Vitiligo (2) Sun protection and skin camouflage
Most people with vitiligo are self-conscious about their appearance, particularly if the white patches appear on their face, neck or hands, and this may make them hesitant to seek help. There are two specific areas in which the pharmacist can provide information: the correct use of sunscreens and the use of skin camouflage products.
Sunscreens absorb or reflect ultraviolet radiation before it reaches the skin. However, many sunscreens offer better protection against UVB (short wavelength UV radiation) than UVA (longer wavelength). Because vitiliginous skin is particularly susceptible to sunburn, there are a number of sunscreens available on the National Health Service, but many people with vitiligo do not know this. These products appear in appendix 7 of the British National Formulary (borderline substances) and it is in the patient’s interest to be informed that sunscreens should be used and can be obtained on prescription.
If a sunscreen has been prescribed, it is helpful to check that the patient has been told how, and how often, to apply it. Sunscreens should be applied liberally and for good protection, they should be reapplied approximately every hour if the person is outside on a sunny day. However, this may be a problem if the wearer also uses skin camouflage products.
It is also useful to check that the patient is happy with the sunscreen selected by the general practitioner — no sunscreen is beneficial to a patient if it is not used. For children of school age, roll-on sunscreens are particularly useful because they can be self-applied with little spillage or embarrassment. Indeed, they may well be viewed as a “cool” item to have in one’s school bag. Many GPs and patients will not be aware that tinted sunscreens are also available on prescription. These will provide both colour and sun protection for the depigmented patches and are particularly helpful for children, or for anyone who wants to disguise the patches but would not feel comfortable using skin camouflage.
Should a person with vitiligo request assistance in choosing from the vast range of non-prescribable sunscreens available, they should be advised to use one containing both UVA and UVB protection. In the case of all people with vitiligo, whatever their ethnic origin, their vitiliginous skin should be treated as type 1 skin (always burns, never tans), which is typical of people with fair skin, light eyes and freckles. They therefore require a sun protection factor of 25 or above. Considerations when recommending products include ease of application, staying power, absorption and stickiness.
Should a patient report that he or she always burns, no matter which sunscreen is used, the pharmacist should find out how the product is being applied. It is also important to ask if the patient is taking drugs for any other condition in order to rule out any drug-induced photosensitivity. Enquiries about any “health” products being taken are also useful because a number of herbs can cause photosensitivity. For example, many people do not realise that for people with vitiligo, herbal products such as St John’s wort can do more harm than good.
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Citation: The Pharmaceutical Journal URI: 10982339
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