Vitiligo - Treatment


Treatment-Vitiligo




Treatment for vitiligo is based on improving the appearance of the skin by restoring its colour.
However, the effects of treatment aren't usually permanent, and it can't always control the spread of the condition.
Your GP may recommend:
Further treatment may not be necessary if, for example, you only have a small patch of vitiligo or you have very fair skin anyway.
You may be referred to a dermatologist (a specialist in treating skin conditions) if further treatment is needed.

Protection from the sun

Sunburn is a real risk if you have vitiligo. You must protect your skin from the sun and avoid using sunbeds.
When skin is exposed to sunlight, it produces a pigment called melanin to help protect it from ultraviolet light. However, if you have vitiligo there isn't enough melanin in your skin, so it isn't protected.
Always apply a high-factor sunscreen, ideally with a sun protection factor (SPF) of 30 or above, to protect your skin from sunburn and long-term damage. This is particularly important if you have fair skin.
Protecting your skin from the sun will also mean you don't tan as much, which will make your vitiligo less noticeable.

Vitamin D

If your skin isn't exposed to the sun, there's an increased risk of vitamin D deficiency. Vitamin D is essential for keeping bones and teeth healthy.
Sunlight is the main source of vitamin D, although it's also found in some foods, such as oily fish.
It might be difficult to get enough vitamin D from food and sunlight alone. You should therefore consider taking a daily supplement containing 10 micrograms (mcg) of vitamin D.

Skin camouflage

Skin camouflage creams can be applied to the white patches of skin. The creams are specially made to match your natural skin colour. The cream blends in the white patches with the rest of your skin, making them less noticeable.
For advice about skin camouflage, your GP may refer you to the Changing Faces skin camouflage service.
You need to be trained in using the camouflage creams, but the service is free (although donations are welcome) and some creams can be prescribed on the NHS.
Camouflage creams are waterproof and can be applied anywhere on the body. They last for up to four days on the body and 12 to 18 hours on the face.
You can also get skin camouflage cream that contains sun block or has an SPF rating.
Self-tanning lotion (fake tan) may also help cover vitiligo. Some types can last several days before they need to be reapplied. Self-tanning lotion is available from most pharmacies.

Topical corticosteroids

Topical corticosteroids are a type of medication that contain steroids. You apply them to your skin as a cream or ointment.
They can sometimes stop the spread of the white patches and may restore some of your original skin colour.
A topical corticosteroid may be prescribed to adults if:
  • you have non-segmental vitiligo on less than 10% of your body
  • you want further treatment (sun protection advice and camouflage creams are enough for some people) 
  • you aren't pregnant
  • you understand and accept the risk of side effects
Topical corticosteroids can be used on the face, but care should be taken in selecting and using this type of medication on your face.
Read more about topical corticosteroids.

Using topical corticosteroids

Your GP may prescribe a cream or an ointment, depending on what you prefer and where it will be used. Ointments tend to be greasier. Creams are better in your joints – for example, inside your elbows.
Possible corticosteroids that may be prescribed include:
  • fluticasone propionate
  • betamethasone valerate 
  • hydrocortisone butyrate
Your GP will tell you how to apply the cream or ointment to the patches and how much you should use. You normally need to apply the treatment once a day.
Topical corticosteroids are measured in a standard unit called the fingertip unit (FTU). One FTU is the amount of topical steroid squeezed along an adult's fingertip. One FTU is enough to treat an area of skin twice the size of an adult's hand.
Read more about fingertip units.

Follow-up

After one month, you'll have a follow-up appointment so your GP can check how well the treatment is working and whether you have any side effects. If the treatment is causing side effects, you may need to stop using corticosteroids.
After another month or two, your GP will check how much your vitiligo has improved. If there's no improvement, you may be referred to a dermatologist (see below).
If it's improved slightly, you may continue treatment, but have a break from treatment every few weeks. You may also be referred to a dermatologist.
Treatment will be stopped if your vitiligo has improved significantly.
Your GP may take photos of your vitiligo throughout your treatment to monitor any signs of improvement. You may also want to take photos yourself.

Side effects

Side effects of topical corticosteroids include:
  • streaks or lines in your skin (striae)
  • thinning of your skin (atrophy)
  • visible blood vessels appearing (telangiectasia)
  • excess hair growth (hypertrichosis)
  • contact dermatitis (inflammation of your skin)
  • acne

Referral

Your GP may refer you to a dermatologist if:
  • they're unsure about your diagnosis
  • you're pregnant and need treatment 
  • more than 10% of your body is affected by vitiligo 
  • you're distressed about your condition 
  • your face is affected and you want further treatment 
  • you can't use topical corticosteroids because of the risk of side effects
  • you have segmental vitiligo and want further treatment 
  • treatment with topical corticosteroids hasn't worked
Children with vitiligo who need treatment will also be referred to a dermatologist.
In some cases, you may be prescribed strong topical corticosteroids while you're waiting to be seen by a dermatologist.
Some treatments your dermatologist may recommend are described below.

Topical pimecrolimus or tacrolimus

Pimecrolimus and tacrolimus are a type of medicine called calcineurin inhibitors, which are normally used to treat eczema.
Pimecrolimus and tacrolimus are unlicensed for treating vitiligo, but they can be used to help restore skin pigment in adults and children with vitiligo.
They can cause side effects, such as:
  • a burning or painful sensation when applied to the skin
  • making the skin more sensitive to sunlight
  • facial flushing (redness) and skin irritation if you drink alcohol
However, unlike corticosteroids, pimecrolimus and tacrolimus don't cause thinning of the skin.

Phototherapy

Phototherapy (treatment with light) may be used for children or adults if:
  • topical treatments haven't worked 
  • the vitiligo is widespread
  • the vitiligo is having a significant impact on quality of life
Evidence suggests that phototherapy, particularly when combined with other treatments, has a positive effect on vitiligo.
During phototherapy, your skin is exposed to ultraviolet A (UVA) or ultraviolet B (UVB) light from a special lamp. You may first take a medicine called psoralen, which makes your skin more sensitive to the light. Psoralen can be taken by mouth (orally), or it can be added to your bath water.
This type of treatment is sometimes called PUVA (psoralen and UVA light).
Phototherapy may increase the risk of skin cancer because of the extra exposure to UVA rays. The risk of skin cancer is lower with UVB light. Your dermatologist should discuss the risk with you before you decide to have phototherapy.
Sunlamps that you can buy to use at home for light therapy aren't recommended. They're not as effective as the phototherapy you'll receive in hospital. The lamps are also not regulated, so may not be safe. 

Skin grafts

A skin graft is a surgical procedure where healthy skin is removed from an unaffected area of the body and used to cover an area where the skin has been damaged or lost. To treat vitiligo, a skin graft can be used to cover the white patch.
Skin grafts may be considered for adults in areas that are affecting your appearance if:
  • no new white patches have appeared in the last 12 months 
  • the white patches haven't got worse in the last 12 months 
  • your vitiligo wasn't triggered by skin damage, such as severe sunburn (known as the Koebner response)
An alternative to skin grafting involves taking a sample of normal skin, removing the melanocytes from it and then transplanting them onto the areas of vitiligo.
These types of treatments are time-consuming, carry a risk of scarring and aren't suitable for children. They're also not widely available in the UK and aren't funded by the NHS.

Depigmentation

Depigmentation may be recommended for adults who have vitiligo on more than 50% of their bodies, although it may not be widely available.
During depigmentation, a lotion is painted on to the normal skin to bleach away the remaining pigment and make it the same colour as the depigmented (white) skin. A hydroquinone-based medication is used, which has to be applied continuously to prevent the skin from re-pigmenting.
Hydroquinone can cause side effects, such as:
  • redness
  • itching 
  • stinging
Depigmentation is usually permanent and leaves the skin with no protection from the sun. Re-pigmentation (when the colour returns) can occur, and may differ from your original skin colour. Applying depigmenting treatments in one area of skin can sometimes cause loss of pigmentation of skin on other parts of the body.

Other treatments

Your dermatologist may recommend trying more than one treatment, such as phototherapy combined with a topical treatment. Other possible treatments include:
  • excimer lasers – high-energy beams of light that are used in laser eye treatment, but may also be used in phototherapy (not available on the NHS) 
  • vitamin D analogues – such as calcipotriol, which may also be used with phototherapy
  • azathioprine – a medicine that suppresses your immune system (the body's natural defence system)
  • oral prednisolone – a type of corticosteroid, which has also been used with phototherapy; it can cause side effects

Complementary therapies

Some complementary therapies claim to relieve or prevent vitiligo. However, there's no evidence to support their effectiveness, so more research is needed before they can be recommended.
There's very limited evidence that ginkgo biloba, a herbal remedy, may benefit people with non-segmental vitiligo. There's currently not enough evidence to recommend it.
Check with your GP if you decide to use herbal remedies. Some remedies can react unpredictably with other medication or make them less effective.

Counselling and support groups

If you have vitiligo, you may find it helpful to join a vitiligo support group. It can help you understand more about your condition and come to terms with your skin's appearance.
Charities, such as The Vitiligo Society, may be able to put you in touch with local support groups (you may need to become a member first). Your GP may also be able to suggest a local group.
If you have psychosocial symptoms – for example, your condition is causing you distress – your GP may refer you to a psychologist or a counsellor for treatment such as cognitive behavioural therapy (CBT).
CBT is a type of therapy that aims to help you manage your problems by changing the way you think and behave.

Unlicensed medicines

Many treatments used for vitiligo are unlicensed. 'Unlicensed' means the medicine's manufacturer hasn't applied for a licence for it to be used to treat your condition. The medicine hasn't undergone clinical trials to see whether it's effective and safe in treating your condition.
Doctors may recommend using an unlicensed medicine if they think it will be effective, and the benefits of treatment outweigh any associated risk. Before prescribing an unlicensed medicine, they should inform you it's unlicensed, and discuss the possible risks and benefits with you.
Read more about unlicensed medicines.
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