Although there is no definitive cure for vitiligo, several treatment options are available.
These are creams and ointments applied to the skin that affect the immune system locally in the areas of application. Although they tend to work slowly, topical steroids can slow or stop the progression of vitiligo lesions and may even bring color back over time.
Topical immunomodulators (tacrolimus, pimecrolimus)
These are available as a cream or ointment. They work similar to topical steroids but may not be as effective. However, they don’t have steroid-associated side effects, such as thinning of the skin, and can be used in delicate areas, such as the eyelids.
A special type of light is available at a dermatologist’s office called narrow band UVB or PUVA. Patients with vitiligo are exposed to this light 2-3 times per week for months at a time. Phototherapy slows down progression of vitiligo and can bring back color to depigmented areas over time. Excimer laser is a more focused form of UVB light that can be used on small areas of vitiligo.
Some dermatology offices offer surgical treatments of vitiligo. This therapy is only effective in individuals with stable vitiligo, defined as less than 10% worsening of lesions in the past 6 months.
Punch grafting (minigrafting): A few centers in the US offer this form of treatment, which consists of taking tiny plugs from normal skin and transplanting into lesions of vitiligo. These small plugs cause pigment to grow outward from each plug, covering the vitiligo lesion over time. Not all patients respond, therefore a test treatment with just a few plugs is often performed initially to check for response.
Blister Grafting: Although used in many centers outside the US, blister grafting centers in the US are rare. Blisters are created in normal skin and the top of the blister is transplanted onto lesions of vitiligo. The vitiligo skin is prepared for the transplant by removing the epidermis with blister formation, dermabrasion or laser surgery.
Melanocyte-keratinocyte transplantation: A suspension of skin cells, including melanocytes, is created from skin harvested from normally pigmented skin. This suspension is then poured onto areas of vitiligo which have been prepared with dermabrasion or laser surgery.
Successful repigmentation of vitiligo depends on good compliance with the prescribed regimen, discipline, patience and time. A combination of treatments is often given, depending on the circumstance. Younger patients generally have better results than older patients. Patients with vitiligo for less than 2 years usually do better than those with long-standing vitiligo. Areas with hair follicles appear to repigment faster than those with no hairs. Fingers, hands, wrists, elbows, knees, ankles and feet respond least to all treatments. Once repigmentation occurs, treatment is not stopped abruptly, but slowly tapered over time. Vitiligo may return if the immune system becomes more active again. At that time, the patient may resume treatment.
Sunlight is not as effective as in-office phototherapy, but can be used when other treatments are not available. Unlike the precise, narrow band of light given in a doctor’s office, sunlight contains a broad spectrum of UVA and UVB rays, which can cause premature aging and promote skin cancers. It is important to carefully follow doctor’s instructions when treating with sunlight to avoid sunburns and other complications. In general, it is a good idea to wear sunscreens when not treating the skin with sunlight or in-office phototherapy.
There are no specific recommendations for patients with vitiligo. A healthy diet that includes a variety of vegetables and fruit is a good way to support the immune system. Antioxidants have been found to be deficient in the skin of vitiligo patients; therefore, vitamins with antioxidants may be helpful, including vitamin C, vitamin E and alpha lipoic acid.
Makeup, such as Dermablend, is available to cover vitiligo lesions in all skin types. Skin stains containing dyhydroxyacetone can be used to color lesions of vitiligo for several days, causing them to be less noticeable.
The most commonly prescribed treatments, whether a topical cream or in-office light therapy, are often covered by medical insurance, and thus requires only a small copay. However, the surgical procedures are not covered by insurance at this time.
For extensive cases of vitiligo, in which more than 50% of the color is gone, depigmentation of the remaining pigmented areas can be performed. This will produce an even, white appearance to the skin. A medication called monobenzone is used for several months to achieve this result. Depigmentation should only be performed in individuals who have decided not to seek treatment to repigment their skin ever again, since the results are usually permanent.