Vitiligo - Treating vitiligo

Treatment for vitiligo is based on improving your skin’s appearance by restoring its colour. However, the effects of treatment are not usually permanent, and it cannot always control the spread of the condition.

Your GP may begin treating your condition with:

• sun safety advice
• a referral for camouflage creams
• topical corticosteroids

No further treatment may be necessary if, for example, you only have a small patch of vitiligo or have very fair skin anyway. You may be referred to a dermatologist (specialist in treating skin conditions) if further treatment is needed.

Read on to learn about the different treatments you may be offered. You can also see a summary of the pros and cons of these treatments, which allows you to easily compare your treatment options.

Protection from the sun

Sunburn is a real risk if you have vitiligo. You must protect your skin from the sun and avoid sunbeds.

When skin is exposed to sunlight, it produces a pigment called melanin to help protect it from ultraviolet light. If you have vitiligo, there is not enough melanin in your skin, so it is not protected.

Always apply a high-factor sunscreen, ideally with a sun protection factor (SPF) of 30 or above, to protect your skin from sunburn and long-term damage. This is particularly important if you have fair skin.

Read more about sunburn.

Protecting your skin from the sun will also mean you don't tan as much. This will make your vitiligo less noticeable.

Vitamin D

If your skin is not exposed to the sun, there is an increased risk of vitamin D deficiency. Vitamin D is essential for keeping bones and teeth healthy.

Sunlight is the main source of vitamin D, although it's also found in some foods, such as oily fish.

To avoid potential problems like rickets (known as osteomalacia in adults), you may need to take vitamin D supplements.

Skin camouflage

Skin camouflage involves applying coloured creams to the white patches on your skin. These creams are specially made to match your natural skin colour. The cream blends in the white patches with the rest of your skin, making them less noticeable.

For advice about skin camouflage, your GP may refer you to the Changing Faces skin camouflage service.

You need to be trained in using the camouflage creams, but the service is free (although donations are welcome) and some creams are prescribed on the NHS.

Camouflage creams are waterproof and can be applied anywhere on the body. They last up to four days on the body and 12-18 hours on the face.

You can also get skin camouflage cream that contains sun block or has an SPF rating.

Self-tanning lotion (fake tan) may also help cover vitiligo. Some types can last several days before you need to reapply them. Self-tanning lotion is available from most pharmacies.

Topical corticosteroids

Corticosteroids are a type of medicine that contains steroids. Topical means that the medicine is applied to the skin, such as a cream or ointment.

Topical corticosteroids are unlicensed for the treatment of vitiligo, but they can sometimes stop the spread of the patches, and may restore some of your original skin colour. Your GP may prescribe a topical corticosteroid cream to adults if:

• you have non-segmental vitiligo on less than 10% of your body
• you want further treatment (sun protection advice and camouflage creams are enough for some people) 
• the treatment is not for your face
• you are not pregnant
• you understand and accept the risk of side effects

Read more about topical corticosteroids.

Using topical corticosteroids

Your GP may prescribe a cream or an ointment, depending on what you prefer and where it will be used. Ointments tend to be greasier. Creams are better in your joints – for example, inside your elbows. Possible corticosteroids that may be prescribed include:

• fluticasone propionate
• betamethasone valerate 
• hydrocortisone butyrate

Your GP will tell you how to apply the cream or ointment to the patches and how much you should use (see below). You normally need to apply the treatment once a day.

How much topical corticosteroid to use

• Topical corticosteroids are measured in a standard unit called the fingertip unit (FTU).
• One FTU is the amount of topical steroid squeezed along an adult's fingertip.
• One FTU is enough to treat an area of skin twice the size of an adult's hand.

Read more about finger tips units.

Follow-up

After one month, your GP should ask you to return, so they can see how well the treatment is working and check for any side effects. If your vitiligo is not improving or the treatment is causing side effects, you may need to stop using corticosteroids.

After another month, your GP will see how much your vitiligo has improved. If there is no improvement, you may be referred to a dermatologist (see below). If your vitiligo has improved slightly, you may continue treatment, but have a two-week break from treatment every three weeks. You may also be referred to a dermatologist.

If the vitiligo has improved, treatment will be stopped. 

Your GP may take photos of your vitiligo throughout your treatment to monitor any signs of improvement. If you have a camera, you may also want to take photos to keep an eye on your condition.

Side effects

Side effects of topical corticosteroids include:

• streaks or lines in your skin (striae)
• thinning of your skin (atrophy)
• visible blood vessels appearing (telangiectasia)
• excess hair growth (hypertrichosis)
• contact dermatitis (inflammation of your skin)
• acne

Referral

You GP may refer you to a dermatologist if:

• they are unsure about your diagnosis
• you are pregnant and need treatment 
• more than 10% of your body is affected by vitiligo 
• you are distressed about your condition 
• your face is affected and you want further treatment 
• you cannot use topical corticosteroids because of the risk of side effects 
• you have segmental vitiligo and want further treatment 
• treatment with topical corticosteroids has not worked

Children with vitiligo who need treatment will also be referred to a dermatologist.

In some cases, you may be prescribed strong topical corticosteroids while you are waiting to be seen by a dermatologist.

Some treatments your dermatologist may recommend are described below.

Topical pimecrolimus or tacrolimus

Pimecrolimus and tacrolimus are a type of medicine called calcineurin inhibitors, which are normally used to treat eczema.

Although they are unlicensed for the treatment of vitiligo, pimecrolimus or tacrolimus may be used for children or adults with the condition.

They can cause side effects, such as:

• burning or painful sensations 
• making the skin more sensitive to sunlight
• facial flushing (redness) and skin irritation if you drink alcohol

Phototherapy

Phototherapy (treatment with light) may be used for children or adults if:

• topical treatments have not worked 
• the vitiligo is widespread
• the vitiligo is having a significant impact on their quality of life

Evidence suggests that phototherapy, particularly when combined with other treatments, has a positive effect on vitiligo.

During phototherapy, your skin is exposed to ultraviolet A (UVA) or ultraviolet B (UVB) light from a special lamp. You may first take a medicine called psoralen, which makes your skin more sensitive to the light. You can take psoralen by mouth (orally), or you can add it to your bath water.

This type of treatment is sometimes called PUVA (psoralen and UVA light).

Phototherapy may increase the risk of skin cancer because of the extra exposure to UVA rays. Your dermatologist should discuss this risk with you before you decide to have phototherapy.

Although you may be able to buy special sunlamps to use at home for light therapy, these are not recommended. They are not as effective as the phototherapy you will receive in hospital. The lamps are also not regulated, so may not be safe. 

Skin grafts

A skin graft is a surgical procedure that involves removing healthy skin from an unaffected area of the body and using it to cover an area where the skin has been damaged or lost. To treat vitiligo, a skin graft can be used to cover the white patch.

Skin grafts may be considered for adults in areas that are affecting your appearance if:

• no new white patches have appeared in the last 12 months 
• the white patches have not gotten worse in the last 12 months 
• your vitiligo was not triggered by damage to your skin, such as severe sunburn (known as the Koebner response)

This type of treatment is time-consuming and is not widely available in the UK. It has a risk of scarring and will not be considered for children.

Depigmentation

Depigmentation may be recommended for adults who have vitiligo on more than 50% of their bodies, although it may not be widely available.

During depigmentation, a lotion is painted on to the normal skin to bleach away the pigment and make it the same colour as the depigmented (white) skin. A hydroquinone-based medication is used, which has to be applied continuously to prevent the skin from re-pigmenting.

Hydroquinone can cause side effects, such as:

• redness
• itching 
• stinging

Depigmentation is usually permanent and leaves the skin with no protection from the sun. Re-pigmentation (when the colour returns) can occur, and may differ from your original skin colour.

Other treatments

Your dermatologist may recommend trying more than one treatment, such as phototherapy combined with a topical treatment. Other possible treatments include:

• excimer lasers – high-energy beams of light that are used in laser eye treatment, but may also be used in phototherapy 
• vitamin D analogues – such as calcipotriol, which may also be used with phototherapy
• azathioprine – a medicine that suppresses your immune system (the body’s natural defence system), which may be used with phototherapy 
• oral prednisolone – a type of corticosteroid, which has also been used with phototherapy, although it can cause side effects

Complementary therapies

Some complementary therapies claim to relieve or prevent vitiligo. However, there is no evidence to support their effectiveness, so more research is needed before they can be recommended.

There is very limited evidence that Ginkgo Biloba, a herbal remedy, may benefit people with non-segmental vitiligo. However, there is currently not enough evidence to recommend it.

If you decide to use herbal remedies, check with your GP first, as some remedies can react unpredictably with other medication or make them less effective.

Counselling and support groups

If you have vitiligo, you may find it helpful to join a vitiligo support group. This can help you understand more about your condition and come to terms with your skin’s appearance.

Charities, such as The Vitiligo Society, may be able to put you in touch with local support groups (you may need to become a member first). Your GP may also be able to suggest a local group.

If you have psychosocial symptoms – for example, your condition is causing you distress – your GP may refer you to a psychologist or a counsellor for treatment such as cognitive behavioural therapy (CBT).

CBT is a type of therapy that aims to help you manage your problems by changing how you think and act.