Vitiligo

How is vitiligo treated?

There’s no cure for vitiligo. Instead, treatment for vitiligo tends to be either repigmentation, which means restoring the loss of colour, or depigmentation, which is removing the remaining colour to create an even skin tone. Treatment for vitiligo is long-term and personalised. It can include phototherapy, topical and oral medications.

Your treatment options will also differ based on your subtype. In the early stages of SV, topical treatments and phototherapy are used. But in the stable stages surgical treatment is the only option. In the stable stages of NSV, topical treatments and phototherapy are often recommended, but surgery may be recommended if these don’t work. Lastly, if your vitiligo is spreading quickly then oral steroids can be taken.

Topical treatments can be categorised into steroids and calcineurin inhibitors. Clobetasol propionate (Dermovate) is a corticosteroid that “re-pigments” skin. It works by suppressing the immune system so it cannot destroy melanocytes. Elidel and Protopic are topical calcineurin inhibitors (TCI). TCI also prevents the immune system from overreacting so it doesn’t destroy the melanocytes. Monobenzone is another topical drug that can be taken to depigment skin. It works by removing the remaining melanin from the skin. However, as with all drugs, they do have side effects and most cannot be used long-term.

Phototherapy is another option to repigment the skin. While phototherapy is a popular option, it can be expensive and time-consuming due to the need for regular visits to the clinic over an extended period to see significant results. It’s also not safe for children or pregnant women, and the treatment may not always produce the desired outcome.

Surgery is an option for SV or localised vitiligo. Two of the most common options include tissue grafting and cellular grafting. With tissue grafting, a small piece of skin is taken from an area of the body that has pigmentation and then transferred to the affected site. Cellular grafting involves the transfer of cells, like melanocytes, to the affected area. But surgery can cause some side effects, such as the Koebner phenomenon. This is when previously healthy skin experiences physical changes as a result of the surgery.

What medications are there for vitiligo?

At Treated, we offer a range of treatments for vitiligo. Dermovate is a steroid that “repigments” skin by suppressing the immune system. Elidel and Protopic are both TIC but contain different active ingredients. When applied, they suppress the immune system. All of these treatments repigment skin. So if one doesn’t work, you can always try another.

Monobenzone (hydroquinone), on the other hand, has the opposite impact. It causes skin depigmentation by removing all remaining melanin in the body. Instead of restoring your skin colour, you’ll have a lighter complexion by the end of it. This is better for those who have widespread vitiligo.

Opzelura is a recent popular vitiligo treatment that can restore colour in patients with NSV. It suppresses the immune system whilst also repigmenting skin on all body parts. However, it can cause serious side effects for some people.

Is there a ‘best’ treatment for vitiligo?

Because each person will have a personalised treatment plan depending on their condition, so there is no ‘best’ treatment. Some treatments will work better for one person and not work for another. The main deciding factor for the treatments is the type of vitiligo you have. After that, there are many options you can choose from.

Does vitiligo always need treatment?

No, treatment is optional in the majority of the cases. Vitiligo doesn’t usually cause any physical discomfort or pain, but it can affect people's self-esteem and confidence. Having an uneven skin tone or being in skin that doesn’t feel like your own can be difficult, so it’s okay to get some type of treatment. However, if you’re comfortable with yourself, then no, you don’t need treatment.