Written By Dr Surbhi, MD Skin
Last updated: 24/07/21

“Doctor, is there a cure for Vitiligo? What are the various treatment options?” Frankly speaking, there is at present no 100% cure for Vitiligo. But due to latest advancements in treatment both surgically and medically, repigmentation is achievable in majority of cases and disease can be kept under control henceforth.

What will happen if I choose not to get myself treated?

The choice of getting yourself treated entirely depends on upon how you feel about your disease. It’s not a harmful disease- it does not cause any symptoms and does not have any internal involvement; the only reason to get it treated is cosmetic. If you decide to live with it, you just need to take special care of your skin because it’s more prone to sunburns and skin cancer.

When to see a dermatologist?

If you are bothered by the vitiligo, then consult a certified dermatologist for not only treatment but also counselling. You will need regular follow-ups until your disease is controlled. You might need to revisit if there is the occurrence of new lesions or increase in the size of existing ones. No single treatment can help all patients; instead, treatment needs to be individualised because each person is different and needs are different. Be assured that treatment when started under the supervision of dermatologist are efficient and free from side effects.

What special care should be taken by patients of Vitiligo ?

The white patches of Vitiligo are devoid of pigment melanin that helps that protects your skin from damaging UV rays. Thus, white skin of vitiligo is more prone to develop sunburns and skin cancer. Thus you protect your white skin by covering with clothing. Wide brimmed hats can protect your face, neck & ears. Prefer to spend time in the shade between 11 am to 4 pm and use sunscreens on white patches regularly SPF 30 or more. Sunscreens should be preferably applied 15 to 30 minutes before sun exposure and reapplied every 3 to 4 hours. For more details read, SUN PROTECTION METHODS- KNOW FROM DERMATOLOGIST

What are the various treatment options for Vitiligo?

Your dermatologist might prescribe one of the following treatment options:

• • Medical treatment consisting of oral & topical medicines, briefly described below:
  • Corticosteroid creams– These are most common treatment given as vitiligo is considered to be of autoimmune origin, so steroids do have an active role. However, self-medication should not be done.
  • Topical calcineurin inhibitors like Tacrolimus ointments are safer alternatives for steroid and are preferred to maintain the disease in remission.
  • Bleaching (depigmentation treatments)- is used for Vitiligo Universalis, cases involving the almost whole of the body . It is non-reversible permanent treatment, wherein remaining pigment cells are destroyed so as to completely depigment the skin. Commonly done by a medicine called as hydroquinone mono-benzyl ether.
  • Oral therapy is used for stopping the progression of diseases like Levamisole, Cyclophosphamide and Azathioprine

Phototherapy is of following three types:

• PUVA treatments- in this psoralen are either given orally or topically and followed by exposure to sunlight or ultraviolet rays (UVA) after an hour.
• Narrowband UVB treatment is the most common type of light treatment, and it uses a light of a specific UVB wavelength.
• Targeted phototherapy is used for localised Vitiligo.

Lasers- 380-nm Excimer laser

Surgical treatments- The main aim of the surgical intervention is to produce cosmetically acceptable repigmentation of the affected skin. Works on the principle of melanocyte introduction in the vitiligo area which in turn will function as epidermal melanin units and work in the production of pigment thus offering a cure. It’s done only in stable cases i.e. no new lesions in the past one year. Various techniques are as follows

• • Tissue grafts
  • Mini punch grafting
  • Suction blister grafting
  • Thin split thickness grafting
  • Hair follicle grafts
  • Smash grafts
  • Mesh grafts

Cellular Grafts

• Noncultured cell suspensions – epidermal cell and follicular cell
• Cultured melanocytes/keratinocytes grafts

No grafting techniques

• Micropigmentation
• Excision / Closure
• Dermabrasion

Skin Camouflage – It involves use of special creams which helps in hiding the vitiligo patches so that patients can live without feeling self-conscious. Camouflage doesn’t cure vitiligo it only makes them less visible. This can be used by anyone irrespective of sex, age, religion and ethnicity. When correctly applied, skin camouflage is usually waterproof and also confers some sun protection. In this, the cream is applied and fixed with a powder after brushing the excess powder the colour is fixed with fixing spray. The two popular brands of camouflage cream are: Dermablend and Kryolan.

• Fake tans change the colour of outermost layer of the skin and require less frequent applications then camouflage. For example, Vitocolor.
• Medical tattooing- More permanent method of camouflage but is suitable for small areas of skin like lips, eyebrows.

This article is AUTHORED BY Dr Amitoj Garg, MD Dermatology

Dr Amitoj Garg is director of Jagdamba Skin & Laser Center, Sriganganagar, Rajasthan. After finishing dermatology training from Krisha Institute of Medical Sciences, he has received formal training in lasers and cosmetic surgery under the guidance of Dr Venkatraam Mysore. He has conducted presentations and has been awarded at various International, National and State conferences. He can be reached at [email protected].