From the Guidelines
Vitiligo treatment should prioritize phototherapy with narrowband UVB light for adults with widespread vitiligo or localized vitiligo with significant impact on quality of life, as recommended by the British Journal of Dermatology 1.
Treatment Options
- Topical corticosteroids like betamethasone or clobetasol applied twice daily for 2-3 months on affected areas
- Calcineurin inhibitors such as tacrolimus 0.1% ointment for sensitive areas like the face
- Phototherapy using narrowband UVB light administered 2-3 times weekly for several months, which should be preferred over oral PUVA due to its greater efficacy 1
Patient Selection
- Phototherapy should be considered for adults who cannot be adequately managed with more conservative treatments, have widespread vitiligo, or have localized vitiligo with a significant impact on quality of life 1
- Ideally, this treatment should be reserved for patients with darker skin types and monitored with serial photographs every 2–3 months 1
Additional Considerations
- Psychological interventions should be offered to improve coping mechanisms in patients with vitiligo 1
- Camouflage makeup and sunscreen (SPF 30+) are important for protecting affected skin
- Treatment effectiveness varies by individual, and management often requires a combination approach under dermatological supervision
From the Research
Treatment Options for Vitiligo
- Topical corticosteroids are used as first line of therapy for vitiligo, although side effects such as adrenal insufficiency are possible 2
- Pimecrolimus, which inhibits calcineurin, has been shown to be effective for the treatment of vitiligo, with comparable results to clobetasol propionate 3
- Narrowband ultraviolet B light combined with treatments such as topical corticosteroids may be more effective than monotherapy for vitiligo 4, 5
- Combination therapies, such as topical corticosteroids and phototherapy, are generally considered to be more successful than monotherapies 4, 5, 6
Safety and Efficacy of Treatment Options
- Doses of 50 g or less per week of clobetasol during a period of 12 weeks are safe on adult vitiligo patients, although local side effects are possible 2
- Combination treatment with home-based handheld narrowband UVB plus topical corticosteroid is likely to be superior to topical corticosteroids alone for treatment of localized vitiligo, but is successful in only around one-quarter of participants 4, 5
- Localized grade 3 or 4 erythema and skin thinning are potential side effects of narrowband ultraviolet B light treatment 4, 5
Management and Prognosis of Vitiligo
- Early initiation of treatment is associated with a more favorable prognosis 6
- Patients should be educated in techniques for cosmetic camouflage, and application of calcineurin inhibitors is recommended to prevent recurrences after successful repigmentation 6
- New insights into the pathogenesis of vitiligo will likely give rise to novel therapeutic approaches 6