How Vitiligo Is Treated

Vitiligo is a condition in which the skin in one or multiple areas becomes lighter than the rest of the skin due to a loss of pigmentation. While primarily a cosmetic issue, vitiligo is associated with other medical conditions such as hearing loss and thyroid problems.

There is no cure for vitiligo, but more treatments are being researched that appear promising.

Causes of Vitiligo

The exact cause of vitiligo is unknown, but it is believed to be the result of one of, or a combination of, the following factors:

• Genetics: About 30% of people with vitiligo have a close relative who also has or has experienced vitiligo.
• Autoimmune disorder: At least some forms of vitiligo appear to be caused by autoimmune factors, where the body destroys its own cells, specifically melanocytes (the cells that produce pigment in skin and hair).
• Neurogenic factors: Nerve endings in the skin may produce a substance that is toxic to melanocytes.
• Self-destruction: Melanocytes may destroy themselves due to a defect within the cells.
• Physical or emotional stress: It is possible that vitiligo could be triggered by physical or emotional stress.

While people of any age can develop vitiligo, it usually starts in adolescence or early adulthood, with nearly half of all people with the condition developing it by the time they turn twenty-one.

Types of Treatment

Medication

Treatment for vitiligo often includes topical or oral medications or a combination of both.

Corticosteroids

• Come in topical or oral form
• Target inflammation that can lead to fewer pigment cells
• Can take up to three months to see results
• May cause skin atrophy (when skin becomes very thin and dry), or striae (stretch marks) when used long-term
• Includes steroids such as clobetasol, betamethasone, and fluocinonide
• About 45% of people using potent or super potent topical corticosteroids regain at least some skin pigmentation by four to six months

Topical medications are usually prescribed for use on small areas and work best for people with darkly pigmented skin.

These medications work better on some areas of the body than others. They are not very effective on the hands and feet but are more effective on the face.

It is important to note that some of these medications should not be used on the face, or other specific body parts, because of the potential for harm. Always check with your healthcare provider before use.

Other topical medications include:

Topical vitamin D analogs

• Used to stimulate melanocytes
• Includes calcipotriol and tacalcitol
• Studies indicate a mixed efficacy
• Serious side effects are rare
• Mild side effects can include dry skin, stinging, and burning, and can subside with continued use
• Typically used in combination with other treatments such as corticosteroids

Protopic and Elidel

• Available by prescription only in the United States
• Immunomodulators that suppress the immune system where applied
• Allows melanocytes to return
• More effective on the face, less effective on hands and feet
• Studies show very little systemic absorption, less than seen in topical steroids
• Side effects such as sensations of itching, stinging, burning, or soreness of the affected skin usually occur within the first few days of treatment and are typically mild or moderate
• Less common, but more serious side effects can occur, so it is important to discuss risks versus benefits with your healthcare provider
• Black box warning from the FDA concerning the extremely rare possibility of developing some form of lymphoma from the use of these medications
• Drinking alcohol may cause flushing in the face (redness, feeling hot), which is not dangerous

Light Treatment

• Phototherapy (light therapy) uses narrow band ultraviolet B (UVB) light to restore lost color to the skin
• Most effective on face, least effective on hands and feet
• Can be administered via a lightbox (for widespread areas affected by vitiligo) or excimer lasers (for targeted treatment of smaller areas)
• Requires two to three treatments per week for several weeks to months
• Effective for many people, with about 70% of people seeing results from treatment with excimer lasers
• Results are not always permanent with about 44% experiencing a loss of regained color one year after stopping treatment, and about 86% after four years
• Can be used on its own or in combination with medications

PUVA Light Therapy

• Uses a combination of UVA light and the medication psoralen to restore color to the skin
• Psoralen can be administered topically or orally (in pill form)
• Can be used for widespread vitiligo
• About 50 to 75% effective for the face, trunk, upper arms, and upper legs, but less effective on hands and feet
• Requires twice a week treatment at a hospital or PUVA center for about 1 year
• Requires an eye exam before and after finishing treatment as psoralen can affect the eyes
• People undergoing PUVA therapy are monitored closely to prevent serious side effects

Surgery

Surgery for vitiligo involves taking unaffected skin from one area of the body and using it to replace an area of skin affected by vitiligo. It can also be done by transplanting skin cells into areas devoid of pigment due to vitiligo.

• Usually performed after other treatments have been ineffective
• Vitiligo must have been stable (unchanged) for at least six months to a year before surgery can be performed
• People who scar easily or develop keloids (scars that rise above the skin) should avoid this treatment
• Effective for up to 95% of people
• Risks include failure to work, cobblestone-like skin, and infection

Micropigmentation (a type of tattooing on a small area, sometimes called permanent makeup) is occasionally performed, usually on the lips. It is not recommended for larger areas.

People with vitiligo and other autoimmune disorders should be careful about getting tattoos because they can cause or worsen skin issues.

Depigmentation

During depigmentation, the drug monobenzone is applied to skin uneffected by vitiligo to remove its pigment in order to match the skin that is unpigmented due to vitiligo.

• Not commonly used
• Usually only used when the majority of a person's skin has lost pigment already from vitiligo
• After depigmentation, a person has completely white skin
• Can take one to four years to complete
• Spots of pigment may reappear after being in the sun. The treatment cream can be applied to these spots to once again remove pigment.

Current Research

While not yet in use, research into a class of medications called JAK inhibitors show promise for their use as a treatment for vitiligo.

JAK inhibitors target a type of immune communication pathway that has not previously been targeted in vitiligo.

It is believed that JAK inhibitors work by:

• Reducing levels of inflammatory chemicals that lead to disease progression
• Stimulating regrowth of melanocytes

Studies involving two types of JAK inhibitors—tofacitinib and ruxolitinib—showed promising results for the treatment of vitiligo when a JAK inhibitor is used in combination with UVB phototherapy. More research needs to be conducted before an FDA approval is reached, but preliminary data of larger studies show encouraging results of repigmentation, particularly on the face.

JAK inhibitors are currently considered off-label as a treatment for vitiligo and can be expensive as they are rarely covered by insurance for the use of vitiligo treatment.

Prognosis

Because vitiligo and vitiligo treatment affects each individual differently, it is not possible to give a guaranteed predicted outcome.

About 10 to 20% of people with vitiligo fully regain their pigment, while others see some regained pigment.

Vitiligo is not life-threatening, and it is not contagious.

Coping

In addition to medical treatments, there are things that can be done to make living with vitiligo more manageable.

• Practice sun safety: People with vitiligo can burn easily, particularly those who have undergone depigmentation. In addition to the risk of sunburn, tanned skin around depigmented areas can make vitiligo more noticeable. Use lots of broad-spectrum, SPF 30+ sunscreen, seek shade, and wear protective clothing.
• Avoid tanning beds and sun lamps: These are unsafe sun alternatives for everyone, including people with vitiligo.
• Add safe, artificial color to your skin: Self-tanner, dyes, and cosmetics such as concealers or makeup can add color to depigmented skin. Self-tanners and dyes give longer-lasting coverage.
• Join a support group: You can find both online support groups, and groups in your area through places like the Global Vitiligo Foundation.

A Word From Verywell

While vitiligo can be life-altering, on its own it is not dangerous to your health. Because it can be associated with other conditions that can be more serious to your health, it is important to see a healthcare provider if you spot signs of vitiligo.

You can start by booking an appointment with your primary care provider. From there, they may suggest, or you can request, a referral to a dermatologist for more specialized treatment.