I?ve had a condition called vitiligo since I was child.

It used to bother me then when kids made fun of me, but now I?ve grown used to it. But I?m still wondering if there are any new treatments that I could consider? ? B.B., Hickory, North Carolina

Vitiligo is a skin condition in which melanocytes, the cells that cause coloration of the skin, are destroyed.

This occurs in localised areas of the skin, resulting in patches of skin with decreased or no colour. What destroys the melanocytes is usually not found.

Vitiligo occurs in about one in 100 people, without regard to race or sex. However, it occurs more frequently in people with thyroid problems, diabetes, pernicious anaemia and Addison?s disease. This loss of colour (depigmentation) of the skin is also related to atopic dermatitis, lupus, psoriasis and alopecia (hair loss).

The major problem people with vitiligo experience is the feeling that he or she is cosmetically disfigured. This causes emotional distress, which may lead a person to become withdrawn. This can be more of a problem for darker-skinned people because the condition is more conspicuous. Another problem is sunburn and skin cancer, to which depigmented skin is very susceptible.

Treatment of vitiligo has improved during the last decade. Some recently developed treatments include: light-sensitive drugs plus ultraviolet light (PUVA), narrowband ultraviolet therapy (UVB), and local corticosteroids plus ultraviolet light. Topical tacrolimus combined with a 308-nm excimer laser also is effective.

All of these treatments can help significantly; the only way to tell which approach is best is to try each one. Often, however, they do not result in the complete return of colour. Moreover, treatment for vitiligo is often prolonged, and the patient must be strongly motivated to continue the treatment indefinitely.

There are important side effects associated with some treatments, including increased risk of skin cancer from ultraviolet light and skin problems with prolonged topical steroids. Because of heightened concerns for children, calcipotriol, which has recently been shown to be helpful in children, should be considered.

Cosmetics are effective in concealing the patches. Sunscreens and coverings should be used to protect against sun exposure. A recent study in Germany found that dihdroxyacetone, found in a commercially available self-bronzing cream, showed satisfactory cosmetic results in most people treated with this formulation.

Surgical methods are a therapeutic option if the disease is stable. Two types of surgical techniques are available: tissue grafts and the transplantation of pigment cells.

As you can see, there are a lot of options. The one that will work best for you depends on the severity of the disease, how stable it is, and your own personal, psychological and motivational factors.

Since all of the treatments except surgery are not permanent, you have the advantage of being able to go down one treatment path and, if you don?t like the results, to shift to another. Unfortunately, as I said before, it can also be very frustrating because most treatments require lifelong effort.

As evidenced by the drop in business in many of the retail outlets focused on ?low-carb? diets, it now appears that low-carbohydrate diets are losing their faddish appeal.

So it?s fitting that a recent medical study evaluated the best available data on the impact of low carbohydrate diets. The researchers found that only three studies have been conducted that conform to the best methods (randomised trials) and lasted more than 90 days.

All three studies did show that low-carb diets resulted in a greater weight loss after six months than diets that simply restricted calories. Two of the studies tracked dieters for 12 months, however, and found no difference in effectiveness over that period between low-carbohydrate diets and calorie-restricted diets.

Once again, it appears that the only reasonable way to lose or maintain appropriate weight over the long run is to eat in moderation and increase physical activity.

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