Q: My 28 years old wife had vitiligo of 1 cm on the lips 9 years ago. She was prescribed Placentrex. But she got blisters and the vitiligo also became little big, so she discontinued using the solution. After she had grafting done on her lips taking a piece of skin from her thighs, it was fine till 3 months ago. Now she has vitiligo again in her lips and the same solution is recommended along with Tacroz cream (Tacrolimus). What would be the permanent treatment for this vitiligo? Can she continue this solution?

A:The course of vitiligo is unpredictable. It can become active anytime after being quiescent for prolonged periods of time. It may spread slowly or very rapidly. How many times this will happen in ones lifetime, nobody can predict. Relapses are treated in the same manner as before. However, blistering with Placentrex lotion is unusual. I have seen blistering with psoralen therapy but not with Placentrex. Therefore I doubt if your wife has vitiligo in the first place, especially if she has no patch anywhere else over the body. Blisters are seen in herpes labialis and this leads to post inflammatory de-pigmentation in some people. This is sometimes misdiagnosed as vitiligo. In most such cases treatment is not required; if necessary some of the medicines used in vitiligo can be tried.