how long to apply the acid.

Cryotherapy involves freezing a wart using a very cold substance (usually liquid nitrogen or dimethyl ether - propane mixture).

It is a standard treatment and can be done in a doctor's office using a probe or a cotton swab or can also be sprayed directly on the warts. It takes only less than a minute.

With liquid nitrogen applied to the wart, the water in the cells expands, thus, exploding the infected tissue.

The exploded cells can no longer hide the human papilloma virus from the body's immune system.

The immune system then works to destroy the virus particles. If a wart is thick and requires extensive or repeated freezing,

nerves around the wart can be damaged, scarring may occur, and the skin may take a long time to recover.

Periungual area may scar if cryotherapy with liquid nitrogen is used improperly.

Scarring could lead to permanent nail disfiguration.

Laser Therapy Lasers are simply very intense light sources.

This light has an enormous amount of energy that heats the tissue enough that it vaporizes.

Shave removal and electrodessication of the base may be necessary when other treatment methods fail.

This would involve numbing the region around the wart and shaving the wart flat with the surface and light electrodessication of the base.

Others Treatments Imiquimod: A topical cream, approved by the U.S. FDA

for genital warts that helps the body's immune system to fight the wart virus by encouraging interferon production. The drug is very expensive.

Dinitrochlorobenzene (DNCB), like salicylic acid, applied

directly to the wart. Studies showed this method was effective with a cure rate of 80%. But DNCB must be used much more cautiously than salicylic acid; the chemical is known to cause genetic mutations, so it must be administered by a physician. This drug induces an allergic immune response resulting in inflammation that wards off the wart-causing virus.

Flurouracil: inhibits DNA synthesis. It is applied directly to the wart (especially plantar warts) and covered (for e.g. with tape).

Others Treatments Bleomycin: The dermatologist may inject anti-cancer drug, bleomycin in each wart. The shots may hurt and can have other side effects, such as nail loss if given in the fingers.

Immunotherapy: This treatment uses the patient’s own immune system to fight the warts. This treatment is used when the warts remain despite other treatments.

One type of immunotherapy involves applying a chemical, such as diphencyprone (DCP), to the warts. A mild allergic reaction occurs around the treated warts. This reaction may cause the warts to go away.

Another type of immunotherapy involves getting shots of interferon. The shots can boost the body’s immune system, which gives the body the ability to fight the virus.

Most warts will disappear without treatment anywhere from 6 months to 3 years.

Warts may recur after treatment and require additional treatments.

Prevention Avoid touching warts on others or touching them on

yourself (refrain from rubbing a warty finger across your face).

Children needs to avoid biting or chewing warts.

Wear shower shoes in the gym locker room to lower your risk of picking up the virus that causes plantar warts from the moist environment.