What are the treatment options for vitiligo?

From the Guidelines

Vitiligo treatment should prioritize topical corticosteroids, such as betamethasone valerate 0.1% applied twice daily for 2-3 months, as first-line treatments for limited disease, according to the most recent guidelines 1. The treatment options for vitiligo can be categorized into several approaches, including:

• Topical treatments:
  • Topical corticosteroids, such as betamethasone valerate 0.1% applied twice daily for 2-3 months, are first-line treatments for limited disease 1.
  • Calcineurin inhibitors, such as tacrolimus 0.1% ointment, are alternatives, especially for facial lesions 1.
• Phototherapy:
  • Narrowband UVB phototherapy sessions 2-3 times weekly for several months may be effective for widespread vitiligo 1.
  • PUVA therapy should be considered for treatment of vitiligo only in adults who cannot be adequately managed with more conservative treatments 1.
• Oral medications:
  • Low-dose oral corticosteroids, such as prednisolone 5-10mg daily for 2-3 months, or JAK inhibitors, such as ruxolitinib cream 1.5% applied twice daily, can help in progressive cases 1.
• Surgical options:
  • Skin grafting or melanocyte transplantation are reserved for stable vitiligo unresponsive to other treatments 1. It is essential to note that patients should protect affected skin from sun exposure using broad-spectrum sunscreen (SPF 30+) to prevent contrast between affected and unaffected areas and reduce the risk of sunburn in depigmented patches 1. The choice of treatment should be based on the individual patient's needs, disease severity, and potential side effects, with a clear explanation of the risks and benefits of treatment provided before treatment 1.

From the Research

Treatment Options for Vitiligo

The treatment options for vitiligo include:

• Corticosteroids 2
• Immunomodulators 2
• Pseudocatalase 3
• Skin grafts 3
• Phototherapy, including:
  • Ultraviolet B (UVB) 3, 2, 4, 5
  • Psoralen plus UVA (PUVA) 3, 6
  • Narrow-band UVB (NB-UVB) 2, 4, 5
• Targeted phototherapy 3, 2
• Topical pimecrolimus and tacrolimus 4
• Vitamin D analogues 2
• Oral corticosteroids 2
• Surgery 2, 6
• Depigmenting agents 2, 6
• Antioxidants 2
• Cosmetic camouflage 6
• Sunscreens with a high sun protection factor (SPF) 6

Therapeutic Modalities

Different therapeutic modalities have been used to treat vitiligo, including:

• Topical treatments, such as corticosteroids and immunomodulators 2, 4
• Phototherapy, including UVB and PUVA 3, 2, 4, 6, 5
• Surgical techniques, such as skin grafts and autologous melanocyte transplantation 3, 6
• Combination treatments, such as phototherapy and topical immunomodulators 4, 5

Treatment Outcomes

The response to treatments varies according to the anatomical location of the lesions, with:

• Lesions on the face responding well to targeted UVB phototherapy 3 and topical pimecrolimus and tacrolimus 4
• Lesions on the neck responding well to NB-UVB 4
• Lesions on the extremities showing no repigmentation with targeted UVB phototherapy 3