How Is Vitiligo Treated?

There is no cure for vitiligo, but a dermatologist may recommend creams, medications, surgery, phototherapy, or laser therapy.

Vitiligo is a long-term skin condition characterized by the loss of pigmentation, resulting in depigmented patches or macules. These areas of depigmentation can appear anywhere on the body and are a result of the malfunctioning of melanocytes, the cells responsible for producing melanin—the pigment that provides color to the skin and hair. While the exact cause of vitiligo remains a topic of ongoing research, current theories suggest that it is an autoimmune condition. In this scenario, the immune system mistakenly targets and attacks healthy melanocytes. While vitiligo is not life-threatening, it can significantly impact a person’s self-esteem and mental health. This article delves into the condition, its treatments, and strategies for living confidently with vitiligo.

Understanding Vitiligo

Vitiligo is characterized by the presence of lightened macules or patches on the skin. These depigmented areas can vary in size and shape and may appear asymmetrically, often affecting only one side of the body. While there is currently no cure for vitiligo, various treatments are available to manage and potentially improve the condition’s appearance.

Seeking Professional Guidance

If vitiligo is interfering with your life or if you wish to address its visual impact, it’s advisable to consult a dermatologist—an expert in treating skin conditions. Dermatologists can offer a range of treatment options tailored to your specific needs and preferences. These treatments include creams, medications, surgical procedures, phototherapy, and laser therapy, all of which aim to either cover the depigmented patches or restore natural skin color.

Sunscreen Protection

The American Association of Dermatology recommends the regular application of sunscreen for individuals with vitiligo. Depigmented skin is highly sensitive to the sun’s ultraviolet (UV) rays, making it prone to sunburn. Using sunscreen can help alleviate this sensitivity and reduce the risk of sunburn. It’s essential to select a broad-spectrum sunscreen with an SPF of 30 or higher to provide comprehensive protection against both UVA and UVB rays. Moreover, sunscreen should be applied consistently, even on cloudy days, as UV rays can penetrate cloud cover.

Makeup and Camouflage Products

For some individuals, covering up vitiligo patches with camouflage makeup or creams is a preferred approach to treatment. These products can help improve the appearance of depigmented areas and enhance self-esteem. A 2020 study found that the use of camouflage products positively impacted the quality of life of individuals with vitiligo, particularly in terms of self-esteem. However, it is crucial to consult with a healthcare provider before using topical makeup or creams to ensure they do not interfere with other treatment options you may be undergoing.

Prescription Creams

Prescription creams are available for the treatment of vitiligo, and their use can vary in terms of duration and intended results.

Short-Term Treatment: If you have vitiligo patches on both sides of your body, your dermatologist may prescribe topical corticosteroids. These creams and ointments are designed to restore skin pigmentation and prevent the spread of depigmented patches. Corticosteroids have anti-inflammatory properties that can interfere with the immune system’s activity, which is beneficial in the case of vitiligo—an autoimmune disorder. However, the use of these products over a large area or for an extended period may lead to severe side effects, such as skin redness, swelling, dizziness, or muscle weakness, and should be monitored closely.

Long-Term Treatment: Opzelura (ruxolitinib) is an FDA-approved prescription cream for nonsegmental vitiligo in individuals aged 12 and older. This cream falls under the category of Janus kinase (JAK) inhibitors, which help regulate the overactive immune response associated with vitiligo. Your dermatologist may also recommend the use of Elidel (pimecrolimus) cream or Protopic (tacrolimus) ointment. These medications, while originally intended to manage eczema, have been used off-label to treat vitiligo effectively.

Light Therapy

When the restoration of skin pigmentation over a broader area is desired, dermatologists may recommend light therapy as a viable option. This approach can be especially beneficial if creams have not yielded the desired results. Light therapy involves exposing the skin to UVA or UVB light through the use of a UV lamp for specific durations. Patients typically attend two to three sessions per week, with noticeable improvements typically observed after six to 12 months of treatment. In some cases, patients may need to take Methoxsalen (psoralen), a drug that enhances the skin’s sensitivity to UV light, before starting light therapy. It’s essential to be aware that PUVA (psoralen and UVA light) therapy may cause nausea and increase the risk of skin cancer.

While some at-home sunlamps are available for self-administered light therapy, their effectiveness may be limited, and they lack FDA regulation. Therefore, dermatologists often advise against their use.

Oral Medications

In specific scenarios, oral medications may be prescribed to address vitiligo. Prednisone, an oral corticosteroid, may be recommended for adults with rapidly spreading vitiligo or for children with progressive vitiligo. Physicians may initiate treatment with a low dose for two to three weeks to assess its effectiveness and monitor potential side effects. Common side effects of prednisone include acne, dizziness, heartburn, and increased sweating.

Surgeries and Procedures

Surgical interventions may become necessary if other treatments fail to produce the desired outcomes. The two primary surgical options for vitiligo treatment are skin grafting and cell transplants:

• Skin grafting: During this procedure, portions of pigmented skin are removed and used to cover depigmented areas affected by vitiligo. This approach is typically recommended for adults who have not developed new white patches in the past year.
  
• Cell transplant: Cell transplantation involves harvesting pigment cells from pigmented skin and placing them onto areas that have lost their color. This method can be suitable for individuals of various skin tones and with different types of vitiligo.

Living with and Managing Vitiligo

While vitiligo can be challenging to control, it’s important to remember that it is not a life-threatening condition. Nevertheless, the visibility of vitiligo may lead to feelings of insecurity or self-consciousness. Many individuals with vitiligo experience self-esteem issues, and some may even grapple with anxiety and depression. Mental health therapy and support groups can be valuable resources for learning more about vitiligo and connecting with others facing similar challenges. If you find yourself struggling with these emotional issues, consider reaching out to your healthcare provider for a referral to a mental health therapist.

In summary, vitiligo is a skin condition that can manifest in various ways, including patchy depigmentation on different body parts such as the arms, face, and neck. The treatment options for vitiligo are diverse and should be tailored to the specific characteristics of the condition, its duration, and the individual’s response to treatment. A dermatologist is a crucial ally in developing an effective treatment plan. Moreover, embracing and managing vitiligo, both physically and emotionally, is essential for fostering self-confidence and overall well-being.