Vitiligo is a disease with unknown cause that causes patches of different color on the skin. An autoimmune process directed against the melanocytes (the cells that make the skin pigment or color) results in patches of skin with less pigment than usual. Vitiligo usually peaks in your 20s or 30s, and it can be associated with other autoimmune diseases. As you can imagine, it can be devastating for folks who are affected.
Well, what can we do about it? And isn’t there anything new? Let’s look at the most recent evidence of successful therapies for repigmentation and cessation of spread.
Topical steroids are the best option for people whose vitiligo doesn’t involve the face.
- Cutivate (fluticasone) or Elocon (mometasone) are typical first choices—these creams are used once a day for 4 – 6 months.
- Fifty five percent of folks respond to these topical steroids.
What about other creams that aren’t steroids?
- Vitamin D3 analogs like Dovonex (calcipotriene .005% cream) regulate skin cell production and proliferation.
- Calcipotriene cream has been best studied used with UV light therapy.
- A topical steroid cream like fluticasone or mometasone + calcipotriene also works better than either alone.
Oral steroids (steroids taken as a pill) are the next step if your vitiligo continues to get worse despite using the topical meds.
- If your dermatologist does start you on oral prednisolone, know that the combination of oral prednisolone plus narrow band UVB light therapy works better than the oral steroid alone
So UV light is also used for repigmentation therapy (returning color to your skin)?
- UVA and UVB light are both used for vitiligo.
- Narrow band UVB (NB-UVB) is a newer treatment that works slightly better than PUVA (psoralen + UVA) for repigmentation. NB-UVB patients also report less nausea and redness than PUVA.
- Narrow band UVB used once a week has been shown to be as effective as using it 2-3 times weekly. Remember, NB-UVB is also better tolerated than PUVA—it has fewer negative side effects.
- PUVA, psoralen + UVA light, is actually ultraviolet radiation (UVA) is used with psoralens, a class of plant-derived phototoxic compounds, to enhance the action of UVA. Pretty cool, and that’s why it’s called PUVA.
What about other combinations of medications + UV light?
- Combination calcipotriene .005% cream (Dovonex) plus PUVA works better than PUVA alone.
- Azathioprine (Imuran) with PUVA also works better than PUVA alone.
- The topical steroid clobetasol propionate worked better alone than PUVA with sunlight. Hmmm. PUVA is not sounding as good now, given the cost.
- Combination therapy with NB-UVB and Scenesse (afamelanotide), an implant under the skin, worked better than NB-UVB alone after 6 months. This is one of the newest vitiligo therapies.
What about lasers?
- The Excimer laser/lamp is used for the treatment of vitiligo. Excimer lamp treatment has been tested vs other phototherapy devices, and the results are the same. So on their own, Excimer lamps, the Excimer laser, and NB-UVB all work the same to treat vitiligo.
- Locoid cream (hydrocortisone butyrate) has been studied with the Excimer laser. The results showed that Locoid cream plus Excimer laser does work better than Excimer laser alone.
Are there any other alternative therapies?
- Ginkgo biloba worked better than placebo in three studies. Ginkgo biloba 40 mg taken three times a day worked better than doing nothing (placebo) for vitiligo.