257 Nursing Assessment, Management and Treatment of Autoimmune Diseases
The goal can be achieved by the follow- ing methods: ● Camouflage therapy : This therapy involves using sunscreen with an SPF of 30 or higher. Use of sunscreens minimizes tanning, thus limiting the contrast between normal and affected skin. Makeup can help to camouflage depigmented areas. Hair dyes can be used if the disease affects the hair. Depigmentation therapy with the medication monobenzone can be used to treat extensive disease. The medication is applied to pigmented patches of skin to turn them white to match affected areas of skin (Cleveland Clinic, 2020). ● Medications : Corticosteroids can be used in oral or topical forms to promote repigmentation. It may take up to 3 months to show results. Topical vitamin D analogs may also be helpful. Topical immunomodulators may be useful for treating small areas of pigmentation. However, there may be a possible link between these kinds of drugs and lymphoma and skin cancer (Mayo Clinic, 2020d). ● Light therapy : Phototherapy with narrow band ultraviolet B may stop or slow progression of the disease. Effectiveness might be enhanced when used with corticosteroids or calcineurin inhibitors. Light therapy is administered two to three times a week. It may take 1 to 3 months before any change is noticed. However, there is a possible risk of skin cancer with the use of calcineurin inhibitors (Mayo Clinic, 2020d). ● Depigmentation : For widespread vitiligo that has not been treated successfully with other options, a depigmenting agent is applied to unaffected areas of skin. The skin is
gradually lightened so that it blends with discolored areas. This type of therapy is done once or twice a day for 9 months or longer (Cleveland Clinic, 2020). If medications and light therapy do not work, surgery may be performed. Pos- sible procedures include the following (Mayo Clinic, 2020d): ● Skin grafting : Small sections of healthy, pigmented skin are grafted to affected areas. Risks include infection, scarring, a cobblestone appearance, spotty color, and failure of the area to recover. ● Blister grafting : Blisters are creating on pigmented skin and then the tops of the blisters are transplanted to affected areas. Risks include scarring, a cobblestone appearance, and failure of the area to recover. ● Cellular suspension transplant : Tissue is taken from pigmented skin, cells from the skin are placed into solution, and then are transplanted onto affected areas. Results start to show within 4 weeks. Nursing interventions Nurses need to teach patients and fam- ilies about lifestyle modifications and home remedies. These include the fol- lowing (Mayo Clinic, 2020d): ● Skin must be protected from the sun and artificial sources of UV light. A broad-spectrum, water-resistant sunscreen with an SPR of at least 30 is recommended. ● Makeup and self-tanning products can help to reduce differences in skin color. If a self-tanner is used, one should be chosen that contains the Food and Drug Administration (FDA) approved ingredient dihydroxyacetone.
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