Falabella Rafael, Barona Maria I
Universidad del Valle, Hospital Universitario del Valle, Cali, Colombia.
Pigment Cell Melanoma Res. 2009 Feb;22(1):42-65. doi: 10.1111/j.1755-148X.2008.00528.x. Epub 2008 Nov 27.
Treatment for vitiligo is difficult and prolonged. Nevertheless, at present considerable knowledge accumulated during several decades on the pathogenic mechanisms, revealed important clues for designing new strategies to improve vitiligo depigmentation. With available medical therapies, high repigmentation percentages mostly on facial and neck lesions are achieved, although they are less effective on trunk and limbs and poor on the acral parts of the extremities. Narrow band UVB and psoralens and UVA are the two most important treatments for generalized vitiligo affecting more than 10-20% of the cutaneous surface, and topical corticosteroids, or calcineurin inhibitors are the most valuable treatments for localized vitiligo. Persistence of achieved regimentation is variable and an undefined percentage of patients may have variable recurrence. When vitiligo becomes refractory, surgical methods may improve depigmentation as effectively as with medical therapy; in segmental (unilateral) or long standing, non-segmental (bilateral) stable vitiligo, repigmentation with surgical methods is usually permanent.
白癜风的治疗困难且疗程漫长。然而，目前在几十年间积累的关于发病机制的大量知识，为设计改善白癜风色素脱失的新策略提供了重要线索。采用现有的医学疗法，虽对面部和颈部皮损大多能实现较高的色素再生率，但对躯干和四肢的效果较差，对四肢末端部位则效果不佳。窄谱中波紫外线以及补骨脂素加紫外线A是治疗累及超过10 - 20%皮肤表面的泛发性白癜风的两种最重要疗法，而外用糖皮质激素或钙调神经磷酸酶抑制剂是局限性白癜风最有价值的治疗方法。已实现的治疗方案的持久性各不相同，且有不确定比例的患者可能会出现不同程度的复发。当白癜风变得难治时，手术方法可能与医学疗法一样有效地改善色素脱失；在节段性（单侧）或长期的非节段性（双侧）稳定型白癜风中，手术方法导致的色素再生通常是永久性的。
