From the Guidelines
Diffuse vitiligo treatment should prioritize a combination of narrowband UVB (NB-UVB) phototherapy and autologous platelet-rich plasma (PRP) therapy, as this approach has shown statistically significant improvement in repigmentation and is a simple, safe, and tolerable technique 1. When considering treatment options for diffuse vitiligo, it's essential to weigh the benefits and risks of each approach, prioritizing those that minimize morbidity, mortality, and improve quality of life.
- Key considerations include:
- The use of NB-UVB phototherapy, which has been shown to be highly effective, particularly in patients with darker skin types 1.
- The combination of NB-UVB with PRP therapy, which has demonstrated superior repigmentation results compared to NB-UVB alone 1.
- The importance of monitoring response closely using serial clinical photographs to identify patients who fail to respond adequately or in whom the disease progresses during treatment 1.
- Treatment approaches may also involve:
- Topical corticosteroids, such as betamethasone valerate, or calcineurin inhibitors, like tacrolimus, for localized areas or sensitive skin.
- Oral medications, including low-dose oral corticosteroids or JAK inhibitors, for extensive cases.
- Surgical options, such as melanocyte transplantation, for stable patches.
- Depigmentation therapy with monobenzyl ether of hydroquinone for cases where vitiligo covers more than 50% of the body.
- Patient education on sun protection, using broad-spectrum sunscreen (SPF 30+) daily, is crucial to prevent contrast between affected and unaffected skin and reduce the risk of sunburn in depigmented areas. The most recent and highest quality study 1 supports the use of NB-UVB and PRP combination therapy, making it the recommended treatment approach for diffuse vitiligo.
From the Research
Treatment Options for Diffuse Vitiligo
- The treatment of diffuse vitiligo aims to prevent the spread of the disease and facilitate repigmentation of affected lesions 2.
- Current therapeutic options are based on three approaches:
- Regulation of the autoimmune response using topical and systemic immunomodulatory agents (corticosteroids and calcineurin inhibitors) 3.
- Decrease in oxidative stress in melanocytes by means of topical and systemic antioxidants 3.
- Activation of melanocyte regeneration using phototherapy (UVB in particular) and transplantation of pigment cells 3.
Topical Treatments
- Topical corticosteroids, such as clobetasol propionate foam, have been shown to be effective in the treatment of vitiligo, with a good safety profile 4.
- Calcineurin inhibitors, such as tacrolimus ointment, can be used alone or in combination with other therapies, such as narrow-band UVB phototherapy, to treat vitiligo 5, 6.
Phototherapy
- Narrow-band UVB phototherapy has been shown to be effective in the treatment of vitiligo, particularly when combined with topical tacrolimus 5.
- Phototherapy can be used to activate melanocyte regeneration and promote repigmentation of affected lesions 3.
Systemic Treatments
- Systemic treatments, such as oral mini-pulsed corticosteroid therapy, methotrexate, minocycline, ciclosporin, Janus kinase inhibitors, and certain supplements, may be used in the treatment of vitiligo, particularly in cases where topical treatments are not effective 2.