Vitiligo is difficult to treat, and responses vary. The most important treatment is to protect areas of vitiligo from the sun. It is very easy for areas without pigment to become sun-burned. This increases the risk of skin cancer. Wear sun-protective clothing and/or apply sunscreen with a sun protection factor (SPF) of at least 30 to areas affected by vitiligo.
Other treatments can be attempted if vitiligo causes emotional or social distress. The goals of treatment are to minimize the contrast in color between your normal skin and skin patches that have lost pigment.
If you are light-skinned, part of your treatment may be to protect your normal skin from tanning by using sunscreens with a sun protection factor (SPF) of at least 30.
Topical treatments are can be helpful in some people. These are applied directly to the skin. Steroid creams or ointments are applied once a day for up to several months. These medications are not always effective, and they can thin the skin with continued use. Other medicines that may be helpful include tacrolimus (Protopic) and pimecrolimus (Elidel), but these medicines are used with caution because of a possible link between these drugs and skin cancer or lymphoma.
Ultraviolet B light treatment can be effective for treating vitiligo in many patients. Ultraviolet light can be provided by a hand-held light box for smaller areas of skin. People who have many areas of skin involved can be treated by putting on goggles and standing inside a closet-sized light box for several minutes. The treatment must be repeated often, usually for three times a week and for at least six months. Side effects, which should be discussed thoroughly with your dermatologist, include itching, pain and sunburn as well as increased risk of skin cancers.
Psoralen plus ultraviolet A light treatment (commonly called PUVA) causes slightly more pronounced side effects than ultraviolet B light therapy, but it is another effective way to treat vitiligo. Psoralens are drugs that cause skin to darken when they react with ultraviolet A light. They can be applied as a cream or taken as pills. After the psoralen medicine is used, you are exposed to ultraviolet light. PUVA treatment is not for pregnant women, women who are breastfeeding or children younger than 10. There is also an increased risk of skin cancers.
Oral medicines that suppress your immune system can sometimes allow normal pigment to return. For people who have large skin areas involved, oral steroids sometimes are used instead of steroids applied to the skin. This treatment is seldom used because of potential side effects of oral steroids.
For people with severe vitiligo, depigmentation can remove the color from normal skin, making all of the skin the same white color. This treatment is rarely used because the skin without pigment is very vulnerable to damage from sun exposure. A bleaching solution is applied daily for up to 12 months. It may be two or three months before you see any effects. About 95 percent of people will be depigmented within 12 months, and must then meticulously avoid sun exposure. Side effects can occur in up to 50 percent of those treated, and include skin redness, dryness, itching and burning, especially on the face.
Skin grafting removes normal skin from less visible areas and uses this skin to replace white areas in places where the person has the most cosmetic concerns. Skin grafting is used only in a very small number of people with vitiligo.