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Medical Therapies

There are several Medical Therapies available for the treatment of the chronic skin disease Vitiligo, most of which are applied topically.

Some of the most commonly used are:

• Topical Steroid Therapy: Steroid creams may be helpful in repigmenting white patches, particularly if they are applied in the initial stages of the disease. Doctors often prescribe a mild topical corticosteroid cream (group of drugs similar to hormones such as cortisone) for children under 10 years old and a stronger one for adults. This cream should be applied on the white patches on the skin for at least 3 months before seeing any results. Corticosteriod creams are the simplest and safest treatment for vitiligo, but are not as effective as psoralen photochemotherapy. Yet, as with any medication, these creams can cause side effects, especially in areas where the skin is thin, such as on the face and armpits, or in the genital region.

• Psoralen Photochemotherapy: Also known as psoralen and ultraviolet A (PUVA) therapy, this is probably the most effective treatment for Vitiligo available in the United States. The goal of PUVA therapy is to repigment the white patches. However, it is time-consuming, and care must be taken to avoid side effects, which can sometimes be severe. Psoralen is a drug that contains chemicals that react with ultraviolet light to cause darkening of the skin. The treatment involves taking psoralen by mouth (orally – used for people with widespread Vitiligo or for people who do not respond to topical PUVA therapy ) or applying it to the skin (topically – mostly used for people with a small number of depigmented patches affecting a limited part of the body and for children age 2 and older who have localized patches of vitiligo). This is followed by carefully timed exposure to sunlight or to ultraviolet A (UVA) light that comes from a special lamp. Typically, you will receive treatments in your doctor's office so you can be carefully monitored for any side effects. You must minimize exposure to sunlight at other times. For patients who cannot go to a facility to receive PUVA therapy, the doctor may prescribe psoralen that can be used with natural sunlight exposure. The doctor will give you careful instructions on carrying out treatment at home and monitor you during scheduled checkups.

• Depigmentation: This treatment involves fading the rest of the skin on the body to match the areas that are already white. For people who have Vitiligo on more than 50% of their bodies, depigmentation may be the best treatment option. Patients apply the drug monobenzyl ether of hydroquinone (monobenzone) twice a day to pigmented areas until they match the already-depigmented areas. You must avoid direct skin-to-skin contact with other people for at least 2 hours after applying the drug, as transfer of the drug may cause depigmentation of the other person's skin. The major side effect of depigmentation therapy is inflammation (redness and swelling) of the skin. You may experience itching or dry skin. Depigmentation tends to be permanent and is not easily reversed. In addition, a person who undergoes depigmentation will always be unusually sensitive to sunlight.

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