Vitiligo Treatment Option 1: Medical Therapies
Vitiligo Medical Therapies
The goal of treating vitiligo is to restore the function of the skin and to improve the patient’s appearance. Therapy for vitiligo takes a long time—it usually must be continued for 6 to 18 months.
The choice of therapy depends on the number of white patches and how widespread they are and on the patient’s preference for treatment.
Each patient responds differently to therapy, and a particular treatment may not work for ever yone.
This page considers:
Topical Steroid Therapy
Steroids may be helpful in repigmenting the skin (returning the color to white patches), particularly if started early in the disease. Corticosteroids are a groupof drugs similar to the hormones produced by the adrenal glands (such as cortisone).
Doctors often prescribe a mild topical corticosteroid cream for children under 10 years old and a stronger one for adults. Patients must apply the cream to the white patches on their skin for at least 3 months before seeing any results.
It is the simplest and safest treatment but not as effective as psoralenphotochemotherapy (see below). The doctor will closely monitor the patient for side effects such as skin shrinkage and skin striae (streaks or lines on the skin).
Psoralen photochemotherapy (psoralen and ultraviolet A therapy, or PUVA) is probably the most beneficial treatment for vitiligo available in the United States. The goal of PUVA therapy is to repigment the white patches.
However, it is timeconsuming and care must be taken to avoid side effects, which can sometimes be severe. Psoralens are drugs that contain chemicals that react with ultraviolet light to cause darkening of the skin.
The treatment involves taking psoralen by mouth (orally) or applying it to the skin (topically). This is followed by carefully timed exposure to ultraviolet A (UVA) light from a special lamp or to sunlight.
Patients usually receive treatments in their doctors’ offices so they can be carefully watched for any side effects. P atients must minimize exposure to sunlight at other times.
Topical Psoralen Photochemotherapy
Topical psoralen photochemotherapy often is used for people with a small number of depigmented patches (affecting less than 20 percent of the body). It is also used for children 2 years old and older who have localized patches of vitiligo.
Treatments are done in a doctor’s office under artificial UVA light once or twice a week. The doctor or nurse applies a thin coat of psoralen to the patient’s depigmented patches about 30minutes before UVA light exposure. The patient is then exposed to an amount of UVA light that turns the affected area pink.
The doctor usually increases the dose of UVA light slowly over many weeks. Eventually, the pink areas fade and a more normal skin color appears. After each treatment, the patient washes his or her skin with soap and water and applies a sunscreen before leaving the doctor’s office.
There are two major potential side effects of topical PUVA therapy: (1) severe sunburn and blistering and (2) too much repigmentation or darkening of the treated patches or the normal skin surrounding the vitiligo (hyperpigmentation).
Patients can minimize their chances of sunburn if they avoid exposure to direct sunlight after each treatment. Hyperpigmentation is usually a temporary problem and eventually disappears when treatment is stopped.
Oral Psoralen Photochemotherapy
Oral PUVA therapy is used for people with more extensive vitiligo (affecting greater than 20 percent of the body) or for people who do not respond to topical P UVA therapy.
Oral psoralen is not recommended for children under 10 years of age because of an increased risk of damage to the eyes, such as cataracts. For oral PUVA therapy, the patient takes a prescribed dose of psoralen by mouth about 2 hours before exposure to artificial UVA light or sunlight.
The doctor adjusts the dose of light until the skin areas being treated become pink. Treat10ments are usually given two or three times a week, but never 2 days in a row. For patients who cannot go to a PUVA facility, the doctor may prescribe psoralen to be used with natural sunlight exposure.
The doctor will give the patient careful instructions on carrying out treatment at home and monitor the patient during scheduled checkups. Known side effects of oral psoralen include sunburn, nausea and vomiting, itching, abnormal hair growth, and hyperpigmentation.
Oral psoralen photochemotherapy may increase the risk of skin cancer. To avoid sunburn and reduce the risk of skin cancer, patients undergoing oral PUVA therapy should apply sunscreen and avoid direct sunlight for 24 to 48 hours after each treatment.
Patients should also wear protective UVA sunglasses for 18 to 24 hours af ter each treatment to avoid eye damage, particularly cataracts.