What are the treatment options for vitiligo?

From the Guidelines

Treatment options for vitiligo should prioritize a combination of intradermal platelet-rich plasma (PRP) injection and narrowband UVB (NB-UVB) phototherapy, as this approach has shown statistically significant improvement in repigmentation and is considered simple, safe, and tolerable 1. The treatment of vitiligo involves a range of medical therapies and supportive approaches.

• Topical treatments, including corticosteroids and calcineurin inhibitors, are typically first-line options.
• Phototherapy, particularly NB-UVB, is effective for widespread vitiligo and should be considered for patients who cannot be adequately managed with more conservative treatments, have widespread vitiligo, or have localized vitiligo with a significant impact on quality of life (QoL) 1.
• For resistant cases, oral medications like systemic corticosteroids or JAK inhibitors may be prescribed.
• Surgical options, such as skin grafting or melanocyte transplantation, can be considered for stable vitiligo patches.
• Depigmentation therapy with monobenzyl ether of hydroquinone may be considered for extensive vitiligo.
• Camouflage makeup and sunscreen (SPF 30+) can help protect affected skin and improve appearance. It's essential to note that the choice of treatment should be individualized based on the patient's specific needs, skin type, and the extent of the disease.
• The combination of PRP and NB-UVB phototherapy has been shown to be an efficient treatment for vitiligo, with higher repigmentation rates compared to NB-UVB alone 1.
• The treatment should aim to suppress the autoimmune response that destroys melanocytes or stimulate repigmentation by promoting melanocyte production and migration to depigmented areas.
• Regular follow-up and monitoring of treatment response are crucial to adjust the treatment plan as needed and minimize potential side effects.

From the Research

Treatment Options for Vitiligo

The treatment options for vitiligo include:

• Topical corticosteroids, which are considered a first-line therapeutic option due to their safety and efficacy 2
• Calcineurin inhibitors, such as tacrolimus and pimecrolimus, which have been shown to be effective in treating vitiligo, particularly in localized cases 3, 4
• Phototherapy, including narrow-band UVB (NB-UVB) and photochemotherapy, which can be used as a first-line treatment option 2, 3, 5, 6
• Vitamin D analogues, which can be used as a second-line therapy 2
• Targeted phototherapy, which can be used to treat specific areas of the body 2
• Oral corticosteroids, which can be used as a second-line therapy, but may have more significant side effects 2
• Surgery, which can be used to treat stable and localized vitiligo, but may not be suitable for all patients 2
• Depigmenting agents, which can be used to treat extensive vitiligo that is recalcitrant to other treatments 2
• Antioxidants, which can be used in association with other therapeutic options 2

Combination Therapies

Combination therapies, such as the use of NB-UVB phototherapy with topical tacrolimus or calcipotriol, may be more effective than monotherapy in treating vitiligo 4, 5, 6

• The combination of NB-UVB phototherapy and topical tacrolimus has been shown to be effective in achieving repigmentation in patients with vitiligo 4, 5
• The addition of topical calcipotriol to NB-UVB phototherapy did not show any significant advantage in one study 6

Response to Treatment

The response to treatment can vary depending on the location of the lesions, with lesions on the face and neck tend to respond better to treatment than those on the extremities 3, 5

• Lesions on the face and neck have been shown to have a higher response rate to treatment with topical immunomodulators and NB-UVB phototherapy 3, 5
• Lesions on the extremities and genital areas may be more resistant to treatment 5