Treatment of Vitiligo

Vitiligo is an acquired depigmenting disorder of the skin, in which pigment cells (melanocytes) are lost. It presents with well-defined milky-white patches of skin (leukoderma). Vitiligo can be cosmetically very disabling, particularly in people with dark skin.

Many treatments are available to help restore skin color or even out skin tone. Results vary and are unpredictable. Some treatments have serious side effects. So your doctor may suggest that you first try improving the appearance of your skin by applying self-tanning products or makeup.

Medicine applied to the skin:

• Several different topical (applied to the skin) medicines can repigment the skin.
• Prescribed for small areas.
• The most commonly prescribed medicine is a potent or super-potent topical corticosteroid. About half, 45 percent, of patients regain at least some skin color after 4 to 6 months.
• A topical corticosteroid may be combined with another medicine to improve results.
• Topical medicine works best in people with darkly pigmented skin.
• Topical medicines are most effective on certain areas of the body, such as the face. They are least effective on the hands and feet.
• Not all topical medicines should be used on the face.
• Drawbacks: These medicines have possible side effects, so patients must be carefully monitored. A possible serious side effect of using of a topical corticosteroid for a year or longer is skin atrophy. This means the skin becomes paper thin, very dry and fragile.

Light treatment:

• Uses light to repigment the skin.
• Patient may sit in a light box or receive excimer laser treatments.
• Light box used to treat widespread vitiligo; laser used to treat small area.
• Works best on the face; least effective on hands and feet.
• Effective for many patients; about 70 percent see results with excimer laser.
• Results can disappear. About half, 44 percent, see results disappear within 1 year of stopping treatment. After 4 years, about 86 percent lose some color restored by treatment.
• May cause patients with darkly pigmented skin to see areas of darker skin after treatment, but treated skin usually matches untreated skin within a few months.
• Requires a time commitment. Patients need 2 to 3 treatments per week for several weeks.
• May be combined with another treatment such as topical corticosteroid.

Surgical treatments include:

• Skin grafts from a person's own tissues. The doctor takes skin from one area of a patient's body and attaches it to another area. This is sometimes used for people with small patches of vitiligo.
• Tattooing small areas of skin.

PUVA light therapy:

• Uses UVA light and a medicine called psoralen to restore skin color.
• Psoralen may be applied to the skin or taken as a pill.
• Can treat widespread vitiligo.
• About 50 percent to 75 percent effective in restoring pigment to the face, trunk, upper arms and upper legs.
• Not very effective for the hands or feet.
• Time-consuming, requiring treatment at a hospital or PUVA center twice a week for about 1 year.
• Psoralen can affect the eyes, so this treatment requires eye exams before starting treatment and after finishing treatment.
• To help prevent serious side effects, patients need to be carefully monitored.