From the Guidelines
Vitiligo treatment should prioritize narrowband UVB phototherapy for adults with widespread or localized vitiligo associated with significant impact on quality of life, as recommended by the British Journal of Dermatology guidelines 1.
Treatment Options
- Topical corticosteroids, such as betamethasone or clobetasol, can be used for mild cases, applied twice daily for 2-3 months to affected areas, followed by a maintenance regimen of twice weekly application.
- Calcineurin inhibitors, like tacrolimus or pimecrolimus, are alternatives, especially for facial lesions, applied twice daily.
- Phototherapy, specifically narrowband UVB, is recommended for more extensive vitiligo, with sessions 2-3 times weekly for several months.
- Oral medications, such as JAK inhibitors (ruxolitinib), are newer options for widespread disease.
Key Considerations
- Combination therapy often yields better results.
- Treatments work by suppressing the autoimmune response or stimulating melanocyte regeneration and migration.
- Results take time, typically 3-6 months before noticeable improvement, and complete repigmentation isn't always possible.
- Early treatment generally produces better outcomes, as noted in the guidelines 1.
Phototherapy Recommendations
- NB-UVB phototherapy should be considered for treatment of vitiligo only in adults who cannot be adequately managed with more conservative treatments, have widespread vitiligo, or have localized vitiligo with significant impact on quality of life.
- Ideally, this treatment should be reserved for patients with darker skin types and monitored with serial photographs every 2-3 months.
- NB-UVB should be used in preference to PUVA due to evidence of greater efficacy and safety, as stated in the guidelines 1.
From the Research
Treatments for Vitiligo
The following are some of the treatments for vitiligo:
- Narrow band ultraviolet B (NB-UVB) phototherapy 2, 3, 4
- Topical immunomodulators such as pimecrolimus and tacrolimus 2, 3, 4
- Topical corticosteroids such as clobetasol propionate and betamethasone dipropionate 5, 3
- Combination therapies, such as NB-UVB phototherapy combined with topical tacrolimus or pimecrolimus 2, 3, 4
- Targeted therapies, such as 311-nm narrow-band microphototherapy 3
- Surgical therapy, such as transplantation 6
Efficacy of Treatments
The efficacy of these treatments varies depending on the location and type of vitiligo:
- Face and neck respond best to all therapeutic approaches 3, 4, 6
- Acral areas are least responsive 6
- Generalized vitiligo responds best to phototherapy with UVB radiation 6
- Localized vitiligo responds best to topical corticosteroids or immunomodulators 5, 6
Safety and Side Effects
The safety and side effects of these treatments also vary: