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Some remarks on the appropriate UV-irradiation for the stimulation of pigmentsynthesis with and without addiitional oral or topical medication.

In short first:

1.       Patients with vitiligo should protect their skin and be careful with sun exposure (especially at those areas which are affected by loss of-          pigmentation) and avoid sun burns in vitiligo areas.

On the other hand:

2.       Pigmentsynthesis needs stimulation by UV-light.

3.       The sunlight is the natural stimulus for pigment synthesis.

4.       Disadvantages using natural sun irradiation for the treatment of vitiligo: natural sun irradiation…

a)      is not always available (winter, covered sky, working in rooms throughout the day etc.)

b)      contains extra wave length and frequencies which do not contribute to pigmentation but contributes to damage and ageing of the skin.

c)       cannot be precisely controlled, regarding the daily irradiation load (energy) that reaches our skin

5.       Artificial irradiation can be controlled easier regarding the energy dose and the quality of wave lengths (or frequencies) which reaches our-         skin.

6.       Artificial UV-irradiation with UVA and UVB respectively (and Exsamer Laser) have different effects regarding the stimulation of pigment -          synthesis, but both stimulate repigmentation.

7.       The combination of UVA and UVB irradiation (with different radiators) are the best combination for repigmentation.

8.       The overall UV-load to the skin, necessary for the treatment of vitiligo, should be compensated during other times, when UV irradiation is not-          used for repigmentation-treatment (Spare time on a sunny beach for example, should be reduced or the skin should be protected).

Text: 

Repigmentation of different degree is attainable with Vitiligo already by adequate UV-irradiation alone, even without taking or using any oral or topical medication.

This applies to UV-A irradiation, to UV-B, to sun exposition in general, sun exposition at the dead sea and the irradiation with Excimer Laser.

This is to be explained by the fact that any kind of irradiation, which represents an adequate stimulation for pigment formation can be effective.

The natural sunlight represents the natural adequate stimulation for the pigment formation.

All “synthetic” forms of irradiation from the UV –light range has a reduced spectrum compared with sunlight.

All “synthetic” forms of irradiation (UVA, UVB, UV-B 311 nm, Excimer laser 308 nm) exercise a reduced, although sufficient stimulus for the melanocytes to react with melanin output.

Thus in particular the UV-B irradiation stimulates primarily the formation of new pigment (Eumelanin,Phaeomelanin), which is an optically not yet visible preliminary stage of melanin, which will be converted into the visible pigment under the influence of. UV-A –light.

The natural sunlight effectuates both at the same time and would thus be the natural and best form of irradiation for pigment formation.

The disadvantage of the natural sunlight consists essentially of the fact that

1. It contains frequencies and wavelengths, which do not make a contribution for the pigment formation, but which contribute to the overall radiation energy load -     which leads to detoiation and ageing of our skin over time (during our lifespan).

2. It is not available sufficiently throughout the year in many regions of our planet.

3. It cannot be controlled correctly regarding the energy dose which it exercises on our skin.(angle of  the sun radiation at different times of the day and seasons, -     atmospheric dust layers, geographical stand of the sun at the different seasons etc. etc.)

A part of these disadvantages of natural sunlight irrigation is eliminated in the region of the Dead Sea.

An appropriate cure at the Dead Sea however is time-consuming and expensive.

For all these reasons a “synthetic” UV- irradiation using a commercial UVA-lamp or a special UVB-radiator is given preference in practice in the treatment of the Vitiligo

All enumerated “synthetic” forms of irradiation mentioned above have pros and cons in comparison with one another.

According to our experience, the irradiation with UV-A in combination with UV-B 311 nm is the most effective irradiation technology with Vitiligo presently.

The irradiation obtained with Excimer Laser, is, however, clearly more expensive than any other irradiation technology for the treatment of vitiligo and still not as reliable in its effects with Vitiligo as we tend to expect when we look at the higher costs involved with its application. Only few skin physicians have the appropriate equipment of Excimer Laser.

All the above was to be said first, concerning effective forms of UV-irradiation with Vitiligo in general.

Concerning the combination of irradiation with the oral medicine which we prescribe because of its additional metabolic effect with the treatment of Vitiligo, this metabolic effect is not limited to certain forms of irradiation. Each kind of irradiation, which supplies the adequate stimulation for pigment formation, is suitable as combination with these oral supplements.

The fact that there are studies using natural sun exposition or UV-A irradiation in connection with  Phenylalanine for example, does not mean, that other sources of UV-radiation (UVB for example) would not have been effective with the treatment of Vitiligo. The use of these special UV-sources has to be understood historically. At times of the first studies with Phenylalanine (in the 1980-years) irradiation with UV-B 311 nm was not yet established in the treatment of skin conditions.

When however the UV-B 311 nm irradiation was established and became the standard irradiation therapy with psoriasis and neurodermitis (and later also with Vitiligo), first studies with vitamin B12 and folic acid were performed. In other words: Studies with folic acid and vitamin B12 could have been performed with sunlight or UV-A exposition also. But at that time the irradiation with UV B narrow band (311 nm) had been already established and UVA was no more in fashion.

I feel, this was necessary to be mentioned, because some people, even specialists, believe that some of our supplements can only be combined with UVA or UVB respectively because of the study in which the respective UV-irradiation source was used. But this is not true.

As mentioned before already: according to our experience the irradiation with UV-A  in combination with UV-B 311 nm represents the most effective irradiation technology with Vitiligo today.

On the other hand it is our experiences also, that repigmentation using our proposed supplements can also be achieved with natural sunlight alone or with the mostly available UVA irradiation, when it is difficult to get in possession of a UVB 311nm-radiator.

Irradiation times for UVA compared to UVB are very different, whereby irradiation times with UVB are much shorter (maximum 2 minutes beginning only with 10 or 20 seconds for the first session!) whereas the usual UVA-therapy ranges from 5 to 10 to 15 minutes per sitting. More details for this is to be discussed the therapist.


Risks of the necessary UV irradiation:

Each kind of irradiation of the skin by natural sun or the appropriate UV irradiation „from the plug socket “in principle represents a risk of damage to our skin.

The damage which the sun (or other) causes to the skin can mainly be divided into acute and chronic damage.

The acute damage would be a brief load of highly excessive irrigation exposure of the unprepared skin, as it often arises in the first summer days, where the skin is still pale from a longer winter period (thus no protecting pigment are present and no protecting cornea/callosity) or with a trip into the Tropics, in the middle in the local winter at home. Such acute excessive load of sun radiation leads to sunburn, an inflammation of the damaged skin.

The chronic damage caused by chronic, even mild UV-radiation load is what we all (and our skin) have to deal with as long as we do not avoid sun exposure altogether, throughout our live span and which in its cumulative dose will cause some damage and skin ageing, in the worst of the cases even skin cancer, even if we do our best, to never get the sunburn.

Repeated acute excessive loads with sun irradiation (but also with UV-radiation „from the plug socket “) can damage the skin after few years including the statistic danger to induce a skin cancer which can occur many years after these acute excessive loads. So excessive UV-exposure must be avoided at any time for these reasons.

The same is true in principle for non acute excessive UV-loads, which means for chronic UV-exposure. But the risk is extremely less.

In summary we must say that we have to avoid acute excessive UV-loads to our skin by all means. But we also have to consider that UV- exposure even in moderate form also contribute to skin damage but only after many many years.

In cases like in the treatment of vitiligo where we need UV-exposure of  our skin in order to stimulate pigmentation, the trick is to avoid UV exposure at times, when we do not need it for repigmentation (for example during holidays on a sunny beach). So we can save some UV-load throughout our lifespan.

 The risk to induce a skin cancer during one year of UV-irradiation for the treatment of vitiligo is certainly much less, when the UV irradiation is performed in the proper way that we suggest in our treatment programme, compared to the risk that we run during a summer holiday on the beach.

If one considers all what we have said and suggested and avoids excessive therapeutic irradiation, then the necessary irradiation treatment in summary does not represent an increased risk for the emergence of skin cancer compared with other humans with an average sun exposition in the course of their life.