From the Guidelines
Narrowband UVB phototherapy is a recommended treatment for hypopigmentation, particularly for patients with widespread vitiligo or localized vitiligo with a significant impact on quality of life, as it has been shown to stimulate melanocyte activity and promote repigmentation 1.
Treatment Options
- Topical corticosteroids and calcineurin inhibitors like tacrolimus (0.1%) or pimecrolimus (1%) can be used for mild cases of hypopigmentation, applied twice daily for 4-6 weeks.
- Phototherapy options such as narrowband UVB or excimer laser therapy can be used for more extensive hypopigmentation, with sessions 2-3 times weekly for several months.
- Combination therapy often yields better results, and cosmetic camouflage products like Dermablend or specialized makeup can provide immediate visual improvement while medical treatments take effect.
Important Considerations
- Hypopigmentation occurs when melanocytes (pigment-producing cells) are damaged or reduced in number, resulting in lighter patches of skin.
- Treatment aims to stimulate melanocyte activity or transplant functioning melanocytes to affected areas.
- Results vary based on the cause and extent of hypopigmentation, with some conditions like vitiligo being more resistant to treatment than post-inflammatory hypopigmentation.
- Sun protection is essential during treatment as hypopigmented areas are more susceptible to sunburn and further damage.
Evidence-Based Recommendations
- A study published in the British Journal of Dermatology in 2008 found that narrowband UVB phototherapy should be considered for treatment of vitiligo only in adults who cannot be adequately managed with more conservative treatments, who have widespread vitiligo, or have localized vitiligo with a significant impact on quality of life 1.
- Another study published in the same journal in 2004 found that narrowband UVB phototherapy can be effective for treating vitiligo, with five out of seven patients achieving > 75% repigmentation with a mean of 19 treatments 1.
From the Research
Treatment Options for Hypopigmentation
- Topical agents, such as corticosteroids and calcineurin inhibitors, can be used to treat hypopigmentation disorders, including vitiligo 2, 3
- Phototherapy, including ultraviolet A therapy and narrowband ultraviolet B therapy, can also be effective in treating hypopigmentation 2, 3
- Surgical grafting techniques and autologous melanocyte transplantation may be considered for patients with stable, self-limited vitiligo 2, 3
- Laser and light-based treatments, such as fractional lasers and laser-assisted delivery of bimatoprost, have shown promise in stimulating re-pigmentation of hypopigmented skin 4
- Epidermal melanocyte harvesting systems may also be used to treat hypopigmentation 4
Considerations for Treatment
- The treatment of hypopigmentation should be based on the underlying cause of the disorder, as well as the affected area, age, and ethnic origin of the patient 5
- Sun protection is recommended to prevent exacerbation of hypopigmentation disorders, and cosmetic coverage may be indicated in some cases 5
- A rational approach to treatment should involve a clear classification and meta-analysis of the literature, as well as consideration of the patient's expectations and clinical presentation 6
Emerging Therapies
- New and emerging therapies, such as laser-assisted delivery of bimatoprost, have shown statistically significant improvement in stimulating re-pigmentation of hypopigmented skin 4
- Further research is needed to fully understand the pathophysiology of hypopigmentation disorders and to develop effective treatments 3