Disclaimer: This information is intended only for informational purposes. Only a physician can determine the best treatment for you.
There are a number of treatments available for vitiligo, and the type of treatment should be tailored for each patient, according to his or her needs. Most treatments are prescribed “off label”, since they are not FDA-approved for vitiligo, yet are approved for other skin diseases.
Topical steroids: Topical steroids are widely available and have been used for many years to treat vitiligo. They are cheap and effective, however they have some side effects, including thinning of the skin, stretch marks, and others. When used correctly, these can be largely avoided.
Topical tacrolimus: Topical tacrolimus is a relatively new treatment for vitiligo that has similar efficacy as topical steroids and few side effects that include a mild burning sensation after application and brief flushing of the skin after alcohol consumption. This is currently an expensive treatment that is not always covered by insurance.
nbUVB (Narrow-band ultraviolet light B): nbUVB is currently the most successful treatment for patients with vitiligo. It is largely safe when administered correctly, but requires a time commitment as it is most often performed in a dermatologist’s office 2-3x per week. A weaker version of these booths can also be purchased for your home, although they can be expensive. The way that nbUVB is administered is very important for safety and treatment success, as too much light could burn your skin, and too little light may not improve your vitiligo. Unlike PUVA treatment (below), nbUVB does not appear to increase the risk for skin cancer.
Here is a protocol that is developed for my patients that has been safe and seems to work well.
|Vitiligo nbUVB Treatment Protocol|
Excimer Laser: The excimer laser is similar a similar approach to treatment as narrow band UVB, but delivers a single wavelength of light (which is what lasers do). This wavelength is 308nm, within the nbUVB spectrum, and this seems to be the "right" wavelength to treat vitiligo. It is highy effective, but works best to treat only small areas of the skin, so it's most often used when a patient has just a few spots. Sometimes dermatologists will start with nbUVB and when the patient gets better with just a few small spots remaining, will switch to excimer laser. There are a number of brands of this laser, including XTRAC, PHAROS, and others.
Handheld UVB units: A number of companies sell relatively inexpensive handheld units online that emit UVB. There aren't very good studies that report that they're effective, and in my experience with patients some say they help a little, and others say not that much. They are quite weak compared to nbUVB booths and lasers, and so probably don't compare to those in terms of effectiveness.
PUVA (Psoralen plus Ultraviolet light A): PUVA combines the chemical psoralen with UVA exposure, which can come from the sun or a light booth in a dermatology clinic; many countries offer topicals that contain PUVA and tell the patient to sit in the sun after applying it. While this method was initially used for vitiligo and can be effective, it is not any better than nbUVB (above) but has many side effects, including skin cancer risk and dark spots returning that don’t match the normal skin color. It is for these reasons PUVA is not widely used for vitiligo anymore.
MKTP (Melanocyte-Keratinocyte Transplant Procedure): in a small subset of patients with vitiligo, transplanting melanocytes and keratinocytes from one part of your body to the areas of vitiligo can be a highly effective treatment, and even a cure. It is most effective for those with the segmental variant of vitiligo, which remains localized to only one site on only one side of your body. You can read more about this procedure here, on our blog post. We have established this procedure here at UMMS, directed by Dr. Dori Goldberg, and are scheduling appropriate patients.
Monobenzone: Monobenzone is the only FDA-approved treatment for vitiligo, however its purpose is to worsen the disease and remove the remaining pigment on your body in order to make the skin color more even. This is only recommended for those patients with widespread disease that have failed other options to return the pigment to the skin. It is not widely available, and must be produced by a compounding pharmacy.
Others: Many other treatments have been suggested for vitiligo, but have either no proven efficacy in disease, or have such little efficacy that we prioritize other proven treatments instead.