May 05, 2016
Journal of Drugs in Dermatology
Written by
Vitiligo is an acquired condition resulting in patches of depigmented skin that is cosmetically disfiguring and can subsequently be psychologically disturbing. For patients seeking to mask their vitiligo, camouflage options have historically been limited and been designated as a cosmetic, rather than a medical, concern. As research has indicated that proper concealment of vitiligo lesions can vastly improve quality of life, we believe it is essential that dermatologists become aware of all the options available to their patients and that discussions of camouflage options be broached from the first visit. Methods for concealment include cosmetic tattoos, dihydroxyacetone, general cosmetics, and various topical camouflage agents, including the newest product, Microskin™. We conducted a literature review of all of the available options for vitiligo concealment and evaluated their advantages and disadvantages. Ultimately, temporary methods of concealment are recommended; but the particular agent used can come from discussion with the patient based on the location of the lesions, degree of concealment desired, cost, and availability.
Vitiligo, like many other dermatologic conditions, can be psychosocially debilitating and greatly impact a patient’s quality of life. Unfortunately, vitiligo can be quite difficult to treat. When repigmentation is not possible, camouflaging depigmented patches becomes essential in the successful management of these patients. This article reviews the advantages and disadvantages of various camouflaging agents.
The camouflage modalities include tattooing, traditional makeups, medical camouflages (Dermablend, CoverBlend, Cover FX, Microskin), and the self-tanner dihydroxyacetone (DHA). Cosmetic tattoos offer the potential of providing permanent camouflage. This is not preferred for most patients because results are variable and dependent on the skill set of the artist. Furthermore, pigment can migrate, tanning will produce a color mismatch, and adverse events including infection and local inflammation can occur. I agree with the authors that traditional cosmetics are often inadequate in vitiligo patients because they require repeated, thick applications to achieve proper coverage and often produce an unnatural appearance. On the contrary they are affordable and readily available. Most dermatologists recommend medical camouflage. These opaque products can be blended to match a wide variety of skin tones, simulating a normal complexion. They are more adherent and water resistant, and wear longer. Unfortunately, they are more costly than traditional make-up and require a consultation for color matching and a lesson on proper application. Men and children who normally do not wear make-up find these products particularly challenging. Self-tanners are longer lasting, water proof, and inexpensive, but it is often difficult to exactly match normal skin tones.
It is important for physicians treating vitiligo patients to review these camouflage techniques along with discussing other treatment modalities. Also, sun-protection and wearing sunscreen may help prevent highlighting the discoloration of vitiligo. Even when treatment is successful over time, camouflaging vitiligo lesions is essential in addressing the psychosocial component of this disease.