Medically reviewed by Owen Kramer, MD on January 31, 2020 New — Written by Jessica Caporuscio, Pharm.D.
Vitiligo is a chronic condition that causes areas of skin to lose their color. The medical term for the loss of skin color is depigmentation. Any area of the skin can lose its pigment. Depigmented patches may be small initially and grow over time.
Vitiligo is an autoimmune condition, and it is linked with several others. The National Institutes of Health (NIH) report that around 15-25% of people with vitiligo have at least one other autoimmune disorder, such as rheumatoid arthritis, type 1 diabetes, or psoriasis. Some people find that vitiligo affects their self-esteem and look for ways to give their skin an even appearance. While there is no cure for vitiligo, some treatments can help restore pigment to affected skin. Other treatments and strategies may help prevent areas of depigmentation from growing.
In this article, we discuss ways of managing vitiligo.
What causes Vitiligo?
While doctors once considered vitiligo to be a cosmetic condition, they now recognise it as an autoimmune disorder. This means that it results from the body’s immune system mistakenly attacking healthy cells. In vitiligo, the immune cells attack melanocytes — cells that give the skin its color. Up to 20% of people with vitiligo experience itching, and the affected skin is more likely to sustain sunburn. Researchers have identified genetic variations that may be associated with vitiligo. However, it is still not clear why the immune system attacks melanocytes.
Can you prevent it?
Certain genetic variations may increase a person’s chances of having vitiligo. However, doctors cannot predict whether a person will develop the condition based on their genetic makeup. There are no ways to prevent vitiligo from developing. However, certain treatments can help prevent existing areas of depigmentation from growing.
Some people with vitiligo decide not to have treatment. Patches of affected skin may be very small, or a person may otherwise not find them bothersome. Other people, particularly younger people, find that vitiligo can have a powerful impact on their quality of life. A person with the condition may choose to camouflage areas of depigmentation with makeup, self-tanners, or skin dyes.
Alternately, most medical treatments aim to restore skin pigment. However, when a very large area of the skin is depigmented, a person may opt for a treatment that involves removing existing pigment to give the skin a more uniform color.
Below, learn about some common treatments for vitiligo.
Dermatologists may prescribe topical creams or ointments that contain potent corticosteroids. These medications can help reduce skin inflammation and allow for the restoration of pigment. However, powerful steroids are not suitable for use on all areas of skin. Around 45% of people will notice some color returning to areas of vitiligo after 4–6 months of using these strong corticosteroids. However, over long periods, they can cause the skin to become thin, dry, and fragile. Anyone using corticosteroids for vitiligo should see their dermatologist regularly for checkups.
Light Therapy for Vitiligo
Light therapy, or phototherapy, can help restore color to areas of skin depigmentation. It requires a person to attend two or three treatment sessions per week for several weeks, which can be expensive, as well as time-consuming. Some doctors combine light therapy with a topical corticosteroid cream. This can boost results, in some cases.
The most common form of phototherapy for vitiligo is narrowband ultraviolet B therapy (NBUVB).
Another option is excimer laser therapy, which doctors tend to recommend when vitiligo has only affected a few areas of skin. Around 70% of people with vitiligo see skin color improvement following this type of treatment. However, results of light therapy are unlikely to be permanent. The American Academy of Dermatology (AAD) report that 44% of people who undergo phototherapy for vitiligo find that restored pigment fades or disappears within 1 year of stopping the treatment, and around 86% experience this within 4 years.
Psoralen and ultraviolet A (PUVA) therapy involves taking a drug called psoralen orally or topically and receiving UVA light treatment. Some dermatologists recommend PUVA for vitiligo, but NBUVB is the more common choice now. According to the AAD, PUVA is not very adept at restoring pigment to the hands or feet, but it is about 50-75% effective at restoring skin color to the:
- upper arms
- upper legs
PUVA is a time-consuming treatment, requiring a person to attend two sessions per week for about 1 year.
If other conventional treatments have not produced the desired results, a person may opt for surgery. The exact procedure can vary based on factors specific to each individual, but the goal of surgery is to transplant healthy, pigmented skin onto areas of depigmentation. The AAD report that these procedures are effective in about 90-95% of people who undergo them.
However, these surgeries can result in complications, such as infections and permanent changes in skin texture.
If vitiligo affects large areas, and the person has not found other treatments to be effective, they may wish to try depigmentation. It involves removing the pigment from healthy skin, giving the skin a more consistent color. To remove pigment, a person must apply depigmentation creams to pigmented areas once or twice a day. It can take 1–4 years before the skin’s surface is an even color. Also, the skin may continue to develop pigment, so the person may need to keep using the products to achieve the desired result.
The AAD note that the following nonconventional treatments may help restore skin pigment:
- amino acids
However, they stress that evidence for the effectiveness of these methods is lacking.
One exception may be Ginkgo biloba, which may benefit the immune system. An older study, from 2003, investigated the effects of Ginkgo biloba extract on the progression of vitiligo depigmentation. Forty-seven participants with limited, slow-spreading vitiligo took part in the study. Each received either 40 milligrams of oral Ginkgo biloba or a placebo three times daily. By the end of the study, 10 people who took the extract had noticeable restoration of skin pigmentation, compared to two people in the placebo group. This result was statistically significant. However, confirming these findings will require more research.
Meanwhile, extract of Polypodium leucotomos, a variety of fern, may also help treat vitiligo and other skin disorders. Some research indicates that PUVA light therapy plus this extract may restore pigment more effectively than the light therapy alone. The extract is widely available under the brand name Heliocare.
People with vitiligo may find that certain strategies help limit depigmentation. In particular, doctors recommend protecting the skin from the sun. Depigmented skin is more sensitive to ultraviolet light and can easily sustain sunburn. Also, areas of depigmentation are more likely to spread following a bad sunburn.
The AAD advise that people choose a broad-spectrum sunscreen, which provides the most coverage, as well as one that is waterproof and has a minimum sun protection factor, or SPF, of 30.
Other ways to reduce exposure include:
- wearing clothing that protects the skin from the sun
- seeking shade when possible
- not using tanning beds or sun lamps
- using alternatives to sunbathing, such as self-tanner, concealing cream, or makeup
Tattoos can also worsen depigmentation. People who have vitiligo and get a tattoo may notice a new area of depigmentation develop about 10-14 days later.
There is currently no cure for vitiligo and no way to prevent the condition. If a person decides to pursue treatment, the aim is generally to restore pigment and prevent depigmentation from affecting more skin. Limiting sun exposure is one of the most effective ways to prevent depigmentation and damage.
Certain medical interventions can help restore the color of skin, but not all treatments are equally effective. Anyone seeking treatment should consult a dermatologist about the best options for them