From the Guidelines
Vitiligo treatment should focus on reducing inflammation and promoting melanocyte regeneration, with topical corticosteroids and phototherapy being primary options. Vitiligo causes skin whitening due to the destruction of melanocytes, the cells that produce melanin pigment, with evidence suggesting autoimmune mechanisms are involved in causing the condition 1. This autoimmune condition results in well-defined white patches on the skin that can appear anywhere on the body. Treatment options include:
- Topical corticosteroids like betamethasone or clobetasol applied once or twice daily for limited periods (typically 2-4 weeks) to reduce inflammation
- Calcineurin inhibitors such as tacrolimus 0.1% ointment or pimecrolimus 1% cream can be used twice daily on sensitive areas like the face without the side effects of steroids
- Phototherapy, particularly narrowband UVB therapy administered 2-3 times weekly for several months, stimulates melanocyte activity
- For extensive vitiligo, oral medications like low-dose oral corticosteroids (prednisone 5-10mg daily for short courses) or JAK inhibitors may be prescribed
- Depigmentation with monobenzyl ether of hydroquinone 20% cream might be considered for widespread cases. Patients should protect affected skin from sun exposure using broad-spectrum sunscreen (SPF 30+) daily, as sunburn can worsen the condition and make the contrast between affected and unaffected skin more noticeable 1. The whitening occurs because melanocytes are attacked by the body's immune system, eliminating the cells responsible for producing the skin's natural color.
From the Research
Treatment Options for Vitiligo
- Topical corticosteroids are used as a first line of therapy for vitiligo, although side effects such as adrenal insufficiency are possible 2
- Phototherapy, such as narrow-band ultraviolet B and excimer laser/lamp, can be used as monotherapy or in combination with other treatments 3
- Combination treatment with home-based handheld narrowband ultraviolet B plus topical corticosteroid is likely to be superior to topical corticosteroids alone for treatment of localized vitiligo 4, 5
Repigmentation Rates
- Repigmentation rates were incomplete with single steroid therapy, making combined therapy a better option 2
- Combination treatment was successful in around one-quarter of participants 4, 5
Safety and Side Effects
- Local side effects are possible with doses of 50 g or less per week of clobetasol during a period of 12 weeks 2
- Grade 3 or 4 erythema was experienced by 12% of participants, and transient skin thinning by 2.5% of participants 4, 5
Systemic Treatments
- Systemic treatments, such as oral mini-pulsed corticosteroid therapy, methotrexate, minocycline, ciclosporin, Janus kinase inhibitors, and certain supplements, have been used in the treatment of vitiligo 6