How Is Vitiligo Treated?

Vitiligo is a long-term condition that causes skin depigmentation. It occurs when the cells that produce melanin—the pigment which gives color to the skin and hair—stop functioning. These cells are called melanocytes. It is not fully understood why this happens, but right now researchers theorize that vitiligo is an autoimmune condition. This means that your immune system is mistaking healthy cells for harmful ones and is attacking them in defense. 

People with vitiligo have lightened macules (small areas of depigmented skin) or patches (larger areas of depigmented skin) that can appear anywhere on the body. It is common for vitiligo to only occur on one side of the body.

There is no cure for vitiligo. If it is interfering with your life or you wish to treat your patches, a dermatologist (a doctor who specializes in treating skin conditions) can help. They may recommend creams, medications, surgery, phototherapy, or laser therapy to help cover your patches or restore your skin color.

They may also discuss the benefits and risks of the different treatment options. Some medications are only safe for short-term use, and procedures require multiple sessions to add pigment to depigmented skin. 

Woman sitting at the bed at her flat and applying cream a her legs

YakobchukOlena / Getty Images

Sunscreen

The American Association of Dermatology Association recommends applying sunscreen if you have vitiligo. Depigmented skin is very sensitive to the sun’s ultraviolet (UV) rays, so you’re more likely to sunburn easily.

Some people with vitiligo feel a tingling sensation on their skin when they are exposed to the sun, so sunscreen can be effective in relieving this symptom.

Choose a broad-spectrum product with SPF 30 or higher, as it protects the skin both from UVA and UVB rays. Apply sunscreen even when the weather is cloudy. Contrary to popular belief, UV rays can pass through clouds and you can get sunburn on a cloudy day.

Makeup and Camouflage Products

Some people prefer covering up their patches with camouflage makeup or creams rather than opting for treatment. If you have vitiligo, your healthcare provider can help you choose the right products for you.

Many people with vitiligo have expressed that it affects their confidence and self-esteem. A 2020 study found that camouflage products help improve the quality of life of people with vitiligo, particularly when it came to their self-esteem.

Discuss Topical Products With Your Healthcare Provider

Always discuss any topical makeup or creams with your healthcare provider. It is important to ensure that they aren’t interfering with any potential treatments you may be undergoing.

Prescription Creams

Prescription creams are available for treating vitiligo. Depending on the cream, they may be used either short-term or long-term.

Short-Term Treatment

If you have vitiligo patches on both sides of your body, your dermatologist may prescribe topical corticosteroids. These are creams and ointments to help regain your skin pigmentation and prevent the patches from spreading.

Corticosteroids (commonly called steroids) have anti-inflammatory properties that interfere with the immune system’s activity. This may be beneficial as vitiligo is considered an autoimmune disorder.

You may be prone to experience serious side effects if you use the product on a large area or as a long-term treatment. Seek medical care if you have any of the following when getting treated with hydrocortisone:

  • Skin redness 
  • Swelling 
  • Dizziness 
  • Muscle weakness

Long-Term Treatment

Opzelura (ruxolitinib) is a prescription cream that is FDA-approved for treating nonsegmental vitiligo in people ages 12 and older. It is a Janus kinase (JAK) inhibitor, which is a type of medication that keeps the overactive immune response associated with vitiligo from triggering.

Your dermatologist may recommend using Elidel (pimecrolimus) cream or Protopic (tacrolimus) ointment. They belong to a class of medications called calcineurin inhibitors. These are FDA-approved to manage eczema and block the immune system's chemicals responsible for flare-ups. They are commonly used off-label to treat vitiligo.

Off-Label Use

A doctor can sometimes prescribe medication “off-label.” This means the drug has not been FDA-approved to treat your condition. In most cases, the drug’s off-label use is common in clinical practice and may be supported by documented case studies and research.

Elidel (pimecrolimus) cream is FDA-approved to treat mild to moderate symptoms of eczema in individuals older than two who have not experienced any relief from topical steroids. It is used off-label to treat vitiligo and eczema in those under two who have sensitive skin and are prone to develop side effects from steroids.

Pimecrolimus can cause burning or stinging if your skin is inflamed. However, these symptoms usually go away after a few uses.

Protopic (tacrolimus) ointment is another product that helps treat eczema but is used off-label in patients with vitiligo. Just like pimecrolimus, it can cause a burning and stinging sensation that usually disappears with repetitive use.

Seek medical attention if you experience adverse effects from using pimecrolimus or tacrolimus. This may look like:

  • Headache
  • Fever
  • Sore throat
  • Nasal congestion

Light Therapy

If you want to restore your skin pigmentation over a large area, your dermatologist may recommend undergoing light therapy. This may also be beneficial if creams have not been effective.

During the procedure, your skin is exposed to UVA or UVB light, using a UV lamp for a specific amount of time. You'll need to attend two or three sessions per week. Most people see noticeable progress after six to 12 months of treatment.

Before starting treatment, you may have to take Methoxsalen (psoralen), a drug that increases your skin's sensitivity to UV light. This is sometimes called PUVA, or psoralen and UVA light. According to a 2017 study, PUVA can cause nausea and increase your risk of skin cancer.

Some retailers sell sunlamps that you can use at home and perform light therapy yourself. Your dermatologist may advise against using them, as they may not be very effective and are not FDA-regulated.

Oral Medications

Prednisone is an oral corticosteroid drug recommended for adults who have vitiligo that is spreading quickly. Prednisone is also safe for children who have progressive vitiligo. Healthcare professionals may prescribe a low dose for two to three weeks to test its effectiveness and determine if they experience any adverse effects.

It is important to let your healthcare provider know if you develop side effects, such as:

  • Acne 
  • Dizziness 
  • Heartburn 
  • Increased sweating

Surgeries and Procedures

Surgery may be the only option if other vitiligo treatments do not work. Surgical options include skin grafting and cell transplants:

  • Skin graft: During a skin graft procedure, the doctor removes some parts of your pigmented skin to cover the areas affected by vitiligo. This is recommended for adults who have not developed any white patches in the last 12 months. 
  • Cell transplant: A cell transplant procedure involves taking some of the pigment cells from pigmented skin, and placing them on the areas that have lost their color. It can be a good option for people of any skin tone and with any type of vitiligo.

Living With and Managing Vitiligo

Vitiligo can be difficult to control; there aren’t many treatment options available.

The good news is that vitiligo is not life-threatening. However, it is normal to feel nervous or insecure about a condition that visibly sets you apart.

A lot of people with vitiligo have problems with self-esteem, and some may also experience anxiety and depression. Mental health therapy and support groups can help you learn more about vitiligo and what others are going through. If you think you need help addressing these problems, ask your healthcare provider to refer you to a mental health therapist.

A Quick Review

Vitiligo can cause patches on different areas, such as your arms, face, and neck. These often appear on one side of your body, but it is possible for them to appear on both sides.

There are different treatment options for patients with vitiligo, such as steroid creams, oral medications, light therapy, and surgery. Treatment options vary depending on the depigmented areas you have, how long you’ve been having vitiligo symptoms, and how well your skin responds to treatment. A dermatologist can help you find the right treatment plan for you.

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Sources
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  4. National Library of Medicine. Pimecrolimus

  5. American Osteopathic College of Dermatology. Tacrolimus & pimecrolimus.

  6. Bae JM, Jung HM, Hong BY, et al. Phototherapy for vitiligo: a systematic review and meta-analysis. JAMA Dermatol. 2017;153(7):666. doi:10.1001/jamadermatol.2017.0002

  7. Lei T-C, Xu A-E, Gao T-W, et al. Consensus on the diagnosis and treatment of vitiligo in China (2021 revision). International Journal of Dermatology and Venereology. 2021;4(1):10-15. doi:10.1097/jd9.0000000000000151 

  8. MedlinePlus. Prednisone.

  9. Frączek A, Kasprowicz-Furmańczyk M, Placek W, Owczarczyk-Saczonek A. Surgical treatment of vitiligo. Int J Environ Res Public Health. 2022;19(8):4812. doi:10.3390/ijerph19084812

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