What Are The Treatments For Vitiligo?

On Jun 20, 2013

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Vitiligo hands
Complete depigmentation of the palms and wrists from vitiligo in a dark skinned person.
Image source:  Wikipedia by author James Heilman, MD

This is the second article of a two part feature on vitiligo.  Check out "5 Facts About Vitiligo That You May Not Have Known!" for information on the causes and signs of vitiligo.  In this article we focus on the treatments for this potentially disfiguring disease.  Vitiligo treatments options fall within 4 categories which include 1) sunscreens, 2) cover-up, 3) restoration of normal skin color with medication/light treatments, and in severe cases, 4) bleaching of the normal skin to remove remaining pigment to give an even color to the skin.

1. Sunscreens

Since the depigmented skin of vitiligo patients is significantly more susceptible to sunburn than their normal skin, application of sunscreen is important to protect from severe sunburns.  In addition, sunscreen also limits the tanning of normal skin and thereby reduces the contrast between tanned normal skin and depigmented white patches.  As discussed in our recent article, you must wear and frequently reapply a sunscreen with broad-spectrum UV-protection and a SPF of no less than 30.

2. Cover-up

Make-up, dyes, self tanning lotions are helpful to cover up the white spots of vitiligo.  They may be especially useful in cases where vitiligo is limited to a small percentage of the body surface.  They may also be used concurrently as other treatment modalities are ongoing.

3. Restoration of normal skin color

While there is no known cure to vitiligo, the following treatments may slow disease progression and/or restore areas of depigmented skin to their normal color.  There are both topical and whole body therapies used to restore normal skin color in vitiligo. 

  • Topical therapies
    • Topical application of corticosteroid creams is an option for vitiligo sufferers.  Usually at least a partial response may be seen within 2 months.  One must follow-up with their dermatologist to monitor for side effects of skin thinning from the topical steroid therapy. 
    • Calcipotriene, or Dovonex, is a vitamin D derivative that is sometimes used as a topical treatment for vitiligo alongside cortisteroid. 
    • Topical oxsoralen, also called methoxsalen, is a substance that modifies the way your skin cells receive UVA radiation and can be applied topically at your dermatologist's office.  Oxsoralen treated spots are extremely sensitive to sunburn and close follow-up with your dermatologist is required when completing this treatment regimen. 
    • Mini skin-grafting is a surgical treatment modality for refractory vitiligo spots in patients with segmental vitiligo.  This therapy involves performing a surgical operation to transplant unaffected skin from your body to vitiligo affected areas of your body. 
  • Whole body therapy
    • For more widespread vitiligo, oral psoralen and UVA treatment (PUVA) is up to 80% effective in patients with vitiligo of the head, neck, upper arms, legs, and trunk.   In this therapy, psoralen, a compound with high UV absorbance properties, is taken orally and allowed to absorb for 2 hours.  After this time has elapsed, you are exposed to artificial UVA light at your dermatologist’s office or PUVA facility.  This treatment typically involves 2 to 3 sessions per week with a break of at least 1 day in between sessions.  If you don’t have access to a PUVA facility, your doctor may direct you to use natural sunlight as light treatment after ingesting the psoralen.  PUVA treatment may have several side-effects including nausea, vomiting, itching, sunburn, or excessive pigmentation of the affected areas or the normal surrounding skin. 
    • In recent years, narrow-band Ultraviolet “B” (nbUVB) therapy has become a viable alternative to PUVA therapy and is frequently preferred by patients and physicians.  nbUVB therapy involves using special lamps which emit a specific frequency of UVB light.  This therapy is administered in similar fashion to PUVA although it does not require any oral medications such as psoralen.  In addition, nbUVB therapy has very few side effects and thus it is considered a safer treatment modality compared to PUVA.  Home nbUVB systems are now available and allow patients to self administer treatment in the comfort and privacy of their own home.

3. Depigmentation Therapy

For widespread, treatment-resistant, vitiligo that affects more than 50% of a patient’s body, depigmentation may be the best treatment option.  The goal of this treatment is to unify the skin tone across the whole body in a patient suffering with severe, widespread vitiligo.  This therapy involves applying Benoquin bleaching cream to the unaffected normal areas of skin on a patient’s body.  Benoquin cream destroys melanocytes, the pigmenting cells of the skin.  This bleaching treatment is permanent and irreversible.  The end stage color of this bleaching therapy is the chalk-white color of the vitiligo spots.  Nonetheless, many patients are satisfied with the uniform skin tone and the finality of the results.  In addition, some patients may wish to take 30mg to 60mg of oral beta-carotene, a precursor to Vitamin A that is abundant in carrots, to give their skin tone an off-white color.  Since skin bleaching eliminates the pigment cells of the skin which protect from the sun’s radiation, patients who undergo the skin bleaching procedure will be extremely sensitive to sunburn.  For this reason, patients should use a high-SPF broad-protection sunscreen, avoid the midday sun, and wear sun-protective clothing.


References:
 
Vitiligo Facts information from the American Vitiligo Research Foundation
Fitzpatrick TB, et al.  "Disorders of Pigmentation," in Dermatology In General Medicine, edited by TB Fitzpatrick et al. New York, McGraw-Hill.
Vitiligo

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