Which Treatment is Best for Vitiligo?

Vitiligo is a skin condition characterized by the loss of pigment, resulting in white patches on the skin. While it does not pose any direct health risks, it can significantly impact a person’s self-esteem and quality of life. With various vitiligo treatment options available, choosing the most suitable one can be overwhelming. Let’s explore the different treatments for vitiligo and which one might be best for you.

Introduction to Vitiligo

Vitiligo occurs when melanocytes, the cells responsible for producing pigment in the skin, are destroyed. This can be due to autoimmune factors, genetic predispositions, or environmental triggers. The condition can affect people of any age, gender, or ethnicity and often begins with small patches of depigmentation that gradually expand over time.

Understanding the Causes of Vitiligo

The exact cause of vitiligo remains unknown, but researchers believe it involves a combination of genetic, autoimmune, and environmental factors. Autoimmune disorders, such as thyroid disease or diabetes, are commonly associated with vitiligo, suggesting an immune system dysfunction. Vitiligo happens when the cells in your body that make color (melanocytes) stop working or die. These cells create melanin, the stuff that gives your skin, hair, and eyes their color. When these cells fail, patches of skin can turn lighter or white. What exactly causes these cells to stop working isn’t entirely clear, but it could be because of:

1. Problems with the Immune System:

Sometimes, your immune system, which usually fights off germs, starts attacking your own healthy cells instead. In the case of vitiligo, it attacks the melanocyte skin cells that produce melanin.

2. Family History:

If someone in your family has vitiligo or other autoimmune conditions (where the immune system goes haywire and attacks the body), you might be more likely to get it too.

3. Triggers:

Certain events or factors could trigger vitiligo, such as:

• Stressful situations, like having a baby
• Skin injuries, like bad sunburns or cuts
• Hormonal changes, like during puberty
• Liver or kidney problems
• Exposure to certain chemicals

What Increases the Risk?

You might have a higher chance of getting non-segmental vitiligo if:

• Other family members have it
• There’s a family history of other autoimmune issues
• You already have another autoimmune condition
• You’ve had melanoma or non-Hodgkin lymphoma
• You have certain gene changes linked to vitiligo

How Segmental Vitiligo Happens:

This type of vitiligo, which is less common, is believed to occur because of harmful chemicals released by nerves in your skin. These chemicals can harm the melanocyte skin cells.

It’s Not Contagious!

Vitiligo is not contagious and does not result from an infection. It’s just your body’s own cells acting up.

Various Treatment Options for Vitiligo

Topical Treatments in Vitiligo

Topical corticosteroids are often the first-line treatment for vitiligo. Topical steroids are creams or ointments applied to the skin to treat vitiligo. These creams or ointments help to repigment the skin by reducing inflammation and suppressing the immune response. Other topical treatments include calcineurin inhibitors and vitamin D analogs, which can also be effective in restoring pigment.

How They Help:

• Halting Spread: They can sometimes stop the white patches from spreading.
• Restoring Color: They may also restore some of the original skin color.

Who Can Use Them:

Topical steroids may be prescribed if:

• You have vitiligo on less than 10% of your body.
• You are seeking further treatment beyond sunscreen and makeup.
• You are not pregnant.
• You understand and accept the potential side effects.

Important Consideration:

Consult with a GP before applying a topical steroid to your face. They can provide personalized advice based on your needs.

Types and Applications:

Your doctor may prescribe either a cream or an ointment, depending on your preference and where it’ll be used. Ointments are easier.

Common Steroids:

Some steroids your doctor might prescribe include:

• Fluticasone propionate
• Betamethasone valerate

How to Apply:

Your GP will explain how to apply the cream or ointment to the patches and how much to use. Usually, you’ll apply it once a day.

Measurement:

Topical steroids are measured using a unit called the fingertip unit (FTU). One FTU is the amount squeezed along an adult’s fingertip, enough to treat an area twice the size of an adult’s hand.

Follow-up:

After a month, you’ll have a follow-up appointment to see how well the treatment is working and if there are any side effects. If there are side effects, you may need to stop using the steroid.

Monitoring Progress:

After another month or two, your doctor will check how much your vitiligo has improved. If there’s no improvement, you might be referred to a dermatologist.

Side Effects:

Possible side effects include:

• Lines in your skin
• Thinning of your skin
• Visible blood vessels
• Excess hair growth
• Burning, stinging, or inflammation of your skin
• Acne

Monitoring:

Your doctor may take photos of your vitiligo to track any changes. You can also take photos yourself if you want to keep an eye on your progress.

Phototherapy For Vitiligo:

Phototherapy involves exposing the affected skin to ultraviolet light, either through narrowband UVB therapy or psoralen plus UVA (PUVA) therapy. These treatments stimulate melanocyte activity and can lead to repigmentation in many cases.

When it’s Used:

Doctors might suggest phototherapy (which uses light) for vitiligo if:

• Other treatments haven’t worked.
• The vitiligo is spread out over a large area.
• The vitiligo is really affecting your life.

How it Works:

During phototherapy, your skin gets exposed to special lamps that emit ultraviolet A (UVA) or ultraviolet B (UVB) light. Sometimes, you might take a medicine called psoralen before the treatment, which helps make your skin more responsive to light. This combo is called PUVA.

Benefits:

Research shows that phototherapy, especially when combined with other treatments, can help with vitiligo.

Risks:

• Skin Cancer Risk: There’s a higher risk of skin cancer with phototherapy because of the extra UVA exposure. UVB light has a lower risk.
• Home Lamps Not Recommended: Lamps you can buy for home use aren’t as good as the ones in hospitals. Plus, they’re not regulated, so they might not be safe.

Important Note:

Before going for phototherapy, talk to your dermatologist about the risks and benefits. They can help you decide if it’s the right choice for you.

Oral Medications

Oral medications such as oral corticosteroids, calcineurin inhibitors, and vitamin supplements may be prescribed for widespread or rapidly progressing vitiligo. These medications work systemically to modulate the immune response and promote pigment production.

Surgical Options

Surgical procedures like skin grafting, melanocyte transplantation, and tattooing can be considered for stable vitiligo that does not respond to other treatments. These procedures involve transplanting melanocytes or pigment from unaffected areas of the body to the depigmented areas.

Skin Grafts for Vitiligo:

A skin graft is a surgery where healthy skin is taken from one part of your body and used to cover an area where the skin is damaged or lost. In the case of vitiligo, it can help cover a white patch with healthy skin.

When It’s an Option:

Skin grafts might be considered for adults if:

• No new white patches have shown up in the last year.
• The existing white patches haven’t gotten worse in the last year.
• Skin damage, like a bad sunburn, didn’t cause the vitiligo.

Alternative Approach:

Instead of using skin grafts, another method involves taking a bit of skin, removing the cells that make pigment (melanocytes), and transplanting them onto the vitiligo areas.

Important Points:

• These treatments take time and can lead to scarring.
• They’re not suitable for kids.
• They’re not widely available in the UK, and the NHS doesn’t cover the cost.

Considerations:

Before opting for skin grafts or similar procedures, discuss them with your doctor to weigh the pros and cons and find the best treatment plan for you.

Depigmentation for Vitiligo:

Depigmentation might be suggested for adults who have vitiligo covering more than half of their bodies, although it might not be widely available.

How It Works:

During depigmentation, a special lotion is applied to the normal skin to bleach the remaining pigment and match it with the depigmented (white) skin. This lotion contains a medicine called hydroquinone, which needs to be applied regularly to prevent the skin from getting its color back.

Potential Side Effects:

Using hydroquinone can lead to side effects like:

• Redness
• Itching
• Stinging

Important Points:

• Depigmentation is usually permanent.
• After depigmentation, the skin won’t have natural protection from the sun.
• Sometimes, the color can come back (re-pigmentation), and it might not match your original skin color.

Considerations:

Before considering depigmentation, discuss the risks and benefits with your doctor. They can help you decide if it’s the right choice for you and provide guidance on how to proceed.

Additional Vitiligo Treatments:

Combination Therapies:

Dermatologists often recommend trying multiple treatments simultaneously for better results. For instance:

• Phototherapy with Topical Treatments: A combination of light therapy and skin creams or ointments.

Other Potential Options:

Here are some other treatments that might be considered:

• Excimer Laser: This treatment uses high-energy light beams similar to those used in laser eye surgery. However, it’s typically not covered by the NHS.
• Vitamin D Analogues: Such as calcipotriol, which can complement phototherapy.
• Prednisolone Tablets: These are oral steroids that have been used alongside phototherapy. However, they carry the risk of side effects.

Key Considerations:

• Consultation with a Dermatologist: Discuss with your dermatologist to determine the most suitable combination of treatments for your condition.
• NHS Coverage: Some treatments, like the excimer laser, may not be available through the NHS.
• Side Effect Awareness: Prednisolone tablets can lead to side effects, so it’s essential to be aware of potential risks and benefits in consultation with your doctor.

Evaluating the Effectiveness of Each Treatment

The effectiveness of vitiligo treatments varies depending on factors such as the extent of depigmentation, the patient’s age, and the duration of the condition. While some individuals may experience significant repigmentation with certain treatments, others may see minimal improvement or no response at all.

Factors to Consider When Choosing a Treatment

When deciding on a treatment for vitiligo, several factors should be taken into consideration, including the extent and location of depigmented areas, the patient’s age and overall health, treatment availability and cost, and potential side effects.

Combination Therapies for Vitiligo

Combining different treatment modalities, such as topical therapy with phototherapy or oral medications, may enhance the effectiveness of treatment and promote better outcomes. Dermatologists often tailor treatment plans to individual patients based on their specific needs and preferences.

Potential Side Effects of Treatment

While many vitiligo treatments are generally safe, they may carry certain risks and side effects. These can include skin irritation, photosensitivity, hyperpigmentation, and, in rare cases, an increased risk of skin cancer. It’s essential to discuss potential side effects with your dermatologist before starting treatment.

Lifestyle and Home Remedies to Manage Vitiligo

In addition to medical treatments, certain lifestyle modifications and home remedies may help manage vitiligo symptoms. These can include wearing sunscreen daily, avoiding trauma to the skin, maintaining a healthy diet rich in antioxidants, and managing stress levels.

The Importance of Sun Protection

Sun exposure can worsen vitiligo by causing sunburns and increasing the risk of depigmentation. Therefore, it’s crucial for individuals with vitiligo to protect their skin from the sun by wearing protective clothing, seeking shade, and using broad-spectrum sunscreen with a high SPF.

Psychological Impact of Vitiligo

Living with vitiligo can take a toll on a person’s mental health and self-esteem, leading to feelings of embarrassment, anxiety, and depression. It’s essential to address the psychological impact of vitiligo and seek support from friends, family, or mental health professionals if needed.

Coping Strategies and Support Systems

Finding effective coping strategies and support systems can help individuals with vitiligo manage the emotional challenges associated with the condition. This can include joining support groups, engaging in activities that boost self-confidence, and focusing on acceptance and self-love.

Addressing Common Misconceptions About Vitiligo Treatment

There are many misconceptions surrounding vitiligo and its treatment, such as the belief that it is contagious or that certain treatments are guaranteed to work for everyone. It’s essential to debunk these myths and educate the public about the realities of living with vitiligo.

Future Directions in Vitiligo Research

Researchers are continually exploring new treatment approaches and technologies to improve outcomes for individuals with vitiligo. This includes stem cell therapy, gene therapy, and immunomodulatory drugs that target specific pathways involved in the development of vitiligo.

Conclusion

Choosing the best treatment for vitiligo depends on various factors, including the severity of the condition, individual preferences, and treatment availability. By working closely with a dermatologist and exploring different treatment options, individuals with vitiligo can find a regimen that suits their needs and improves their quality of life.

References:

1. Ezzedine K, Eleftheriadou V, Whitton M, van Geel N. Vitiligo. Lancet. 2015;386:74–84. doi: 10.1016/S0140-6736(14)60763-7. [PubMed] [CrossRef] [Google Scholar]
2. Krüger C, Schallreuter KU. A review of the worldwide prevalence of vitiligo in children/adolescents and adults. Int J Dermatol. 2012;51:1206–1212. doi: 10.1111/j.1365-4632.2011.05377.x. [PubMed] [CrossRef] [Google Scholar]
3. Gauthier Y, Cario Andre M, Taïeb A. A critical appraisal of vitiligo etiologic theories. Is melanocyte loss a melanocytorrhagy? Pigment Cell Res. 2003;16:322–332. doi: 10.1034/j.1600-0749.2003.00070.x. [PubMed] [CrossRef] [Google Scholar]
4. D’Mello SA, Finlay GJ, Baguley BC, Askarian-Amiri ME. Signaling pathways in melanogenesis. Int J Mol Sci. 2016;17(1144) doi: 10.3390/ijms17071144. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
5. Videira IF, Moura DF, Magina S. Mechanisms regulating melanogenesis. An Bras Dermatol. 2013;88:76–83. doi: 10.1590/s0365-05962013000100009. [PMC free article] [PubMed] [CrossRef] [Google Scholar]