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What is the most effective treatment for vitiligo on the genitals?

Q: I am 18 years old. I have vitiligo for the last 10 years. It appeared on my face and after applying some ointment my skin was fine again. Then after a year, it started appearing on my feet. Usually whenever I got an injury, a small white spot would appear after the healing process of the cut or wound. But then something strange happened. A small spot appeared on my scrotum when I was 12. I was quite worried but didn't have the courage to talk to a doctor about it. In the meanwhile I was using an ointment prescribed by a dermatologist, called Diprolene, on the spots on my feet and knee so one of the spots disappeared but I couldn't continue the medicine and after that the spots kept spreading especially on my scrotum. My scrotum is almost 80 percent white now due to vitiligo. I haven't consulted a dermatologist about this yet. I need your opinion before I do so. Is there a treatment other than laser treatment and the melanocyte transplantation surgery? If yes, is it safe?

A:Vitiligo (also called leucoderma) is a skin condition in which there is loss of pigment from areas of the skin resulting in irregular white spots or patches, even though the skin has normal texture. Vitiligo may appear at any age. Although it is a progressive condition, many people experience years or decades without developing new spots. The cause of vitiligo is not really understood. Vitiligo is not contagious in any way. Injury can increase the spread of vitiligo and this is known as Koebners Phenomenon. The face, underarms, hands, wrists, fingers, feet, elbows, knees and genitals are the most commonly affected. The reality is, a substantial number of people with vitiligo (estimated at 25 to 40 percent) do experience at least some (if not extensive) vitiligo on their genitals. For many people, this can be a serious effect on their own esteem, and in their social and sexual lives. Genitals can be treated and are often very receptive to treatment. Traditional therapies, such as steroid creams, and PUVA, have been used to treat the genitals. Limited use of steroid creams has brought re-pigmentation to many. Topical psoralen has also been used. Pseudocatalase cream and Narrow Band UVB is generally safe to use, and excimer laser is also used on the genitals. Tacrolimus has also been prescribed by doctors for use on the genitals. With any ointment or cream being applied to the genitals, care should be taken around the urethral opening to avoid risk of irritation or infection.

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