The goal in treating vitiligo is to attempt to restore color (pigment) to your skin and improve your appearance. Depending on the type of therapy, treatment for vitiligo may take from six to 18 months. Treatment choices are based on the number of white patches you have and how widespread they are. Each person responds differently to treatment, and a particular therapy may not work for you.
Proper diagnosis is needed to distinguish whether or not you have vitiligo. See your doctor if areas of your skin, hair or eyes lose coloring. Although there’s no cure for vitiligo, treatments exist that may help to stop or slow the process of depigmentation and attempt to return some color to your skin.If your doctor suspects you have vitiligo, he or she will ask about your medical history.
Important factors in your medical history include:
- A family history of vitiligo.
- A rash, sunburn or other skin trauma at the site of vitiligo within two to three months of the start of depigmentation.
- Premature graying of the hair (before age 35).
- Stress or physical illness.
In addition, your doctor will need to know whether you or anyone in your family has had an autoimmune disease. He or she will ask if your skin is sensitive to the sun. Your doctor will examine you to rule out other medical problems or skin conditions, such as dermatitis or psoriasis. Your doctor may take a small sample (biopsy) of your affected skin. He or she may take a blood sample to check your blood cell count and thyroid function. In some cases, your doctor may recommend an eye examination to check for inflammation in your eye (uveitis). A blood test to look for the presence of antinuclear antibodies (a type of autoantibody) also may be done to determine if you have an autoimmune disease.
Topical corticosteroid therapy. Corticosteroids may help return color to your skin (repigmenting), particularly if they’re started early in the disease. These drugs, which include cortisone, are similar to the hormones produced by your adrenal glands. Your doctor may prescribe a mild topical corticosteroid cream or ointment for children younger than 10 years old or a stronger form for adults. You may need to apply the cream or ointment to the white patches on your skin for at least three months before you see any results. This treatment is simple and safe, but your doctor will monitor you closely for side effects, such as skin shrinkage and streaks or lines on your skin (skin striae). Calcipotriene (Dovonex), a vitamin D derivative, also may be used topically and is sometimes used with corticosteroids or ultraviolet light.
- Topical corticosteroid therapy. Corticosteroids may help return color to your skin (repigmenting), particularly if they’re started early in the disease. These drugs, which include cortisone, are similar to the hormones produced by your adrenal glands. Your doctor may prescribe a mild topical corticosteroid cream or ointment for children younger than 10 years old or a stronger form for adults. You may need to apply the cream or ointment to the white patches on your skin for at least three months before you see any results. This treatment is simple and safe, but your doctor will monitor you closely for side effects, such as skin shrinkage and streaks or lines on your skin (skin striae). Calcipotriene (Dovonex), a vitamin D derivative, also may be used topically and is sometimes used with corticosteroids or ultraviolet light.
- Topical psoralen plus ultraviolet A (PUVA). Topical PUVA may be a treatment option if you have a small number of depigmented patches (affecting less than 20 percent of your body). PUVA, also called photochemotherapy, is performed under artificial UVA light once or twice a week in your doctor’s office. Your doctor or a nurse will apply a thin coating of psoralen to the depigmented patches of your skin about 30 minutes before UVA light exposure. You’re then exposed to an amount of UVA light that turns the affected area of your skin pink. Your doctor may slowly increase the dose of UVA light over many weeks. Eventually, the pink areas of your skin fade and a more normal skin color appears.
Potential short-term side effects of topical PUVA therapy include severe sunburn and blistering and too much repigmentation or darkening of the treated patches or the normal surrounding skin (hyperpigmentation). You can minimize your chances of sunburn by avoiding exposure to direct sunlight after each treatment. Hyperpigmentation is usually a temporary problem and eventually disappears when treatment stops.
- Oral psoralen photochemotherapy (PUVA). Oral PUVA therapy may be used if you have extensive vitiligo (affecting more than 20 percent of your body) or if you haven’t responded to topical PUVA therapy. Oral PUVA isn’t recommended for children younger than 10 years of age because of an increased risk of damage to the eyes, such as cataracts. For oral PUVA therapy, you take a prescribed dose of psoralen by mouth about two hours before exposure to artificial UVA light or sunlight. Your doctor adjusts the dose of light until the skin areas being treated become pink. Treatments are usually given two or three times a week, with at least one day in between.
If you don’t have access to a PUVA facility, your doctor may prescribe psoralen to be used with natural sunlight exposure. Your doctor will give you careful instructions on carrying out treatment at home and monitor your progress with frequent office visits.
Short-term side effects of oral PUVA may include sunburn, nausea and vomiting, itching, abnormal hair growth, and too much repigmentation or darkening of the treated patches or the normal surrounding skin (hyperpigmentation). If received for longer periods of time, this type of treatment may increase your risk of skin cancer. To avoid sunburn and reduce your risk of skin cancer, you’ll need to apply sunscreen and avoid direct sunlight for 24 to 48 hours after each treatment. Wear protective UVA sunglasses for 18 to 24 hours after each treatment to avoid eye damage, particularly cataracts.
- Narrow-band Ultraviolet “B” (nbUVB) therapy. In recent years, special lamps have become available that emit only the very small and specific frequency of ultraviolet B light (“narrowband”, or nbUVB) that is medically effective in treating Vitiligo. This has become preferable to PUVA, which is rapidly falling out of favor. nbUVB treatments are administered much like PUVA, only without the need for the psoralen medications. This greatly simplifies the process and eliminates the many undesirable psoralen-related side effects. Over the last several decades, nbUVB phototherapy has proven to be a much safer and longer-term alternative to PUVA. It carries virtually no negative side effects and appears to be effective for the large majority of Vitiligo sufferers. Plus, as there are no medications required, home nbUVB systems are now a very practical reality to provide long-term regimentation for most people in the privacy of their own home (and without continual co-payments and trips to the office).
- Depigmentation. Depigmentation involves fading the rest of the skin on your body to match the already-white areas. If you have vitiligo on more than 50 percent of your body, depigmentation may be the best treatment option. In this procedure, the drug monobenzone (Benoquin) is applied twice a day to the pigmented areas of your skin until they match the already-depigmented areas. Avoid direct skin-to-skin contact with others for at least two hours after applying the drug.
The major side effect of depigmentation therapy is redness and swelling (inflammation) of the skin. You may experience itching, dry skin or abnormal darkening of the membrane that covers the white of your eyes. Depigmentation is permanent and cannot be reversed. In addition, if you undergo depigmentation you will always be extremely sensitive to sunlight.
- Autologous skin grafts. This type of skin grafting uses your own tissues (autologous). Your doctor removes tiny pieces of skin from one area of your body and attaches them to another. This procedure is sometimes used if you have small patches of vitiligo. Your doctor removes sections of your normal, pigmented skin (donor sites) and places them on the depigmented areas (recipient sites). Possible complications of this procedure include infection at the donor or recipient site. The recipient and donor sites may develop scarring, a cobblestone appearance, spotty pigmentation, or may fail to repigment at all.
- Blister grafting. In this procedure, your doctor creates blisters on your pigmented skin primarily by using suction. The tops of the blisters are then cut out and transplanted to a depigmented skin area where a blister of equal size has been created and removed. The risks of blister grafting include the development of a cobblestone appearance, scarring and lack of repigmentation. However, there’s less risk of scarring with this procedure than with other types of skin grafting.
In a procedure called an autologous melanocyte transplant, your doctor takes a sample of your normal pigmented skin and places it in a laboratory dish containing a special cell culture solution to grow melanocytes. When the melanocytes in the culture solution have multiplied, they’re transplanted to your depigmented skin patches. This procedure is experimental and performed only in a few institutions where vitiligo research is conducted.