Vitiligo Treatment & Prevention

Protect from sun | Skin camouflaging | Topical medicines | Home management tips

There are quite a few treatment options for vitiligo. The goal is restoration of skin color lost due to destruction of melanocytes. Your GP may plan the treatment regimen or if needed, may refer you to a dermatologist. Some people may not choose to undergo any treatment except use cosmetics to improve the appearance of white patches and good sun protection.

Protect from sun

Areas with vitiligo are very sensitive due to melanin loss and tend to burn easily if exposed to sun and worsen the vitiligo status. So it is imperative to use a sunscreen that is

• Water-resistant.
• Offers broad spectrum, UVA-UVB protection.
• With a sun-protection-factor (SPF) of 30 or more.
• Use it every day, about 15 minutes before going out.
• Reapply sunscreen every two hours.
• Use sunscreen after a swim, vigorous exercise session etc.
• Use a cap, scarf, hat or umbrella  when outdoors.
• Avoid going out during hot midday hours – 10 a.m. to 4 p.m.
• Use UV protective sunglasses.
• Must not use tanning beds or sun lamps etc.
• Wear clothing with high SPF.

Skin camouflaging

Make white patches less obvious with clever camouflaging with cosmetics like

• Camouflage creams to paint over white patches – creams and dyes that match your skin color, that are waterproof and can last on the body up to four days, and on the face 12-18 hours.
• Self-tanning lotion – an over-the-counter product that can stay for several days.

Topical medicines

Your GP will look at your vitiligo patches and customize the use of topical medicines and other modalities as needed. Topical medicines that can help are

• Topical corticosteroids.
• Topical immunomodulators (calcineurin inhibitors).
• Topical Vitamin D analogue-particularly calcipotriol used alone or in combination with topical steriods or UV light ( including NB-UVB ).
• Topical pseudocatalase with UVB

Oral therapy

Are suggested when the lesions are very active and unstable and rapidly progressing.

• Minipulse oral steriod 
• Oral psoralen photochemotheraphy

Phototherapy

• Light box.
• PUVA therapy. (topical and oral)
• Narrowband UVB therapy.

Surgery

Indication – Surgery is indicated for stable vitiligo not responding to medical treatment. Lesion is said to be stable when there is absence of progression of disease for 1 year.

Surgical Procedures

• Mask the depigmented area – Tatooing.
• Excision and closure.
• Stimulation of existing melanocytes – Dermabrasion and phenol peel.
• Grafting techniques – Autologous suction blister grafting, split-thickness grafting, punch grafting, smash grafting, single follicular unit grafting, cultured epidermal suspensions and autologous melanocyte culture grafting.

Laser

Excimer laser – This laser emits narrow band ultraviolet B light and has been shown to promote re-pigmentation in those who have lost pigment in their skin.

Home management/tips

• Join a support forum, group to manage psychological effects like low self-confidence, social isolation etc.
• Take vitamin D supplements .
• Ginkgo biloba, an herb, has helped in restoring skin color; stopped deterioration of vitiligo in clinical trials.

Outcome

Treatment for vitiligo is time consuming; at least six to eighteen months to show positive effect. It is not easy to predict which treatment will suit you or you will respond favorably to. What may work for you may not work for another and the efficacy of treatments may vary. Treatment results may differ from one part to another of the same person. Combining treatments works best to get an even skin tone.

• References

• • Indian Journal of Dermatology, Venereology and Leperology – Contact vitiligo: etiology and treatment (P Singh, J Singh, US Agarwal, RK Bhargava) view
  • Indian Journal of Dermatology, Venereology and Leperology – Vitiligo: A part of a systemic autoimmune process (KVT Gopal, G Raghu Rama Rao, Y Hari Kishan Kumar, MV Appa Rao, P Vasudev, Srikant) view
  • NHS UK – Vitiligo view
  • Mayo Clinic – Vitiligo Home Remedies view
  • British Association of Dermatology view
  • American Association of Dermatology – Vitiligo Diagnosis and Treatment view