What are the treatment options for vitiligo?

From the Guidelines

Vitiligo treatment should prioritize the combination of intradermal platelet-rich plasma (PRP) injection and narrowband UVB (NB-UVB) phototherapy, as it has been shown to be a simple, safe, and effective technique with significant improvement in repigmentation 1. The treatment of vitiligo aims to restore skin color and prevent further depigmentation.

• Topical corticosteroids, such as betamethasone or clobetasol, can be applied once or twice daily for 2-3 months, but skin atrophy is a common side-effect 1.
• Calcineurin inhibitors, like tacrolimus 0.1% or pimecrolimus 1%, can be used for sensitive areas like the face, with a better side-effect profile compared to highly potent topical steroids 1.
• Phototherapy, specifically NB-UVB, can be administered 2-3 times weekly for several months, and is preferred over PUVA due to its greater efficacy and safety 1.
• The combination of PRP and NB-UVB has been shown to have a statistically highly significant improvement in repigmentation, with 34.6% of patients showing an excellent response and 50% showing a good response 1.
• Other treatment options, such as oral medications, surgical procedures, and camouflage makeup, can also be considered, but the combination of PRP and NB-UVB is the most effective treatment based on recent evidence 1.

From the Research

Treatment Options for Vitiligo

• Topical corticosteroids, calcineurin inhibitors, phototherapy, and photochemotherapy are considered first-line therapeutic options for vitiligo due to their safety and efficacy 2
• Vitamin D analogues, targeted phototherapy, oral corticosteroids, and surgery are recommended as second-line therapies 2
• Antioxidants can be used in association with other therapeutic options, while depigmenting agents should only be used in cases of extensive vitiligo that are recalcitrant to other treatments 2

Therapeutic 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

Combination Therapies

• Combination therapies are generally considered to be more successful than monotherapies 3, 4
• Hand-held narrowband ultraviolet B light plus topical corticosteroid combination treatment is superior to topical corticosteroids alone for treatment of localized vitiligo 4

Emerging Treatments

• Oral mini-pulsed corticosteroid therapy, methotrexate, minocycline, ciclosporin, Janus kinase inhibitors, and certain supplements have been used in the systemic treatment of vitiligo 5
• New insights into the pathogenesis of vitiligo will likely give rise to novel therapeutic approaches 3, 6