From the Guidelines
Vitiligo diagnosis involves clinical evaluation and sometimes biopsy, while treatment options include topical corticosteroids, phototherapy, and in severe cases, oral medications or surgery, with the goal of improving quality of life and reducing the psychological impact of the condition. The condition is characterized by the loss of skin pigment, resulting in white patches on the skin, and occurs when melanocytes, the cells responsible for skin color, are destroyed 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 2-3 times weekly for several months, which should be considered for treatment of vitiligo only in adults who cannot be adequately managed with more conservative treatments, and ideally reserved for patients with darker skin types 1
- In severe cases, oral medications like oral mini-pulse dexamethasone (5-10mg twice weekly) or JAK inhibitors like ruxolitinib cream 1.5% applied twice daily
- Camouflage makeup and sunscreen (SPF 30+) are important for protecting affected skin
Surgical Treatment
Surgical treatments in vitiligo should be used only for cosmetically sensitive sites where there have been no new lesions, no Koebner phenomenon, and no extension of the lesion in the previous 12 months, with split-skin grafting being the best option when a surgical treatment is required 1.
Phototherapy
NB-UVB phototherapy should be considered for treatment of vitiligo only in children or adults who cannot be adequately managed with more conservative treatments, and ideally reserved for patients with darker skin types, with a limit of 200 treatments for skin types I–III due to the risk of photodamage 1.
Quality of Life
Vitiligo is an autoimmune condition where the body's immune system mistakenly attacks melanocytes, with both genetic and environmental triggers playing roles, and while not physically harmful, the psychological impact can be significant, and treatment outcomes vary with some patients experiencing repigmentation while others may have persistent patches 1.
Recommendations
- Topical corticosteroids and phototherapy are the first-line treatments for vitiligo, with surgical options considered for cosmetically sensitive areas.
- Patients should be made aware of the potential side effects of treatments, including skin atrophy and hypertrichosis with topical steroids, and photodamage with phototherapy.
- Camouflage makeup and sunscreen are important for protecting affected skin and improving quality of life.
From the Research
Diagnosis of Vitiligo
- Vitiligo is a chronic autoimmune skin condition that can be easily recognized and diagnosed in its classical forms 2
- The initial approach to a patient who is thought to have vitiligo is to make a definite diagnosis, offer psychological support, and suggest supportive treatments 2
Treatment of Vitiligo
- Treatments for vitiligo are generally unsatisfactory, but various options are available, including:
- Topical corticosteroids and calcineurin inhibitors for localized and unstable cases 3
- Corticosteroid minipulse in progressive generalized vitiligo 3
- Narrowband UVB phototherapy for extensive forms of the disease 3, 4
- Surgical modalities for segmental and stable generalized vitiligo 3
- Topical and systemic anti-JAK drugs, which are being tested with promising results 3
- Combination treatments, such as narrow-band ultraviolet B microphototherapy (NB-UVB), narrow-band ultraviolet B excimer laser, and monochromatic excimer light, can achieve excellent therapeutic results 5
- Phototherapy, particularly narrowband UVB, is considered the cornerstone treatment for vitiligo and can induce stabilization and repigmentation of vitiligo lesions 4
Treatment Considerations
- The choice of treatment depends on the individual patient and disease characteristics, and there is no standard treatment for vitiligo 4
- Treatment options should be considered in terms of potential side effects, and patients should be informed of the risks and benefits of each treatment 6, 2
- Referral to a dermatologist may be necessary for patients with difficult-to-diagnose or unresponsive cases, or those experiencing psychological distress 2