What Vitiligo Treatments Actually Work? A Look at Lotions, Creams, and UV Therapy

Vitiligo can be a difficult condition to deal with. While there’s no cure, there are several treatment approaches. Options range from lotions to light therapy and lasers. Here’s a look at some of the most effective vitiligo treatments.

What is vitiligo?

Vitiligo is a disease 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.

What are the best treatments for vitiligo? 

Many different vitiligo treatments can help with repigmentation (when vitiligo spots get their normal color back). The treatment you use depends on a few things, including how much vitiligo you have and where it is on your body. Options include:

• Prescription topical treatments, like steroid creams, are generally the first approach.

• Steroid pills and lasers are an option when the vitiligo is more severe. 

Let’s take a deeper look at the studies and the most effective treatments for vitiligo. 

Vitiligo lotions

Creams and lotions are a common treatment for vitiligo spots that aren’t that large. Some of them are prescription lotions that help lower the immune response. Others allow people to cover vitiligo spots. Depending on your situation, you may combine one or more of these lotions to treat vitiligo.  

Here are some of the most common creams and lotions for vitiligo treatment.

Steroid creams 

Moderate-strength to high-strength topical steroids are usually the best option to treat localized vitiligo. But using topical steroids for too long can have side effects, like skin thinning. So you may use weaker ones on sensitive areas like the face or skin folds. To help lower this risk, you can combine steroids with other nonsteroid prescription creams.

Examples of steroid creams include fluticasone (Cutivate) and mometasone (Elocon). 

Nonsteroid creams

Nonsteroid prescription lotions that work for vitiligo don’t cause as many side effects as steroid creams. This means people often use them alone or in combination with steroids, especially in sensitive areas like the face. Options include: 

• Janus kinase (JAK) inhibitors are a new class of medications that block certain signals in the immune system. Opzelura (ruxolitinib) cream is the first FDA-approved treatment for vitiligo that re-pigments skin. People 12 years of age and older can use it twice a day.

• Vitamin D3 analogs, like calcipotriene 0.005% cream (Dovonex), regulate skin cell production and proliferation. A topical steroid cream, like fluticasone or mometasone, combined with calcipotriene also works better than calcipotriene alone. 

• Topical calcineurin inhibitors, like tacrolimus (Protopic) and pimecrolimus (Elidel), also lower the immune system but have fewer side effects than steroids. 

Vitiligo creams that camouflage 

Some people decide to cover their vitiligo spots so they blend in with unaffected skin. This may be because they don’t want treatment or treatments didn’t work. Some popular vitiligo creams people use to match healthy skin include:

• Covermark

• Dermablend

Other non-topical treatments for vitiligo

If your vitiligo continues to get worse despite using other treatments, you may be able to take stronger medications in pill form. These can have more serious side effects, so they’re only used in more advanced cases for a short period of time. Here are examples of oral medications for vitiligo: 

• Oral steroids can stop vitiligo from spreading and help repigmentation of vitiligo spots. They work by decreasing the immune system response and can treat many different conditions, like asthma and autoimmune conditions. Examples include betamethasone, dexamethasone, and prednisone. 

• Methotrexate also works by lowering the immune system response and can help stop vitiligo from spreading. It also promotes repigmentation of vitiligo spots. 

• Minocycline is an antibiotic that people often use to treat acne. It has anti-inflammatory effects and has been shown to help treat vitiligo in some people. 

UV light for vitiligo repigmentation therapy (returning color to your skin)

Ultraviolet A (UVA) and ultraviolet B (UVB) are repigmentation therapies that can both treat vitiligo. UVB treatment works better than UVA treatment to return your skin to its natural color, and it has fewer negative side effects:

• UVA is delivered as PUVA, or psoralen plus UVA light. PUVA is UV radiation (UVA) used with psoralens, a class of plant-derived phototoxic compounds that enhance the action of UVA. 

• UVB is delivered as narrow-band UVB (NB-UVB). It’s a newer treatment that works slightly better than PUVA for repigmentation. People having NB-UVB treatment also report less nausea and redness than with PUVA. People see the fastest results when they have NB-UVB three times a week, but twice a week can be a convenient or lower-cost option for some people. 

Laser treatment for vitiligo

The excimer laser and lamp are both treatments for smaller areas of vitiligo and have about the same effectiveness. They both use the same wavelength as NB-UVB. And some studies show that the laser works better than NB-UVB.

There’s also evidence that combining Locoid cream (hydrocortisone butyrate) with the excimer laser may work better than the excimer laser alone.

Can you combine medications and UV light to treat vitiligo?

For some people, phototherapy (UV light) works better when they combine it with other vitiligo treatments. Here are some combination treatments that may work better than light treatment alone:

• Combination calcipotriene .005% cream (Dovonex) plus PUVA may work better than PUVA alone.

• Azathioprine (Imuran), a pill that lowers your immune system, along with PUVA also may work better than PUVA alone.

• Prednisolone, a type of steroid pill, plus NB-UVB light therapy may work better than the oral steroid alone.

• Combination therapy with NB-UVB and afamelanotide (Scenesse), an implant under the skin that increases skin pigment, may work better than NB-UVB alone. This is one of the newest vitiligo therapies.

Alternative treatments for vitiligo

Some studies show that alternative treatments and dietary supplements may help improve vitiligo, but more research needs to be done to see how effective they are. Some examples include:

• Ginkgo biloba worked better than placebo in three studies. 

• Polypodium leucotomos is an antioxidant that may work well in combination with NB-UVB. 

• Phenylalanine is an amino acid (which helps make proteins) that you can use as a supplement. It may be helpful in treating vitiligo when you combine it with phototherapy. 

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Written by:

Maria Robinson, MD, MBA

Maria Robinson, MD, MBA, is a board-certified dermatologist and dermatopathologist who has practiced dermatology and dermatopathology for over 10 years across private practice, academic, and telehealth settings. She is a fellow of the American Academy of Dermatology and the American Society of Dermatopathology.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

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