There are a number of vitiligo treatments
involving changing the colour of the skin through surgery, tattooing, or simple camouflage make-up to cover the white skin spots.
The severity of the condition and the individual circumstances of the patient will affect their choice of treatments and patients with vitiligo
are urged to consider their decisions carefully, especially in cases where vitiligo treatments have permanent, irreversible effects.
The extent of the hypopigmentation will also determine the type of treatment a patient receives, as will any other medical conditions the patient suffers from. The treatment options for vitiligo include surgery, medications, and support although most aim to restore some degree of colour to the white patches of skin.
A number of treatments for vitiligo can have harmful side-effects, which may lead patients to forego such therapy in favour of techniques such as vitiligo cover up using special vitiligo makeup instead. Where an immune system malfunction is thought to blame for vitiligo, a patient may be given a steroid cream to use. However, steroid creams
may not be recommended for long-term use as they can thin the skin and make a patient more susceptible to other skin problems.
Oral medications, plus UVA light therapy (PUVA), and depigmentation of other skin areas to match the white patches are all other treatment options for vitiligo sufferers. Other patients may decide to undergo surgery including skin grafts to cover small patches of vitiligo, or the use of tattoos to add colour to the white patches of skin. Let’s look more closely at some of these options for treating vitiligo.
Vitiligo is incurable but there are a number of treatments, including natural vitiligo treatments, that can help slow down the spread of the condition and help patients feel better about their vitiligo
. Some treatments focus on evening out skin tone by using cover-up make-up on the white skin patches, tattooing to repigment the white spots of skin, or through depigmentation of the remaining skin areas. Where extensive vitiligo has caused almost complete loss of melanocytes and there are just a few patches of pigmented skin remaining some patients do choose to deliberately destroy those remaining melanocytes for an even skin colour.
Many patients with vitiligo simply choose to ignore or live with the condition or just use extra sunscreen and cosmetics to protect and camouflage the white skin spots. Homemade skin stains using food colouring and rubbing alcohol may also be used although the alcohol can severely dry out the skin and lead to other skin conditions aside from the vitiligo.
More conventional vitiligo treatment usually involves the use of topical steroid creams, topical immunomodulators, and/or narrrow-band UVB in an attempt to slow down the progressive depigmentation.
As the causes of vitiligo are largely unknown it is difficult to apply effective treatments for all patients. The general approach is based on the concept of vitiligo being an autoimmune condition where the body is triggered to destroy its own pigment-producing cells. Using those medications mentioned can be extremely effective for vitiligo in children as they respond much faster to such intervention than adult vitiligo patients do.
Topical Corticosteroid Therapy for Vitiligo
When corticosteroid treatment is used for children with vitiligo it can sometimes help in returning colour to the skin. This is less likely to happen in adults or older children unfortunately, but for those under ten years of age a mild topical corticosteroid applied to the white patches of skin is the simplest of vitiligo treatments and often effective. There are however possible side-effects including streaking of the skin and skin-thinning. Corticosteroid treatment must, therefore, be closely monitored and children should not be left to apply the vitiligo treatment themselves, nor should anyone other than the patient for whom it is prescribed use the steroid cream. Corticosteroid creams for vitliligo are often used alongside a topical vitamin D derivative.
Topical Psoralen Plus Ultraviolet A (topical PUVA) Treatment for Vitiligo
One of the most effective vitiligo treatments
is the combination of topical psoralen plus ultraviolet A (known as topical PUVA). A thin layer of psoralen on the white patches of skin, left for thirty minutes to soak in and then exposed to UVA light can help restore pigment to the white skin spots. The skin will usually turn pink initially and then normal skin colour may be restored as the pinkish hue fades.
This type of treatment occurs over a number of weeks with sessions once or twice weekly. The results of treatment vary between individuals with potential side-effects of topical PUVA therapy including severe sunburn, blistering of the skin, and hyperpigmentation where the treated skin and/or surrounding areas of skin become darker than normal skin.
Oral Psoralen Photochemotherapy (oral PUVA)
Oral psoralen photochemotherapy (oral PUVA) is another possible vitiligo treatment that may be used for patients with extensive depigmentation affecting more than a fifth of their skin. Patients who tried topical PUVA with little success may be advised to attempt oral PUVA instead. This vitiligo treatment involves the ingestion of prescribed psoralen two hours prior to exposure to UVA light or sunlight.
The treatment is given two or three times a week but not on consecutive days so as to allow the skin time to heal and avoid blistering or sunburn as far as possible. Patients may experience side-effects such as itching of the skin (pruritis), nausea, vomiting, sunburn, and hyperpigmentation.
Changes in hair-growth may also occur and the oral PUVA treatment increases the patients’ risk of skin cancer and damage to the eyes. As such, it is important to use sunglasses with protective UVA filters to protect the eyes as well as sunscreen
on the skin during the next day or two after treatment. Patients are advised to avoid direct sunlight as much as possible for the 24-48 hours after vitiligo therapy to minimise skin damage.
Narrow-Band Ultraviolet B Therapy
Another light-based vitilgo treatment uses UVB rather than UVA without the need for psoralen, either orally or topically. This makes treatment simpler to administer and, arguably, safer than PUVA therapies. Patients may have treatment three times a week and this is often the preferred vitiligo therapy for those with white patches covering more than 20% of their body.
Perhaps one of the most drastic steps to take for a vitiligo sufferer is deciding to depigment those areas of naturally healthy skin
that remain unaffected by vitiligo. This is an option only usually suggested or considered once the white patches of skin cover more than 50% of the patient’s body.
Depigmentation is a technique which involves fading the normal skin to match the colour of the areas that have lost pigment. Monobenzylether of hydroquinone (monobenzone) is applied twice daily to the normal skin until the loss of pigmentation matches that of the affected skin. Those choosing this vitiligo treatment option should be aware that side effects such as redness and swelling of the skin are common, and permanent sun sensitivity also occurs.
Other effects include pruritis (itchy skin), dry skin, and a darkening of the whites of the eyes. Such treatment requires careful consideration as it is permanent.
Vitiligo Treatments – Surgery
Another drastic step in treating vitiligo
is to undergo surgery to transplant skin from an unaffected area to the area that has lost pigment. These autologous skin grafts (known as minipunch skin transfers) pose little risk of tissue rejection as the patients’ own skin is used.
Unfortunately, the trauma inflicted on the skin at the site of the graft may exacerbate vitiligo, as can infection if it arises. Scarring may also occur, pigmentation may become patchy, and the skin may develop a blotchy appearance after skin transplants for vitiligo.
An alternative technique is called blister grafting and involves the use of heat, cold, or suction to blister pigmented skin for removal and transplantation to blistered depigmented skin. This causes less scarring than more extensive skin grafts (although this is still a risk, alongside a blotchy appearance).
Tattooing for Vitiligo
Where patients with vitiligo wish to avoid surgery and the use of medications
they may opt for permanent tattooing of the skin to give the appearance of pigmentation, although this is not generally recommended for patients.
Micropigmentation is often sought where vitiligo has affected the lips, particularly in darker skinned people where white patches on the lips are more apparent. It is tricky to match the natural lip colour using this technique, however, and the shade may fade over time. Other risks include the chance that the trauma of tattooing the lips will cause blisters and lead to the spread of vitiligo to further areas of skin trauma.
A number of other therapies, including natural therapies for vitiligo exist with varying degrees of efficacy and benefit. One potential help for vitiligo sufferers comes in the form of stem cell therapy using autologous melanocyte transplantation.
No clinical trials have, as yet, been conducted to test such a technique and so patients with this patchy skin condition
will usually have to choose from the above options for vitiligo treatments.
All vitiligo patients are advised to use broad-spectrum sunscreen
as the areas of hypopigmentation are at a higher risk of sun damage and can increase the possibility of skin cancer developing. Patients with vitiligo are encouraged to find a doctor experienced in treating skin disorders, with general practitioners often referring patients to a skin specialist (dermatologist) for further guidance.
The alteration in appearance can be highly distressing for many patients and they may wish to find a local support group or online group to help them cope with the emotional effects of vitiligo. Family and friends are another great source of support for many patients and it is, therefore, important that they know what vitiligo is, that it is not contagious, and what they can do to help.