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Cosmetic camouflage in vitiligo
Abstract
Vitiligo is not a life-threatening nor a contagious disease. But the disfigurement of vitiligo can be devastating to its sufferers, especially dark-skinned individuals. Available treatment options are disappointing and sufferers often use various forms of camouflage. Remedial cosmetic cover creams help conceal the blemish of vitiligo at least temporarily. A high concentration of pigment is incorporated into water-free or anhydrous foundations to give a color that matches the patient's skin, thereby concealing vitiligo patches. The article highlights the content and technique of application of these creams.
... and pigmentary foundations. 2,3 The main drawbacks of permanent tattoos are difficult color adjustment and elimination; in addition, they are not approved by the Food and Drug Administration (FDA). 4 An ideal temporary camouflage entails good color-matching, longevity, and simple application and removal. ...
... Generally, improper application and uneven color are the major negative aspects of temporary camouflage. 2,3,5 This study aimed to evaluate DLQI in vitiligo patients and their acceptance and willingness to use camouflage regularly, a vital point that has not been previously tackled among Egyptian vitiligo patients. The influence of regular application of temporary camouflage on DLQI was further evaluated in a subgroup of patients. ...
... For extensive lesions, camouflage was only applied to lesional borders where contrast was most pronounced to merge vitiligo with the surrounding skin making the contrast less noticeable. 2,3 Patients were advised to remove the products with tap water to avoid alcohol-and acetone-induced cutaneous irrita- ...
Background
Vitiligo is a pigmentary disorder associated with considerable psychological imbalance. Partial response to therapy and long duration for repigmentation are common. Meanwhile, camouflage may help through concealing vitiligo lesions and improving patient confidence and self‐esteem.
Aim
To assess the Dermatology Life Quality Index (DLQI) in vitiligo patients, and to determine the patients’ acceptance and willingness to utilize camouflage regularly and the impact of using camouflage as an adjuvant modality.
Patients/Methods
The study was carried out on 100 vitiligo patients who underwent thorough history taking, clinical examination, and DLQI assessment. Forty patients were randomly chosen, taught how to apply camouflage, and followed up over 1 month of regular application.
Results
Dermatology Life Quality Index in the 100 vitiligo patients was found to be 12.2 ± 3.9, denoting the very large effect on quality of life vitiligo has. It was significantly worse in female patients, adolescents, students, and high‐socioeconomic level patients, in visible sites and genitalia, and in unstable cases. There was a significant positive correlation between the DLQI and disease duration (r = 0.75, P < .001) and VES (r = 0.79, P < .001). The 40 cases on camouflage showed a significant percent reduction in their DLQI when compared to noncamouflage users (P: .00).
Conclusions
Dermatology Life Quality Index is significantly affected by vitiligo. Camouflaging is a technique that needs to be taught to the patient to overcome the anticipated problems that drive them away from using it; especially, it significantly improves their DLQI in their devastating disease.
... Temporary camouflage includes liquid dyes, indigenous products, foundation-based cosmetic camouflages and self-tanning products. [11] Permanent camouflage is achieved mainly by micropigmentation/ medical tattooing. ...
... Getting a good color match is difficult with these preparations too. [11,12] Foundation-based cosmetic camouflage These are the most common and best daily use preparations available for camouflage purposes. Camouflage preparations typically contain up to 25% more pigment compared to normal make-up foundations. ...
... They predominantly contain talc (hydrated magnesium silicate). [11] Fixing sprays are also available that serve the same purpose as the fixing powder. [17] f) Finally, remove any surplus powder with a brush. ...
Vitiligo is known to be associated with social stigma and a decreased quality of life, especially when lesions are located over the face. While there are numerous treatment options for vitiligo, most of these need a long time to produce good cosmetic results. Camouflaging the skin lesions can be a useful option in such patients. The proper use of camouflage has been shown to improve the quality of life in patients with vitiligo. In this article, we discuss the different camouflage options available in vitiligo - products and techniques with their relative advantages and disadvantages.
... Liquid dyes, traditional remedies, foundation-based cosmetic camouflage, and selftanning products are examples of temporary camouflage [95]. Sufferers frequently adopt various techniques of disguise; at least temporarily, corrective cosmetic cover creams can hide the vitiligo imperfection. ...
... With one or more applications, makeup concealer like shade cream base, some fruit juices such as Roselle, henna, and dyes like potassium permanganate can also be used to cover vitiligo lesions. These covers produce an instant, natural colour that is easily removed by washing and can last for several weeks or even months [95,100]. ...
Vitiligo is an acquired, chronic condition characterised by depigmentation of the epidermis or by destruction/loss of melanin. Skin cells (melanocytes) are responsible for producing melanin, the substance that gives pigmentation to the skin. This review aims to provide a comprehensive overview of the current state of knowledge about vitiligo. Although there is no specific ethnic group, gender, or skin type that is more prone to vitiligo than others, it can affect anyone. The most commonly prescribed treatments for vitiligo are systemic and topical phototherapy and immunomodulators such as corticosteroids, calcineurin inhibitors, and vitamin D analogues, in addition to cosmetics that can camouflage and improve the quality of life. Even though vitiligo is typically thought of as a cosmetic disorder, its effects on the physical and psychosocial health of sufferers cannot be ignored.
... Available treatment options were disappointing and sufferers had more often used various forms of camouflage (remedial cosmetic cover creams) to conceal the blemish of Vitiligo temporarily [7]. Homoeopathic medicines such as Calcarea carbonica, Arsenicum album, Sulphur, Phosphorus, Natrum muriaticum, Thuja, Lycopodium, Mercurius solubilis and Arsenicum sulphuratum flavum were found to be most frequently prescribed in the Vitiligo cases, which are mostly the constitutional medicines with the exception of Ars. ...
... Secondly, re-pigmentation in the affected patches are important as far as the psychological satisfaction of the patient is concerned [6]. It was observed that most of the times combination therapies generally gave better results for Vitiligo, however, with marked improvement with single medicine in this case in remarkable [7]. With complete recovery with re-pigmentation, the quality of life for the patient may improve and the symptoms of associated diseases, such as thyroid dysfunction, may also improve [4]. ...
Background: Vitiligo is alternatively known as leukoderma which is an autoimmune skin condition that arrives due to expression of low melanin pigment. Vitiligo is although is not very uncommonly seen, difficulties exist for its successful treatment. Objective: Treatment of Vitiligo with homeopathic medication. Case Reports: A female 7 years old child with Vitiligo around her both the eyes was considered as the subject for the present study. She was treated with some of homoeopathic medicines such as Arsenicum sulfuratum flavum-6X, Hydrocotyle-Ø and Psoralea cor-Ø were prescribed as empirical formulations; albeit a successful result was not achieved. Based on her the totality of symptom, a constitutional medicine Calc. carb-0/1 to 0/8, was able to fully cure the Vitiligo spots within 4 months. Conclusions: In a 7 years girl with Vitiligo treated with individualized homeopathy, the cure was achieved. It is believed that homeopathy may be effective in treatment of Vitiligo with careful selection of medicine(s) as per the totality of the symptoms of the patient.
... Vitiligo surgeries [5,14,15] such as cosmetic tattooing is used for localised stable vitiligo, especially of the mucosal type. Pigments used in cosmetic tattoo are inert iron oxides that are available in more than 15shades. ...
... Nowadays, technique called "laser toning" or "laser facial" has become increasingly popular for the treatment of melasma. This involves the use of a large spot size (6-8 mm), low fluence (1.6-3.5 J/cm 2 ), multiple passed QS 1064 nm Nd: YAG laser performed every 1-2 weeks for several weeks [14]. Although good efficacy has been seen with this technique, side effects have also been reported. ...
Vitligo and melasma are acquired pigmentary disorder of the skin and also the leading cause for dermatologist consultation in South Asian countries like Nepal. Vitiligo vulgaris and melasma are common examples for depigmentary and hyperpigmentary conditions respectively. Even with the presence of multiple proven medical, surgical and combined modalities of managing them the challenges in South Asian countries with Fitzpatrick skin types III-V are the psychosocio-cosmetic morbidities associated with them.
... Generally, patients experience depigmentation in areas distal to the application after 3-6 months. Alternative treatment options include 4-methoxyphenol, 88% phenol solution, laser, and cryotherapy 16,21 . ...
Vitiligo is a chronic skin disorder characterized by the loss of pigmentation, resulting in white patches on the skin. The condition arises from the destruction of melanocytes, the cells responsible for producing melanin, the pigment that gives colour to the skin, hair, and eyes. Although the exact etiology of vitiligo remains elusive, it is believed to involve a complex interplay of genetic, autoimmune, and environmental factors. This overview provides the key aspects of vitiligo, including its epidemiology, pathogenesis, clinical manifestations, and current treatment approaches. The prevalence of vitiligo varies globally, affecting individuals of all ethnic backgrounds and age groups. The autoimmune hypothesis proposes that the immune system mistakenly targets and attacks melanocytes, leading to their destruction. Triggering factors, such as oxidative stress, viral infections, and neural factors, may contribute to the initiation and progression of vitiligo. Clinically, vitiligo can significantly impact the quality of life for affected individuals, both psychologically and socially. The distribution and extent of involvement vary, and the condition can affect any part of the body. Various treatment modalities are available for vitiligo, ranging from topical corticosteroids and calcineurin inhibitors to phototherapy and surgical interventions. While these approaches may help to re-pigment the skin to some extent, there is no definitive cure, and the outcomes can be unpredictable. Ongoing research is focused on understanding the molecular mechanisms underlying vitiligo and developing targeted therapies to address the root causes of the disease. Keywords: Vitiligo, Autoimmune, Melanocytes, Pigmentation, Corticosteroids, quality of life.
... NCES dilaporkan memberikan hasil yang lebih baik dibandingkan SBEG, berupa pencapaian repigmentasi memuaskan (90-100%) pada NCES (71%) dibandingkan SBEG (27%), kepuasan pasien dan penurunan skor dermatology life quality index (DLQI) yang lebih tinggi dengan metode NCES dibandingkan SBEG. Namun pada SBEG didapatkan repigmentasi yang lebih cepat 4 minggu dibandingkan dengan NCES.84,89 Terapi dengan pembedahan membutuhkan biaya yang cukup besar, waktu yang lama, berisiko memunculkan fenomena Koebner pada daerah graft, serta kurang efektif dalam mengobati lesi yang luas. ...
Vitiligo merupakan gangguan pigmentasi berupa bercak putih tidak berpigmen pada kulit dan rambut akibat hilangnya fungsi melanosit. Vitiligo pada anak umumnya berhubungan dengan penyakit autoimun lain dan memberikan efek gangguan kosmetik serta psikososial yang serius. Modalitas terapi vitiligo pada anak terdiri dari terapi topikal, fototerapi, terapi sistemik, dan pembedahan. Vitiligo pada anak memiliki prognosis yang relatif baik dibandingkan dengan pada orang dewasa. Repigmentasi pada kasus vitiligo anak umumnya terjadi secara spontan dan kasus relapse jarang sekali didapatkan.
... Many patients either show no response or incomplete repigmentation after treatment and they are eventually advised to use a cosmetic camouflage. 3 The use of trichloroacetic acid (TCA) in the treatment of vitiligo is a very recent entity and only few studies have evaluated its efficacy as a therapeutic option. [4][5][6] No definite explanation is yet available for the role of TCA in repigmentation of vitiligo. ...
Background:
Despite the recent advances in the treatment of vitiligo, results are still largely unsatisfactory and many patients show either weak or no response to treatment. Few clinical trials have investigated the use of trichloroacetic acid (TCA) to induce repigmentation in stable vitiligo.
Objective:
To evaluate the efficacy and safety of TCA, in different concentrations, for the treatment of stable localized vitiligo.
Methods:
The study included 100 patients with acral/nonacral stable vitiligo. Trichloroacetic acid was applied, as a monotherapy, to the vitiliginous patches at different concentrations according to the treated site every 2 weeks until complete repigmentation or for a maximum of 6 treatment sessions. Follow-up was done every month for 6 months to detect any recurrence.
Results:
Eyelid vitiligo showed the highest response to TCA treatment (excellent response in 80% of cases), followed by the face, trunk, and extremities. Lower response rates were noticed in the hands and feet vitiligo. Adverse effects were transient and insignificant in few patients.
Conclusion:
Trichloroacetic acid seems to be a potential, cost-effective, well-tolerated therapeutic option for the treatment of vitiligo in the adults and pediatric populations.
... Use of cosmetics can also increase acne patients' adherence with their medical regimen, which is estimated to be poor in 50% of patients. Perhaps the most important type of concealer is the corrective type, and is most effective in a liquid formula, like La-Roche Posay Toleriane Teint Corrective Pen, which has corrective colors to help tone down ruddiness, fade the appearance of hyperpigmentation, and yes, even cover up any more irritating blemishes [86][87][88][89][90]. ...
Cosmetology incorporates the most advanced scientific knowledge and technology including chemistry, pharmacology, molecular biology, genetic/new materials engineering, immunology, and neurology, etc. Cosmetics are readily available today in the form of creams, lipstick, perfumes, eye shadows, nail polishes, hair sprays etc. Other cosmetics like face powder give glow to the skin after applying the base cream. Cosmetic ingredients/excipients are incorporated to obtain detergency, wetting, emulsifying, staining and soothing effects. Adverse reactions of chemicals have effects on environment and humans, particularly severe in long term. Many cosmetics have therapeutic effects in use. Again, different population have different profile of cosmetics use. As a consequence of this increasing application of science to beauty, the line between cosmetic and medical research is becoming blurred; the laboratories of major cosmetic companies perform cutting-edge research in areas such as matrix biology, antioxidants and ageing processes. Proper rules and regulation should be imposed on their manufacturing, marketing and distributions along with pricing.
... Maybe the most essential kind of concealer is the restorative sort, and is best in a fluid equation, similar to La-Roche Posay Toleriane Teint Corrective Pen, which has remedial hues to help tone down rosiness, blur the presence of hyperpigmentation, and indeed, even concealment any all the more chafing flaws. [39][40][41][42][43] Foundation is utilized to smooth out the face by covering spots, skin break out, flaws, or uneven skin tone. These are sold in a fluid, cream, or powder, or more as of late in a mousse. ...
The word “cosmetics” actually stems from its use in Ancient Rome. They were typically produced by female slaves known as “cosmetae,” which is where the word “cosmetics” stemmed from. Cosmetics are used to enhance appearance. Makeup has been around for many centuries. The first known people who used cosmetics to enhance their beauty were the Egyptians. Makeup those days was just simple eye coloring or some material for the body. Now-a-days makeup plays an important role for both men and women. In evolutionary psychology, social competition of appearance strengthens women’s desires for ideal beauty. According to “The Origin of Species”, humans have evolved to transfer genes to future generations through sexual selection that regards the body condition of ideal beauty as excellent fertility. Additionally, since women’s beauty has recently been considered a competitive advantage to create social power, a body that meets the social standards of a culture could achieve limited social resources. That's right, even men have become more beauty conscious and are concerned about their looks. Cosmetics can be produced in the organic and hypoallergenic form to meet the demands of users. Makeup is used as a beauty aid to help build up the self-esteem and confidence of an individual. The importance of cosmetics has increased as many people want to stay young and attractive. Cosmetics are readily available today in the form of creams, lipstick, perfumes, eye shadows, nail polishes, hair sprays etc. Other cosmetics like face powder give glow to the skin after applying the base cream. Then we have lipsticks, which are applied by many women of all ages. They are made from wax and cocoa butter in the desired amount. Cosmetics like creams, gels, and colognes are used on a daily basis by both women and men. Creams act as a cleanser for the face in many circumstances. More recently anti-ageing creams have been manufactured which can retain younger looking skin for many years. The best cleansing agents are cleansing cream, soap and water. Cosmetic creams serve as a skin food for hard, dry and chapped skin. It mainly lubricates, softens and removes unwanted dirt from the skin. Some popular fat creams that are used include Vaseline and Lanolin. Dry creams are used in the manufacture of soap and gelatin which is used as a base for the skin. Hair care has become one of the fastest developing markets in the beauty industry. Many young men turn to oils and gels to maintain and style their hair. Products like hair gels, oils, and lotions have been introduced in the market to help protect hair fall and dandruff. Some professions, like the show business industry, focus on the importance of the outer appearance. Many personalities and artists have utilized makeup to beat the harsh lights and the glare of camera flashes. They very well know the importance of their looks and maintain them by using a variety of cosmetics. Their appearance is their most valuable asset and they take every endeavor to appear as the fans want them to appear. Recent research has shown that makeup helps in protection from harmful rays of the sun. Many beauty products manufacturers have utilized the needs of people to protect themselves and their skin from the rays of the sun. This is a great achievement because earlier make up and sun protection could not blend together. The Importance of Cosmetics Today Cosmetics help to enhance our appearance and make us feel more confident. With more cosmetics on the market today than ever before, it becomes obvious to us that they play a great role in our everyday life.
... Patients with hypomelanosis are usually susceptible to developing cutaneous malign neoplasms due to a lack of melanin in the affected skin. Thus, the use of photoprotectors is of paramount importance in patients with these cutaneous pathologies (Sarveswari, 2010;Kaliyadan, Kumar, 2012). ...
The aim of this study was to develop and evaluate a corrective and photoprotective makeup for patients with dyschromias. An emulsion was prepared and pigment mixtures were incorporated in the formulation, producing five shades of corrective makeup: BEIGE (I, II, III), BRONZE and TAN. The sun protection factor (SPF) and UVA/UVB ratio of the corrective makeup were determined using spectrophotometry with a Labsphere® analyser. The spreadability, occlusivity, stability, and photostability of the photoprotective formulations were also evaluated. For all formulations there was no statistical difference among them (p > 0.05) in terms of spreadability, occlusivity and SPF. They were considered to be photostable under solar radiation, with variations in SPF value and UVA/UVB ratio lower than 20%. The corrective makeup presented average-to-high UVB photoprotection and broad spectrum photoprotection. After 90 days, pH, density and SPF values showed no significant differences among formulations (p>0.05). All corrective makeup presented separation of the pigments, however, they returned to a homogeneous aspect and to the original color shade after shaking. The corrective makeup presented a fine texture, little brightness, and a homogeneous, dry-to-the-touch aspect. This work may benefit patients with dyschromias, improving their quality of life, besides promoting photoprotection and covering the skin blemishes.
... For temporary camouflage, self-tanning dyes are administered. Potassium permanganate, indigo-carmine, Bismarck brown, and henna (Lawsonia sp.) paste are some of preferred tanning agents [42]. Dihydroxyacetone (DHS), a glycerone-based camouflage creams are popular. ...
Vitiligo is an idiopathic systemic autoimmune disease affecting skin, hair and oral mucosa. This genetic yet acquired disease characterized by melanin loss is a cause of morbidity across all races. Though thyroid disturbance has been recognized as a key trigger of this pathology, an array of other factors plays critical role in its manifestation. Multiple hormones (corticotropin-releasing hormone, adrenocorticotropic hormone, α-melanocyte-stimulating hormone, melatonin, calcitriol, testosterone, estrogen), genes (Human leukocyte antigen (HLA), Cytotoxic T lymphocyte-associated antigen 4 (CTLA-4), Forkhead box D3 (FOXD3), Cluster of differentiation 117 (CD117), Estrogen receptor (ESR) 1, Cyclooxygenase-2 (COX2), Vitiligo-associated protein 1 (VIT1)), and lifestyle choices (stress, diet, cosmetic products, and medications) have been suspected as drivers of this disorder. The pathological mechanisms have been understood in recent times, with the aid of genomic studies; however a universally-effective therapy is yet to be achieved. This review discusses these under-investigated facets of vitiligo onset and progression; hence, it is expected to enrich vitiligo research.
... However, it is important to counsel the patients regarding the disease, procedures and their expected outcome, and follow strict criteria while selecting patients, so that the outcome is satisfactory both for the doctor and the patient. The choice of procedure must be individualized, considering the size of the lesion to be treated, and readily available facilities [3,5,[9][10][11]. ...
... [4] Available treatment options are disappointing and sufferers often use various forms of camouflage (remedial cosmetic cover creams) to conceal the blemish of vitiligo temporarily. [5] In the surgical method, cellular grafts have an established role in the management of vitiligo. However, possible risk of cancer, the cost of treatment, and the need for special reagents are its disadvantages. ...
Background: Vitiligo has an immense psychological impact on the affected individual and a reason for low self-esteem. Considering the disappointing outcomes, A multicentric open clinical study was undertaken by the Central Council for Research in Homoeopathy, at five institutes and units in India from October 2005 to September 2010.
Aims and Objectives: This observational study aimed to see the usefulness of homoeopathic therapy in the management of vitiligo.
Materials and Methods: 432 patients of all age groups suffering from vitiligo were enrolled in the study. Out of that, 169 patients completed 2 years of follow-up and were considered for analysis. Homoeopathic medicines, based on the totality of symptoms and repertorization were prescribed. The analysis of the cases was based on the Vitiligo Symptom Score (VSS) and photographs of the patients. Result was analyzed using statistical method of SPSS version 20.
Results: The changes in the mean VSS at intervals of every 6 months was found to be statistically significant. Homoeopathic treatment was found to be useful in relieving vitiligo in varying degrees in 126 patients, out of which 4 (2.94%) cases showed marked improvement, 15 (11.03%) cases showed moderate improvement, 77 (56.62%) cases showed mild improvement, and 30 patients although improved, fell in the category of not significant improvement group (below 25% improvement). Ten homoeopathic medicines were found useful in the study of which Sulphur (n = 27), Arsenicum album (n = 19), Phosphorus (n = 19), and Lycopodium clavatum (n = 10) were the most commonly indicated and useful medicines.
... Because repigmentation can take months to years and is often resistant to therapy, both temporary and permanent cosmetic camouflage can help conceal vitiligo patches, which has been shown to improve quality of life [92]. Cosmetic camouflage options include tattooing, liquid dyes, self-tanning products and various cosmetic products [93]. ...
As the demographics of the USA continue to evolve, dermatologists will be expected to better understand and manage common medical and cosmetic concerns in patients with skin of color. Structural and functional differences, as well as cultural practices, contribute to variations in the prevalence, clinical presentation and quality of life impact of dermatologic disorders. Common dermatologic conditions that are more prevalent in patients with skin of color include dyschromia, keloids, central centrifugal cicatricial alopecia, melasma and pseudofolliculitis barbae. This article discusses practical approaches to medical and cosmetic dermatology in skin of color patients.
Vitiligo is characterized by the development of white patches on the skin either due to the loss of functional melanocytes or perturbations in the melanogenesis pathway. In this study, we investigated the therapeutic potential of herbo-mineral formulation, Melanogrit in neutralizing the white patches in the skin. The study utilized UPLC/MS-QToF technique to determine the diversified phytochemical profile in Melanogrit. The murine B16F10 cells when treated with Melanogrit underwent morphological changes, including increased angularity, enlarged cell size, and greater dendritic protrusions. To establish an equivalent model to study melanogenesis, we carefully optimized the dosage of alpha-melanocyte stimulating hormone, αMSH in B16F10 cells as an alternative to using melanocyte-keratinocyte cocultures. The study determined a sub-optimal dose of αMSH (0.2 nM) in B16F10 cells that does not manifest any measurable effects on melanogenesis. In contrast, Melanogrit when used in conjunction with 0.2 nM αMSH, induced a dose-dependent increase in extracellular and intracellular melanin levels. Melanogrit transcriptionally upregulated the decisive genes of the melanogenesis pathway, MITF, TYR, and TRP1; which was evident from the increased cellular tyrosine activity. Our findings also demonstrated that Melanogrit ameliorated the MITF protein levels by inhibiting pERK; notably without involving GSK3β in the process. Taken together, our findings strongly suggest that Melanogrit has the potential to stimulate melanogenesis, making it a promising candidate for clinical applications in the treatment of white skin patches that develop in vitiligo patients.
Micropigmentation, also termed medical tattooing, can be a useful alternative treatment for patients with vitiligo who are resistant to conventional treatments. To assess the benefits and risks of micropigmentation in the treatment of refractory vitiligo, 25 lesions of 14 patients with vitiligo (Fitzpatrick skin types III and IV) were subjected to micropigmentation using an electric tattooing machine between December 2018 and March 2019. The procedure was repeated until satisfactory results were obtained. Treatment response was assessed by color matching of the treated lesion and surrounding skin using a 4‐point scale (poor, fair, good and excellent). Excellent color matching was achieved in 80% (20/25) of cases after a median of three (range, 1–5) treatment sessions. Procedure‐associated pain was considerable, but no anesthetic injection was needed. Immediate erythema and swelling were noticed after each procedure, but resolved within a few days. Overall, the treatment was tolerable. This study was limited by a small sample, no control group and a short follow‐up period. This study revealed that micropigmentation was beneficial for patients with refractory vitiligo who had light to moderately colored skin. Pigment selection, implantation depth and selection of body parts amenable to treatment were critical.
Vitiligo is the most common acquired hypopigmentary disease in the community. Piperine as an herbal extract derived from black pepper has strong impact on the melanocyte proliferation and adverse side effects less than synthetic drugs such as corticosteroids. For the first time, this study was aimed to evaluate the effect of topical piperine combined with narrowband ultraviolet B (NB‐UVB) on vitiligo treatment. In this double‐blind clinical trial, 63 patients with facial vitiligo were randomly divided into 2 groups: treated with piperine (case) and placebo (control). Also, both groups received NB‐UVB phototherapy every other day for 3 months. In the case group, 10 patients have burning sensation on their skin areas (p value = .002). Also, redness of the treated areas was observed in 6 patients (p value = .028). Both side effects were temporary. Regarding repigmentation at time intervals of 1, 2, and 3 months after treatment, its level in the case group was significantly higher than the control group (p value < .001). Based on our findings, the combination therapy with NB‐UVB/topical piperine has more influence on facial vitiligo than that of NB‐UVB alone. It could be concluded that the simultaneous use of NB‐UVB and topical piperine has a remarkable effect on treatment of vitiligo.
Camouflage is useful for three disorders of vitiligo, namely: pigmentation disorders; vascular skin conditions; and contour defects. A variety of products are available, and patients should be helped in selecting and using a camouflage preparation that best suits their needs. Cosmetic camouflages are available in various formulations as follows: hard greasy form; soft greasy form; pancake products; and lotion formulation. The process of preparing camouflage with a patient's own hair is actively being investigated. The melanin pigment from hair can be extracted using an acidbase method called Bolt's procedure. This chapter discusses the details of this procedure. The extracted melanin is dried to form a powder which is incorporated into colloidal carrier systems for better skin penetration. A portion of hair is bleached with hydrogen peroxide, thus producing melanin in various shades of brown which can be mixed to match the skin color of the patient.
Camouflage therapy is an alternative form of treatment that can be used to supplement medical or surgical therapy.
Camouflage makeup can be used to cover facial blemishes and imperfections.
Patients with vitiligo and/or melasma are likely to develop depression, loss of self-esteem, and emotional distress.
Camouflage techniques can normalize the appearance of the skin, minimize stigmatization, and improve the quality of life.
In the 2009 case of R. v. Grant, the Supreme Court of Canada reformulated the exclusion of evidence framework in the context of Charter breaches. The case was something of a revolution for those who study evidence law and the Charter. Thus far, the case has been the subject of much debate and even empirical study. Few academic papers have explored the philosophical predilections of the Court in the decision. In this paper, the authors briefly review the history of the exclusion of evidence test, explain the new framework and discuss the academic and legal responses to the case. The authors place the reasoning of the Court in a broader socio-legal context arguing that the test articulated by the Court is informed by a type of populism that combined with recent Charter cases in the police powers context allows for flexible potentials, ones that could, on occasion, encroach on due process protections. The authors call for scholars and activists to keep a close eye on the emerging jurisprudence in this critical area of Charter adjudication.
"Vitiligo" is a word that bears endless possibilities and no promises. Each vitiligo patient has a different story that demands a different therapeutic approach. Even though great efforts have been made to evaluate, study, compare and document the different therapeutic modalities available for vitiligo, clearly handling their modes of actions as well as their side effects and establishing clear stratified guidelines, numerous dilemmas are frequently met on practical grounds. "Stabilize", "repigment", "depigment" or "camouflage"?, for whom and how do we achieve the best results ? Separately or in combination ?; questions that need to be answered and decisions need to be taken in the appropriate timing and altered when the necessity arises. In the current Viewpoint we have utilized the available knowledge and exploited years of experience in an attempt to go beyond the guidelines to set the rationale for an optimal and personalized therapy, within the framework of a stratified approach. This article is protected by copyright. All rights reserved.
Introduction:
Vitiligo is an acquired progressive disorder characterized by destruction of melanocytes in the lesion and the lesional hair follicles. A number of new therapeutic options for vitiligo have become available over the last decade or so both on the medical as well as surgical side. One among them is the smashed skin grafting or simply smash grafting, which is a modification of split-thickness grafting. In this method, the graft undergoes "smashing" before being applied to the recipient site. Though a simple and effective procedure, very few people are doing the procedure either due to lack of awareness or due to lack of published data.
Materials and methods:
Smash skin grafting was performed in 26 patients with vitiligo in Mahatma Gandhi Institute of Medical Sciences, Sewagram, Maharashtra, India.
Results:
Smashed skin grafting helped to achieve more than 90% repigmentation of the vitiligo patches in our patients.
Conclusions:
Smashed skin grafting is a simple procedure with fewer side effects, better outcome, and high patient satisfaction or, in simple words, it can be considered as an alternative to various conventional surgical modalities like punch grafting and melanocyte cell culture methods. This article deals with the steps of the procedure, results of the surgery in a small group of patients, and the necessity of increasing the awareness of smash grafting.
Dermatology is a specialty in the field of medicine, which constantly changes at a vast rate. Alongside technology, new drugs, methods and treatments are continuously developed for the treatment of all common skin diseases. The first edition of "The European Handbook of Dermatological Treatments" received an overwhelming response from dermatovenereologists all over Europe. Its easy-to-read format, which is also used for this 2nd edition, is aimed at helping the physician to obtain comprehensive information at a glance. The three main sections listed alphabetically define the different diseases, the drugs available and the various methods of treatment used in dermatological practice. Each chapter begins with a brief section of the aetiology and pathogenesis of the skin disease, and leads into the description of the clinical characteristics, the diagnosis and the differential diagnosis. Followed by a detailed discussion on treatment methods, alternative methods are covered as well. Each section ends with a reference list for further reading. This new edition provides an excellent update including the newest developments of drugs, methods and treatments in dermatological practice maintaining the clear structure and well-proven format. It is a very comprehensive and practical guide and should not be missed by those treating patients with skin diseases.
Previous research has indicated that there is often a considerable degree of stigma attached to various dermato-logical conditions, including vitiligo, which involves gradual depigmentation of the skin. Some individuals are more affected by the disease than others, suggesting that psychological mechanisms, including the way that sufferers process information about themselves and about social situations, play a crucial role in adjustment. In this study a questionnaire package, which included measures of perceived stigma. self-esteem and disability. as well as a quest to supply qualitative information on incidents when vitiligo had affected their lives, was completed by 614 members of the UK Vitiligo Society. The results suggested that both sociological and psychological approaches are helpful in understanding expectations and experience. A regression analysis indicated that levels of distress, disability and self-esteem accounted for 55% of the variation in perceived stigmatisation. Respondents were much more likely to report incidents involving felt stigma than enacted stigma. but both types of incidents were similarly related to reports of distress and disability. The results indicate that vitiligo patients could benefit from psychological interventions which target perceptions of the self and interpretations of others' behaviour.
The subjective benefit of attendance at cosmetic clinics has not previously been reported.
To assess the effect on perceived quality of life (QoL) of cosmetic camouflage advice.
In a three-centre study, 135 individuals were invited to complete a dermatology-specific QoL measure, the Dermatology Life Quality Index (DLQI), before and 1 month after their first visit to a cosmetic camouflage clinic.
Eighty-two completed DLQI questionnaires were returned before the camouflage clinic appointment, and 56 corresponding questionnaires were returned 1 month after. The mean age of responders was 50 years, and the mean duration of their skin conditions was 15 years. The main conditions seen were pigmentary disorders (29%), scars (22%) and vascular disorders (13%). There was a significant difference in mean DLQI scores before and after the clinic visit (9.1 vs. 5.8, P = 0.0001).
When assessed at 1 month, attendance at a cosmetic camouflage clinic appears to improve QoL significantly.
Few studies have paid attention to the effects of treatment interventions on the psychosocial consequences of vitiligo.
To quantify and analyse the psychosocial benefit of the use of camouflage in vitiligo patients.
78 vitiligo patients completed the Dermatology Life Quality Index (DLQI) and an adapted stigmatization questionnaire, and 62 of them completed the DLQI after at least a 1-month use of camouflage.
The initial mean overall DLQI score (n = 78) is 6.9 (SD 5.6). The mean global stigmatization score is 38%. Disease extent and disease severity are strong predictors of the DLQI (p < 0.0001). Vitiligo on the face/head/neck substantially affects the DLQI, independently of degree of involvement. The mean DLQI score before and after use of camouflage (n = 62) is 7.3 (SD 5.6) and 5.9 (SD 5.2; p = 0.006). Mainly the high-scoring items 'feelings of embarrassment and self consciousness' and 'choice of clothing' improve. Predictors of improvement are higher DLQI scores (p = 0.0005) and higher total severity scores (p = 0.03).
Camouflage can be recommended, particularly in patients with higher DLQI scores or self-assessed disease severity. Patients with minor involvement of the face benefit from camouflage.
Most treatment protocols for vitiligo usually do not result in complete repigmentation. Therefore, cosmetically acceptable camouflage, low cost and easy to handle alternatives are warranted.
To evaluate the efficacy of low-cost self-tanner available in the Thai market in normal subjects with skin types III, IV, and V, and the efficacy for camouflage of 6% dihydroxyacetone (DHA) cream in the treatment of vitiligo on exposed areas of Asian skin.
The study was divided into two parts. Part 1 is a prospective study of 15 healthy volunteers using three different DHA creams which were available in the Thai market with concentrations of 3.5%, 4.2%, and 5%. Part 2 was a retrospective study of 20 patients suffering from vitiligo affecting the face and/or hands and feet who were treated with 6% DHA. The data were collected through direct examination, telephone interview, face-to-face interview, and photographs.
In healthy volunteers, we found that color matching was achieved by using a higher concentration of DHA in darker-skin subjects. Most of the vitiligo patients (88.9%) reported moderate to marked satisfaction with the cosmetic results of 6% DHA cream.
Dihydroxyacetone offers a safe and effective therapeutic option for recalcitrant vitiligo. Dark-skin subjects need a higher concentration of DHA cream than lighter-skin subjects.
Skin camouflage-A guides to remedial techniques: Cover creams. Stanley Thornes publishers
- J Allsworth
Dermatologic clinics: Dermatologic aspects of cosmetics-Colored facial cosmetics
- Z D Draeks
In ′Textbook of Dermatosurgery and Cosmetics′. 2 nd ed. ASCAD Publishers
- S Savant
- Tattooing