Treatment Options for Vitiligo

Vitiligo is a chronic autoimmune disease that causes skin pigmentation loss. This happens when melanocytes, or the cells that create skin pigment, are destroyed. It can present as patches of white skin on the body.

There is no cure for vitiligo. Treatment involves stopping the progression of the pigment loss and achieving re-pigmentation.

Skin injury, including sunburn and cuts, can trigger a new patch of vitiligo to form. People of any skin color can develop vitiligo. However, it may be more noticeable in people with darker skin.

Whether you’re in the early stages of vitiligo or have had this skin condition for a while, it’s important to know about all the treatment options available.

Talk with a dermatologist to help determine which treatment option may work best for you.

Creams and ointments for vitiligo are available by prescription only. They may include:

• Corticosteroids: Corticosteroids may work best for people who have only recently developed vitiligo or those with newer lesions. They are typically used for limited periods of time due to the risk of possible side effects.
• Calcineurin inhibitors: These include pimecrolimus cream and tacrolimus ointment. They are often used on the eyelids, face, neck, armpits, or groin, as these areas may be more prone to side effects from topical corticosteroids. They can be used for a longer time than corticosteroids and do not cause skin atrophy.
• Calcipotriene: This medication can be effective when used with a corticosteroid, according to the American Academy of Dermatology Association (AAD).
• Ruxolitinib (Opzelura) cream: Ruxolitinib (Opzelura) is a Janus kinase inhibitor (JAK inhibitor) that was approved by the Food and Drug Administration (FDA) for the treatment of non-segmental vitiligo (vitiligo that appears in patches) in adults and children ages 12 years and older. Treatment may take 24 weeks or longer to see satisfactory results.

Corticosteroids and calcineurin inhibitors work by decreasing inflammation in the skin. This may reduce the spread of pigmentation loss.

It can take several months for topical treatments to work. Dermatologists can prescribe these treatments for both adults and children with vitiligo.

Corticosteroid creams can have side effects, especially when used for long periods of time. For that reason, they are only prescribed short-term. Possible side effects of corticosteroid creams can include discoloration and thinning skin.

Prednisone is an oral prescription medication that may help slow the progression of active vitiligo. It may also help restore skin color.

This medication is typically taken for 1 to 2 weeks.

Light therapy uses controlled ultraviolet (UV) light exposure to restore your natural skin color.

Light therapy can work by suppressing the immune system to prevent the melanocytes from being destroyed. It can also work by stimulating certain growth factors in the skin.

Depending on the location and amount of pigmentation loss, a doctor may suggest:

• Phototherapy: This type of light therapy involves standing in a light box for a specific amount of time determined by a dermatologist. Phototherapy is used if a large area of the body needs treatment, such as the trunk.
• Laser therapy: More targeted laser therapy can help restore pigmentation to a specific part of the body, such as the face, neck, fingers, toes, and lips.
• PUVA (photochemotherapy): Sometimes UVA light therapy is combined with a plant-based medication called psoralen, which is taken orally, applied topically to smaller areas of the affected skin, or added to bathwater. This type of therapy is less commonly used due to potentially toxic side effects.

People may typically receive light therapy 2 to 3 times per week for a period of 3 to 4 months. If the treatment delivers positive results, it may be continued for up to 2 years.

Light therapy may not be recommended for people with very fair skin.

If light therapy or laser treatments don’t work, a dermatologist may recommend treating vitiligo with skin grafting.

Skin grafting involves a dermatological surgeon removing pigmented skin from one area of the body and transplanting it to one of the areas affected by vitiligo. The top layer of skin affected by vitiligo is removed before the new skin is transplanted.

This treatment is typically used for smaller patches of skin.

Grafting may only be used on stable vitiligo — that is, if new patches of vitiligo have not appeared and existing patches have not grown for the previous 12 months.

While skin grafting can work for many people with vitiligo, sometimes the process can create a cobblestone-like pattern of discoloration. In other cases, the affected patches may fail to regain pigment.

Blister grafting to even tone

Like skin grafting, blister grafting also involves transplanting small portions of your skin. With this procedure, a doctor uses either a suction-like device or liquid nitrogen (cryotherapy) to make blisters on unaffected areas of skin. These blisters are then transplanted to depigmented areas to help match them with the rest of your skin color.

Blister grafting may help even out your skin tone. Still, there are several potential outcomes to consider, such as:

• a cobblestone-like appearance in your skin
• failure to regenerate color
• additional discoloration
• scarring

Cell transplant is a type of surgery in which a surgeon removes pigmented skin from an area not affected by vitiligo. Then, cells are extracted from the skin that was removed. These healthy skin cells are transplanted onto an area with vitiligo.

According to the AAD, repigmentation typically happens between 6 to 12 months after surgery.

The AAD also notes that surgery may be an option for people with different types of vitiligo and people of all skin tones.

However, like skin grafting, cell transplant surgery can only be used on stable vitiligo. It is not recommended for people with active vitiligo — those who have had new spots appear or existing spots grow within the past 12 months.

Cosmetics have come a long way in covering the appearance of redness, hyperpigmentation, and depigmentation.

A dermatologist may recommend products to cover depigmentation. These products may include:

• Makeup: You can try tinted primers, foundations, and powders. Be sure to choose a color that most closely matches your natural skin tone. You’ll need to apply camouflaging makeup daily for continued results. Waterproof makeup may hold up better under rain, humid conditions, and sweat.
• Self-tanner: These products may provide coverage for up to 5 days.
• Skin dyes and stains: These products may be longer lasting than makeup. How long they last may depend on how often you wash the affected area.

Micropigmentation is a type of tattooing. This treatment works for vitiligo by implanting (or tattooing) new pigment into areas of blotchy skin.

While this process may be effective, it will likely have to be repeated every few years so you can maintain natural-looking color.

Micropigmentation is performed on stable vitiligo. If performed on active vitiligo, it is possible that the tattooing could trigger more pigmentation loss.

Depigmentation is rarely used. It refers to is a process where the color of your skin is lightened to match the patches of color loss. This treatment may be recommended for people who have lost most of their natural skin color and don’t want to continue with treatment meant to restore color to their skin. It is permanent.

During the process, you’ll apply a prescribed depigmenting agent to unaffected areas of your skin only. The idea is to match these areas with the depigmented spots you already have from vitiligo for even skin tone.

While depigmentation can reduce the look of blotchy skin, there may be some emotional side effects from the loss of your natural skin color. You may also experience sun sensitivity, redness, and swelling from your treatment.

There’s no single treatment measure that works for everyone with vitiligo. While you’re trying out different medical treatments, there are natural ones you can try, too. You can also consider lifestyle measures that reduce the risk of worsening vitiligo.

Talk with your doctor about the following steps you can take:

• light therapy used in conjunction with certain micronutrient supplements
• reduced sun exposure
• sunscreen of at least SPF 30 to prevent uneven tanning and hyperpigmentation

While natural treatments may help, a small 2017 review of 14 cases suggests that they may be more effective in the early stages of vitiligo. More research is needed to determine the efficacy of any homeopathic approach to this condition.

Vitiligo can affect the lips, which is a delicate area to treat. Laser therapy may help restore pigmentation to the lips.

Makeup such as lip stains and lipsticks may also reduce the appearance of pigmentation loss.

Protecting your lips by wearing a lip balm with SPF may help prevent sun damage that can trigger new patches to form. Look for one with an SPF of at least 30.

While there’s no cure for vitiligo, treatments can help prevent the progression of this autoimmune disease. There are also ways you can cover up uneven patches so you feel more confident in your skin.

The downside to any of the above treatments is that new depigmented patches may still occur. Work with a dermatologist to determine the best vitiligo management plan for you.