Vitiligo is a skin depigmenting disorder characterised by patches of white skin; to read more and understand about the condition, you can check out – All About Vitiligo. There’s no known way to prevent or cure vitiligo. But you can make your affected skin look better with treatment. Treating the condition involves changing the skin’s appearance by restoring the original colour. Your skin specialist may suggest either medical or surgical options depending on the type of vitiligo and whether it is spreading or not. Before beginning the treatment, here are some of the lifestyle modifications which you can do.

Natural Therapy | Lifestyle Modifications

Protection from the sun

There is a high risk of sunburn in vitiligo because of the absence of melanin so one must protect his/her skin from the sun. Always apply a sunscreen with a minimum SPF of 30 or above in order to protect your skin from sunburn and long-term damage. This is especially important for those who have fair skin. Apply sunscreen generously and reapply every three hours. You can also seek shade and wear clothing that covers your skin like full sleeve tops and scarves/caps/broad-brimmed hats.

Vitamin D

Sunlight is the main source of vitamin D, although a form of vitamin D is also found in some foods. If your sun exposure is limited then it might be difficult to get sufficient vitamin D from food and sunlight alone. Consider taking a daily supplement containing 10 micrograms (mcg) of vitamin D in that case.

Skin camouflage

Skin camouflage creams can be applied to the white patches of skin. The creams are made to match your natural skin colour. The cream helps to blend the white patches with the rest of your skin, so they are not as noticeable. Camouflage creams are waterproof and can be applied to any areas. They usually last for around 12-18 hours on the face and up to 4 days on the body. Your doctor can recommend a skin camouflage cream if you want to use it, which is sometimes helpful before any social events.

Conceal affected skin

Makeup can help to minimize the differences in skin colour. You may need to try out a few different products to find one which blends well with the surrounding skin tone. Once you have found a product which suits your skin tone and skin type, it can be a valuable tool to apply as far as the face is concerned.

Tattoo

When your vitiligo is in the unstable phase, tattooing can cause new patches to appear on the tattoo site within 2-4 weeks. So it is not advisable to do tattooing. However, a new technique of micro-pigmentation is useful in the stable phase of vitiligo where the depigmented skin can be injected with the same colour as the surrounding skin to achieve a good cosmetic outcome.

Talk to your skin specialist for more information on dermablading | micro-pigmentation | cosmetic tattooing.

Alternative medicine

The herb known as Ginkgo biloba has been effective to return skin colour to normal in a small number of studies. Few other studies have shown that alpha-lipoic acid, folic acid, vitamin C and vitamin B-12 may help in restoring skin colour for some people. Check with your doctor before trying alternative therapies and their effectiveness.

Medical Management

Topical Steroids

Steroid creams are most commonly used to stop the spread of white patches and restore some of the original colour. It is the preferred option in the following cases:

Localised vitiligo on less than 10% of your body.
You want further treatment after trying the natural remedies.
You understand and accept the risk of side effects.

Find out more about topical steroids.

Using topical steroids

A doctor may prescribe a steroid cream of different strength depending on the age and other relevant factors. The skin specialist will also explain to you, how to apply the cream and how much to apply. You usually need to apply the cream or lotion once a day.

Follow-up

After 1 month, you’ll have a follow-up appointment and the skin specialist can check how well the treatment is working and decide how to proceed further. After another 1-2 months, the doctor will check how much your vitiligo has improved. If there’s no improvement, then new additions to the treatment can be made for better results.

If it improves slightly, you may need to continue the treatment, but have a break from treatment every few weeks. The treatment may be stopped if your vitiligo has improved significantly. The doctor may take photos of your vitiligo throughout your treatment to monitor any signs of improvement. You should also take photos, yourself.

Pimecrolimus and tacrolimus

Pimecrolimus and tacrolimus are calcineurin inhibitors, which are usually used topically to treat dermatitis. They can be used to help restore the skin colour in children and adults with vitiligo. Unlike steroids, it will not cause thinning of skin or atrophy so it is a good steroid-sparing option.

Other treatments

A skin specialist may start multiple treatments simultaneously for better results. Some of the useful medicines in stopping the progress of vitiligo are:

Calcipotriol: It is a vitamin-D analogue which has been found to be useful as a steroid-sparing agent in vitiligo.
Prednisolone tablets – It is an oral steroid. Usually, it is given in cases where more than 30% of the skin has been affected or in cases where new lesions are occurring rapidly and the disease is in the unstable phase. However, talk to your skin doctor to understand in detail about this medicine and take it only after understanding the risks and benefits.
Methotrexate: A medicine that suppresses your immune system and helps by preventing the immune-mediated destruction of melanocytes.
Azathioprine: Another medicine which suppresses the immunity. Given in rare cases.

The choice of treatment depends on your age, sites and area of involvement and how quickly the disease is progressing. It also depends on how much it is affecting your life.

Phototherapy

Phototherapy, or light therapy, using UVB and UVA light can slow or stop the progression of your vitiligo. In some cases, this is done in combination with the medicines your doctor prescribes. It can be done a few times every week in a doctor’s office or by using a portable device which allows you to get the treatment at home. Ask your skin specialist about it.

NBUVB Light Therapy: Phototherapy with narrowband ultraviolet B (UVB) has been shown to stop or slow the progression of active vitiligo. It might be more effective when used with corticosteroids or calcineurin inhibitors. You’ll need therapy 2-3 times per week and it could take up to 3 months before you notice any changes and up to 6 months or longer to get the full effect. Possible side effects of NBUVB therapy include redness, itching and burning but these side effects usually clear up within a few hours after the treatment.

Psoralen and light therapy. This treatment combines a plant-derived substance called psoralen with light therapy and it is known as photochemotherapy. You have to take the psoralen tablet or apply the psoralen lotion to the affected skin and then expose your skin to ultraviolet A (UVA) light. If dedicated UVA machines are unavailable, direct sunlight can be used (PUVA-SOL).

Removing the remaining colour (depigmentation). This therapy may be an option if your vitiligo is widespread (generalised vitiligo, universal vitiligo). A depigmenting cream is applied to unaffected areas of skin which gradually lightens the skin so that it blends with the white areas. It may need to be used for up to 9 months. But be cautious since the depigmentation is permanent.

Medications and light-based therapies are available to help restore skin colour. But the results often vary and they are unpredictable. Some people get very good results whereas some people do not get an adequate response. If you and your doctor decide to treat your condition with medical therapy or phototherapy, the process may take many months to judge its effectiveness. And you may have to try more than one approach or a combination of approaches before you find the treatment that works best for you.

Even if treatment is successful for a while, the results may not last or new patches may appear. In such cases, your skin specialist may recommend a medication as maintenance therapy to help prevent relapse.

Surgery

If light therapy and medications don’t work, some people with stable disease may be good candidates for surgery. The following techniques are usually used:

Skin Grafting. In this procedure, your skin specialist will transfer a small section of your healthy skin with pigment into areas that have lost colour. This procedure is helpful if you have small patches of vitiligo. Although it sounds painful, the area is usually anaesthetised and it is a relatively painless procedure.
Blister grafting. In this procedure, the skin specialist will create blisters on your pigmented skin with a suction technique and then transplant the top of the blisters to the areas of skin discolouration.
Cellular suspension transplant. In this procedure, your doctor will take a small portion of your pigmented skin and put the cells into a solution which is then transplanted onto the prepared, affected area. The results of this repigmentation procedure start to show within four weeks and the advantage is that more area can be covered since the prepared solution is easy to spread.

Potential future treatments

A drug to stimulate melanocytes: Afamelanotide is a potential treatment. It can be implanted under the skin to promote the growth of melanocytes.
A drug that helps control melanocytes: Prostaglandin E2 is being tested as a way to restore skin colour. It is applied to the skin as a gel.

Coping and support

The change in your appearance due to vitiligo might make you feel anxious, stressed, self-conscious or sad. The following self-care approaches can help you cope with vitiligo:

Find a good Dermatologist. A dermatologist is a doctor who specializes in the care of the skin. You should find a doctor who knows a lot about this condition.
Learn about your condition: Find out as much as you can about vitiligo and your treatment options so that you can help decide what steps to take.
Communicate your feelings: Let your doctor know if you’re feeling sad, anxious or depressed. He or she can refer you to a mental health provider who specializes in helping people with depression.
Talk with others: Ask your doctor about support groups in your area for people with vitiligo.
Confide in loved ones. Seek understanding and support from your family and friends. You can bring them to the doctor during your visit so that they also understand the condition in a better way.