It includes local application of creams, phototherapy and, on rare occasions, oral tablets. All medical therapies are under medical supervision.
All medical therapies are effective on hairy areas with pigmented hairs. On non-hairy areas such as wrists, feet, ankles and in presence of grey hair, they have very little or no effect.
They are used when Vitiligo is restricted to less than 5% of the body surface area.
- Topical Corticosteroids: This is the most commonly used medication. Prolonged use is associated with several side effects such as skin atrophy, pimples, stretch marks, etc.
- Topical Calcineurin Inhibitors: Tacrolimus Pimecrolimus are known generic products. They do not contain any steroids and are safer, and known to be equally effective as steroids.
- Topical Psoralens: Makes skin sensitive to sunrays (ultra violet rays), stimulates multiplication of melanocytes, thus helping to re-pigment white spots. This is not a common treatment at present because of the potential of sunburn and blisters.
Narrow Band Ultra Violet B (NB UVB): This is considered the Gold Standard treatment for Vitiligo. The patient exposes the whole body or affected area to NB UVB (311nm wavelength) two or three times a week, for a period of 3 to 24 months. Whole Body Chambers (more effective than small home units) or Small Home Units are used. It has the potential to stop the spread of disease. Short-term side effects are: redness, itching, blisters, dryness of skin. Long-term side effects are: tanning of skin, dryness and redness of eyes, activation of viral infections. Development of skin cancer is more theoretical, because existing studies indicate no increase in risk of skin cancer compared to normal population. Moreover, skin cancers are extremely rare in brown-skin & Vitiligo affected populations.
- PUVA (Photochemotherapy): It is not commonly used at present. It uses oral medication (psoralen), followed by exposure to UVA light (320nm – 400nm wavelength) either in a chamber or with sunlight. It can produce sunburn type reactions and increased risk of skin cancer.
- Excimer Laser (308nm): This is a targeted form of exposure to NB UVB light, sparing exposure to normal skin and is useful for localized lesions. Adverse effects are similar to those of Whole Body NB UVB and are very expensive.
- Oral Steroid Mini Pulse Therapy: Betamethasone / dexamethasone / prednisolone are used as weekly doses. It is very effective in arresting the spread of Vitiligo and moderately effective in producing repigmentation. This treatment is controversial, is associated with several side effects and course of Vitiligo after discontinuation of oral steroids is unpredictable. According to present consensus, it can be recommended for up to 4 to 6 months in patients with rapidly spreading Vitiligo.
- Oral Immunosuppressants: Methotrexate, Azathioprine, Levamisole are used to control the spread of Vitiligo. However, there is not enough data to support their efficacy and are associated with several side effects.
These are used occasionally. However, there is not enough data to support its efficacy.
Important Note: It is important to note that since no cause is known, there is no permanent cure for Vitiligo/Leukoderma. The disease can be treated to achieve re-pigmentation of Vitiligo patches, but it cannot be cured from the root.