4 Vitiligo Treatment Options to Consider
There’s no cure for the skin condition vitiligo, which causes patches of skin—sometimes very large patches—to turn a lighter color. Given that this main symptom is so visible, many people get help from psychological interventions like cognitive behavioral therapy and tips for improving their self-esteem.
Vitiligo does not necessarily need to be treated. Many people turn to makeup to conceal the changes in their skin. Others fully embrace their light patches. But for those who do decide to pursue vitiligo treatment, there are medical options that sometimes stop the disease from spreading—and may even restore some pigment.
“The purpose of treatment is to stabilize the disease if it’s active,” Henry W. Lim, MD, former chair of dermatology at Henry Ford Hospital in Detroit, tells Health. “The next step is to bring the color back.”
In general, your face is the most responsive to vitiligo treatment, followed by your body, says Dr. Lim. Lips, nipples, and the tips of your toes and fingers are reluctant to respond to any treatment.
“The unfortunate thing is that for a fair number of patients, nothing works great,” Daniel J. Aires, MD, director of dermatology at the University of Kansas Health System in Kansas City, tells Health. “But there are many treatments, and they can be helpful for some patients.”
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Topical treatments
One of the mainstays of vitiligo therapy is topical treatment, creams or ointments that go directly on the skin. Topical corticosteroids, for instance, can darken light patches of skin.
“Topical steroids can be very effective for local treatments, but there are still some potential side effects, particularly thinning of the skin,” says Dr. Aires. Blood vessels may show in areas where skin is already thin (like your face), and wrinkles may appear. You also shouldn’t use any type of steroids for long periods of time.
Tacrolimus (Protopic) and pimecrolimus (Elidel) are prescription topical medications in a class of drugs called calcineurin inhibitors that can also help treat vitiligo.
These usually don’t have side effects, says Dr. Lim, who is also past president of the American Academy of Dermatology. They work by stimulating your melanocytes (cells that make melanin) to produce pigment again. Although they’re more expensive than corticosteroids, they may also be more effective, especially if you use them in combination with light therapy (more on that below).
Some people get benefits from calcipotriene, a version of vitamin D. “The data is inconclusive” as to whether or not topical vitamin D will truly help people with vitiligo, Dr. Aires says. But it’s also not likely to hurt you and is “certainly something to consider,” he adds.
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Phototherapy
Phototherapy or light therapy is the other long-standing mainstay of vitiligo treatment, especially vitiligo that’s more widespread. Phototherapy in the form of narrowband ultraviolet B (UVB) rays helps stimulate melanocytes to start producing pigment again. Sometimes the therapy is given with a drug called psoralens, which ramps up your sensitivity to light.
“You can expose the whole body or you can use targeted phototherapy, meaning using lasers to treat small areas of skin,” says Dr. Lim. “These are very safe treatments.”
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Oral steroids
Oral corticosteroids may help slow vitiligo if it’s progressing quickly. Like other vitiligo treatments, it can be combined with UVB phototherapy.
“This is a bigger gun if the vitiligo is really widespread and very, very debilitating,” says Dr. Aires.
But there can be major downsides, especially if oral steroids are used for more than four or five months at a time. “There are potentially a lot of side effects, including weight gain, diabetes, and bone thinning—all kinds of things you’d really rather not have,” Dr. Aires says. “Certainly they can be used, but they’re something to think about very carefully.”
Generally, oral steroids aren’t effective for stable vitiligo, meaning vitiligo that is no longer spreading.
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Surgery
Surgery for vitiligo is a last resort, and only for people who’ve had stable disease for at least a year.
“There’s no reason to do this on people with active lesions because you’d be chasing after the disease,” Dr. Lim says. Also, “it’s not practical for very large surfaces.”
Surgery falls into two main categories. Skin-grafting is when you take skin from parts of the body that haven’t been affected by the disease and put them onto areas that have vitiligo.
Transplantation involves moving healthy melanocytes to areas of skin that have lost melanocytes and, therefore, pigment.
The surgery can sometimes cause side effects of its own, like scarring.
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