The easiest way I have found to explain vitiligo to patients is by mentioning the highly visible celebrity who suffered its depigmented wrath, Michael Jackson. Although this condition may attack small spots or large plots of skin, Michael suffered from the latter. It is rumored that his vitiligo was so severe that it was much easier to remove the remaining pigment, versus trying to reverse the expanding white patches. Thus….Michael Jackson inevitably appeared to completely change from the melanisized pigmentation of his racial genetics, to that of a more European like appearance.
Vitiligo is often first noted around orifices (body openings) such as eyes, nose, mouth, belly-button, and peri-anal region. However, it is also quite common in general on the face, scalp, neck, and hands. Vitiligo is thought to be an auto-immune disorder. However, conditions such as thyroid or parathyroid abnormalities, lupus, sunburn, industrial chemical exposure, or other auto-immune disorders may precede a vitiligo diagnosis.
In vitiligo, the pigment producing factories of the skin, just stop making pigment. Stimulating those factories to keep the conveyer belt going, is a difficult task, and can be resistant to direction. I estimate to patients that 50% of those treated may respond over a 6-12 month period. Yet, some people will never regain pigment despite multiple efforts. Nonetheless, if you decide to target your pigment factories, its best to know what can be done and the path that entails.
The most important product for use over-the-counter is sunscreen. Vitiligo patches can easily burn while the skin with remaining pigment will darken causing a more noticeable contrast. An SPF of 30 or higher should be used daily, with reapplication every four hours during outdoor exposure.
Other OTC products may only minimally help with small vitiligo patches like using hydroquinone to bleach dark patches (like the brand Ambi) or hydrocortisone to stimulate pigment in white patches, which is unlikely to work due to its minimal strength.
A few supplements have also shown variable results in improving vitiligo. A daily regimen of Gingko Biloba (40 mg), Alpha-Lipoic Acid, Folic Acid, Copper, Zinc, and Vitamin B12 may be helpful for some.
Cosmetic products are a non-medicative alternative to cover-up depigmented patches and even out the skin. In the make-up realm, concealers like Dermablend or Judith August Cosmetics use a specific corrective mixture to address extensive color variations. However, such products can wash right off. Waterproof skin dyes like Chromelin Complexion Blender can be used to pigment light patches, even in children. It gives a longer lasting result with application every few days after an initial greater application period.
The first line of therapy is a topical steroid (triamcinolone, desoximetasone, flucinolone, etc). The theory behind its use is that it will calm any inflammatory process of the pigment producing cells, and stimulate them to work again. With intermittent use, in order to avoid side effects, this may be used anywhere from two to 12 months.
Non-steroidal anti-inflammatory medications are a great alternative to topical steroids (ie. less risk for skin thinning, further discoloration, stretch-marks) and can be used over a long duration. Discuss products like Protopic or Elidel with your clinician.
Although off-label for vitiligo treatment, case studies regarding the use of Latisse, or Bimatoprost in small hair bearing areas of vitiligo has shown positive improvement in depigmented patches. Yet, further research is needed to elicit the treatment responsiveness rates, safety, dosing, and tolerability.
Complete depigmentation may be an option for those with extensive disease in whom, removing the remaining pigment is easier (ie. the Michael Jackson route). Benoquin (20% hydroquinone) is used twice daily over 1-12 months, for irreversible pigment removal.
In-Office or Surgical Procedures
PUVA (Psoralen Ultra Violet UVA) is a widely used therapy wherein psoralen capsules are taken or a skin soaking of psoralen bathwater is used two hours before standing in a cabinet of UVA bulbs for a duration of 1-30 minutes. It may take 30-60 treatments three times a week to see sufficient results. It is considered to be 50-70% effective for face, trunk, and extremities, but not as potent on the hands.
Narrow-band UVB is most appropriate for small areas of vitiligo and is used 2-3 times a week for several weeks and considered 70% effective. However, re-pigmented areas will often be lost over a year if treatments not continued intermittently.
Skin grafts and transplants are another more invasive option you may discuss with your surgeon.
There is no cure for vitiligo and treatments can be time consuming, messy, and are only effective for half who try them. Thus, overall, your first treatment priority should be learning to love the skin you’re in, no matter what shade appears or regresses. And if you need a little esteem boost, remember, people like Michael Jackson and super-model Winnie Harlow (www.officialwinnieharlow.com/) have acheived great success pushing beyond what anyone thought of their skin. In the end you are the person who comes out from within.
*The information provided above or in any blogs on this site is for educational purposes only. I does not replace advice or necessary examination and diagnosis from your healthcare clinician. Please see your healthcare provider for any and all concerns with changes in your health or treatment of disease.*