Treatment Of Vitiligo
Vitiligo has no cure. But effective treatments are available to help control the disease in the majority of patients.
The main aims of treatment are to:
- Slow down and stop the spread of vitiligo patches
- Gradually restore colour back to depigmented skin
There are several ways to treat vitiligo. Not every method is suitable for all patients.
The optimal method or combination of methods will depend on the type of vitiligo, the extent of depigmentation, how the patient responds to the treatment, patient’s other medical conditions, patient’s preference and commitment to treatment.
Vitiligo Treatment Methods
Method: Apply makeup, self-tanners or skin dyes to even out skin tone approaching that of surrounding normal skin
Suitable for: Patients with small areas of stable vitiligo patches
Advantage: Avoid side effects of medication
Disadvantage: Short term patch-up, needs to be applied repeatedly, can be time-consuming, takes practise to achieve natural looking colour
Topical Medication (creams/ointments)
Method: Daily to twice daily external application of a high strength corticosteroid cream or immune modulating agent known as calcineurin inhibitor to areas of discoloured skin.
Suitable for: Patients with limited areas of vitiligo patches (usually less than 10% of total body surface area). Creams or ointment can also be used in conjunction with phototherapy to improve results.
Advantage: Established method of treatment with proven results in clinical trials, ease of use, convenience of self treatment at home
Disadvantage: Potential side effects of corticosteroid creams include local skin thinning, appearance of streaks or lines, bruising, increased hair growth.
Method: Daily or twice weekly intake of an oral corticosteroid tablet for several months or until symptoms are controlled.
Suitable For: Patients with rapidly spreading vitiligo patches
Advantage: Helps to stop disease progression
Disadvantage: Not effective in restoring colour back to skin. Multiple potential side effects such as weight gain, acne, thinning of the skin and bones, high blood pressure and high blood glucose, fluid retention, mood swings, insomnia, increased vulnerability to infection, muscle weakness and eye disorders.
To minimise these potential side effects, doses are usually kept low and duration of use kept to the shortest possible for achieving intended effect. May not be suitable for patients with certain medical conditions.
Method: Ultraviolet (UV) light treatment. This can either take the form of 1) whole-body treatment where the patient stands within an enclosure lined with UV lamps and receives UV irradiation that covers the entire body surface or 2) localised treatment where the UV beam is delivered to specific parts of the skin via handheld devices. Treatment needs to be repeated regularly until the desired outcome is achieved.
Suitable for: Most patients including children, except those with significant history of skin cancer or severe light sensitivity due to underlying medical conditions such as systemic lupus erythematosus.
Advantage: Safe, effective and painless treatment for a broad range of conditions including widespread and progressive vitiligo.
Disadvantage: Requires time commitment to attend 2 to 3 treatment sessions per week.
Method: Various techniques are in use. They generally involves removing the top layer of discoloured vitiliginous skin to replace it with well-pigmented skin or its elements that were harvested from elsewhere in the body.
Suitable for: Patients with localised stable vitiligo for whom other medical treatments (as mentioned above) have been tried but did not work.
Advantage: High success rate of re-pigmentation if performed by qualified personnel. Can be a once off treatment, although procedure may be necessary
Disadvantage: Risk of infection, scarring, cobblestone-like skin, failure of treated area to recolour, new vitiligo patches may develop at harvest site.
Method: Removes remaining colour from skin by daily application of a medicated cream
Suitable for: Patients with widespread vitiligo
Advantage: Allows patient with severe, widespread vitiligo to achieve a single skin colour (white)
Disadvantage: Depigmentation is often permanent. Patients will always be extremely sensitive to sunlight as a result of complete depigmentation.
Limited studies suggest that supplementation with certain vitamins (C, E, B12, folic acid), anti-oxidants (alpha-lipoic acid) and herbs (Ginkgo biloba) especially when used in conjunction with phototherapy may increase the success of treatment and repigmentation. Current evidence is limited however, and more studies are needed to establish efficacy before they can be recommended in routine treatment.