What is the treatment for vitiligo?

Treatment for Vitiligo

For vitiligo treatment, narrowband UVB (NB-UVB) phototherapy is recommended as the preferred treatment option due to its superior efficacy and safety profile compared to other phototherapy options. 1

First-Line Treatments

Topical Therapies

• Potent or very potent topical corticosteroids:

  • Recommended as first-line therapy for limited areas of vitiligo 2, 1
  • Apply a thin layer twice daily for no more than 2 consecutive weeks 3
  • Monitor for skin atrophy, which is a common side effect 2
  • Efficacy: Up to 80% repigmentation in facial lesions and 40% in other body areas 1
  • Not recommended for long-term use due to risk of HPA axis suppression 3

• Topical calcineurin inhibitors (tacrolimus, pimecrolimus):

  • Preferred for facial areas and in children due to better safety profile 1
  • Particularly effective in darker skin types 1
  • Consider as alternatives to potent topical steroids to avoid skin atrophy 2
  • Studies show comparable efficacy to topical corticosteroids 4

Phototherapy

• Narrowband UVB (NB-UVB):
  • Preferred over PUVA due to greater efficacy and safety 2, 1
  • Recommended for widespread vitiligo or cases that cannot be managed with topical treatments 2
  • Monitor with serial photographs every 2-3 months 1
  • Safety limits: Maximum 200 treatments for skin types I-III 2
  • Especially beneficial for darker skin types 2

Second-Line and Combination Approaches

Combination Therapies

• Corticosteroids + Calcipotriene:

  • Can achieve up to 95% repigmentation, even in patients who previously failed corticosteroid monotherapy 5
  • Application regimen: corticosteroids in the morning and calcipotriene in the evening 5
  • Facial and eyelid areas respond particularly well 5

• Topical treatments + Phototherapy:

  • Combining topical agents with NB-UVB often yields better results than monotherapy 1
  • Consider for resistant cases or widespread disease 1

Surgical Options

• Consider for stable vitiligo that has not responded to medical treatments 1:
  • Split-skin grafting
  • Autologous epidermal suspension
  • Suction blister transfer

Special Considerations

Skin Type Considerations

• For very fair skin (types I-II), consider no active treatment other than camouflage cosmetics and sunscreens 2, 1
• Darker skin types (IV-VI) may benefit more from aggressive treatment approaches 1

Anatomical Considerations

• Treatment response varies by location:
  • Face and neck: Better response to treatment
  • Hands and feet: More resistant to treatment 1

Maintenance Therapy

• Consider maintenance therapy to reduce risk of relapse, as over 40% of patients lose treatment response after 1 year without treatment 1

Psychological Support

• Offer psychological interventions to improve coping mechanisms 2
• For children with vitiligo, provide psychological counseling to parents 2

Common Pitfalls and Caveats

• Avoid prolonged use of potent corticosteroids due to risk of skin atrophy and systemic absorption 3
• Do not use clobetasol propionate on the face, groin, or axillae 3
• Avoid occlusive dressings with topical corticosteroids 3
• Set realistic expectations: treatment response is often slow and may be incomplete
• Treatment adherence is crucial - patients who adhere to >75% of the treatment protocol are more likely to achieve success 1
• If no improvement is seen within 2 weeks of corticosteroid therapy, reassessment of diagnosis may be necessary 3

By following this structured approach to vitiligo treatment, focusing first on topical therapies for limited disease and phototherapy for widespread disease, patients have the best chance of achieving repigmentation and improving their quality of life.