From the Guidelines
Vitiligo and renal stones should be managed separately, with vitiligo treatment focusing on topical corticosteroids, calcineurin inhibitors, and phototherapy, and renal stone management emphasizing increased fluid intake, dietary modifications, and pharmacologic therapy as needed. For patients with both conditions, it's essential to address each condition separately.
- For vitiligo, treatment options include:
- Topical corticosteroids like betamethasone
- Calcineurin inhibitors like tacrolimus
- Phototherapy as an additional option
- For renal stones, management strategies include:
- Increased fluid intake of 2-3 liters daily to achieve at least 2 L of urine per day, as recommended by the American College of Physicians 1
- Dietary modifications based on stone composition, such as reducing oxalate intake for calcium oxalate stones and limiting purine consumption for uric acid stones
- Pharmacologic therapy, such as thiazide diuretics, citrate, or allopurinol, for patients with active disease in which increased fluid intake fails to reduce stone formation 1 It's crucial to note that some vitiligo treatments, like systemic corticosteroids, may affect kidney function, so regular monitoring is advisable when treating both conditions simultaneously. Additionally, patients with vitiligo often develop autoimmune thyroid disease or other autoimmune diseases, and a history of autoimmune disease in a family member is obtained in 32% of patients 1. Therefore, screening for abnormal thyroid function or the presence of autoantibodies to thyroid antigens may be helpful in the management of adults with vitiligo.
From the Research
Vitiligo and Renal Stones
There is no direct evidence in the provided studies that links vitiligo to renal stones.
Treatment of Vitiligo
- The mainstay of treatment for unstable vitiligo has been topical agents (corticosteroids, calcineurin inhibitors) and phototherapy 2.
- Systemic treatments, such as oral mini-pulsed corticosteroid therapy, methotrexate, minocycline, ciclosporin, Janus kinase inhibitors, and certain supplements, are increasingly being used to treat vitiligo 2.
- Topical clobetasol propionate has been shown to be effective in treating vitiligo, particularly on the face, with repigmentation of 90% to 100% achieved in more than 80% of patients 3.
- UVB phototherapy, specifically narrowband UVB, is considered a cornerstone treatment for vitiligo and can induce stabilization and repigmentation of vitiligo lesions 4, 5.