By: Therese Anne Limbana; December 19, 2021
Overview
Vitiligo is a skin condition characterized by the loss of color (i.e., pigment) in the skin. This results in patches of lighter skin compared to the person’s natural skin tone.
More specifically, smaller areas without pigment are known as macules, while larger areas are referred to as patches. In cases where vitiligo occurs in areas of the body with hair, the hair may also become white or silver.
In this article, I will briefly touch on the causes of vitiligo, then delve into the details of how we can treat this condition.
What causes vitiligo?
Vitiligo occurs when there is a lack of melanin, which is the pigment responsible for skin color. The exact cause of this condition is still unknown, but research suggests that it could be attributed to the following factors:
Autoimmune condition – Some researchers believe that vitiligo may stem from an autoimmune response, where the immune system mistakenly identifies healthy melanocytes (the cells that produce melanin) as harmful invaders and produces antibodies that neutralize their action.
Genetic changes – Changes or mutations in the genes related to melanocyte function can influence the development of vitiligo. There are more than 30 genes that can increase the risk of developing this condition.
Stress – Emotional or physical stress following an injury can impact the production of pigment by melanocytes.
Environmental triggers – Certain environmental factors, such as exposure to ultraviolet radiation from the sun or contact with toxic chemicals, can also affect the functioning of melanocytes. These triggers may disrupt melanin production and contribute to the development of vitiligo.
What are the treatments for vitiligo?
Several medications are available for the treatment of vitiligo. These medications help reduce the spread of pigmentation loss.
Here are some treatment options:
1. Creams and ointments
Corticosteroids
Corticosteroids are effective for people who have recently developed vitiligo or have newer lesions. However, patients usually use corticosteroids for a limited period due to potential side effects.
Calcineurin inhibitors
Pimecrolimus cream and tacrolimus ointment are examples of calcineurin inhibitors. They are commonly applied to areas, such as the eyelids, face, neck, armpits, and groin, as these areas may be more sensitive to the side effects of corticosteroids. Luckily, you can use calcineurin inhibitors for a long duration without causing skin atrophy.
Calcipotriene
When combined with a corticosteroid, calcipotriene can be very effective, according to the American Academy of Dermatology Association (AAD).
Ruxolitinib (Opzelura) cream
Ruxolitinib (Opzelura) is a Janus kinase inhibitor (JAK inhibitor) approved by the Food and Drug Administration (FDA) for the treatment of non-segmental vitiligo in adults and children aged 12 years and older. It may take around 24 weeks or more to see satisfactory results.
2. Oral corticosteroids
Prednisone is an oral medication that slows down the progression of active vitiligo and restores skin color. Typically, you will need to take this drug for 1 to 2 weeks.
3. Light Therapy
Light therapy uses controlled exposure to ultraviolet (UV) light to restore natural skin color. Experts suggest that this technique suppresses the immune system to protect melanocytes from destruction or by stimulating certain growth factors in the skin.
Most likely, you need to administer light therapy 2 to 3 times per week for 3 to 4 months. If you see positive results, you may continue the treatment for up to 2 years. Light therapy may not be suitable for individuals with very fair skin.
Different types of light therapy include:
Phototherapy
This involves standing in a lightbox for a specific time recommended by a dermatologist. It is suitable for treating larger areas, such as the trunk.
Laser therapy
Targeted laser therapy can restore pigmentation to specific parts of the body, including the face, neck, fingers, toes, and lips.
PUVA (photochemotherapy)
You can use UVA light therapy combined with a plant-based medication called psoralen orally, topically, or in bathwater. However, this therapy is less commonly used due to potential toxic side effects.
4. Cosmetics, Tanning Products, and Skin Dye
Cosmetics can cover redness, hyperpigmentation, and depigmentation. Dermatologists recommend various products to cover depigmentation, including:
Makeup
Tinted primers, foundations, and powders can help. It is important to choose a color that closely matches your natural skin tone and apply the makeup daily for consistent results. Waterproof makeup may be more resistant to rain, humidity, and sweat.
Self-tanner
These products can provide coverage for up to 5 days.
Skin dyes and stains
These products may last longer than makeup, depending on how often you wash the affected area.
5. Micropigmentation for Implanting New Pigment
Micropigmentation is a tattooing technique that involves implanting new pigment into blotchy areas of the skin affected by vitiligo.
Although this treatment can be effective, you might need to repeat it every few years to maintain a natural-looking color. Note that dermatologists recommend this treatment for stable vitiligo, as it could trigger further pigmentation loss if performed on active vitiligo.
6. Supplements and Lifestyle Changes
Since there is no single treatment that works for everyone with vitiligo, you can explore natural options and make lifestyle changes to help mitigate your symptoms.
Here are some steps you can discuss with your doctor:
- Light therapy combined with specific micronutrient supplements
- Reduce sun exposure
- Use sunscreen with at least SPF 30 to prevent uneven tanning and hyperpigmentation
Despite the potential benefits of vitiligo’s natural treatments, a 2017 review concluded that these treatments are most likely to be effective in the early stages of vitiligo. Further research is necessary to determine the efficacy of any homeopathic approach to this condition.
Takeaway message
Vitiligo is a chronic condition that has vague causes. The signs of this condition can be the source of severe mental distress. Thankfully, there are numerous treatment options to address this condition.
About the Author:
Therese Anne Limbana was born and raised in the Philippines. She migrated to the US to work as a nurse and served as a front-liner during the global pandemic. She aims to be a dermatologist and has authored numerous peer-reviewed publications in dermatology and psychiatry. You can visit her site at drmissionsny.com
