Currently Available Treatments
Types of current treatments
Topical Treatments
Topical treatments are intended for cases where vitiligo involves less than 5% of the surface of the body. Treatments include:
- Topical steroidal ointments – this is the most common treatment. These ointments work by regulating the local immune response and reducing inflammation. Long-term use side effects include reduced skin elasticity, skin thinning.
- Stimulant ointments – topical treatments based on compounds which lead to a stimulation of the skin, which in turn stimulates melanocytes to produce pigment. Used less commonly in Israel.
- Calcineurin Inhibitors – topical substances intended to stimulate the immune system (immunomodulators), such as Elidel and Protopic. These substances are as effective as steroid-based ointments, with the advantage of not causing the side effects associated with long-term steroid use.
- Dermo-aesthetic products – which may mask the spots.
Systemic (Oral) Treatments
- Orally-administered steroids in a variety of forms and doses
- Orally-administered immunomodulators – such as Imuran and Methotrexate, which help suppress the heightened immune response in order to halt or stop the progression of the disease and which help to restore part of the lost pigment.
- Recommendations for using these drugs are not unanimous, especially when prolonged use is required, as it may be accompanied by multiple side effects.
- Antioxydants – no solid medical information is available on the efficacy of these treatments.
Phototherapy Treatments
These treatments involve exposing the affected skin to ultraviolet light rays. Treatments are done two to three times per week, for a few seconds each time, with a gradual increase each treatment until the desired effect is obtained. This treatment affects the inflammatory activity in patients’ skin and leads to an improvement.
There are different types of phototherapy:
- Narrow-range ultraviolet rays (331-nanometer wavelength) which are the cutting edge of phototherapy. Side effects include burns which resolve on their own. No increase in the frequency of skin cancer has been reported as a result of exposure to this type of radiation.
- PUVA – this treatment involves applying a liquid to the skin, and then exposing the applied skin to ultraviolet rays. This type of treatment calls for caution as it may cause burns and even future skin tumors.
- Excimer Laser – radiation therapy using a 308-nm wavelength, which is directed specifically at the vitiliginous spot, thus saving the surrounding healthy skin from unnecessary radiation. Side effects are similar to those of narrow-range ultraviolet radiation.
Surgical Methods
- Skin Grafts – this procedure involves peeling the external skin layer (the epidermis) in the affected skin patches and transplanting a harvested healthy skin patch and attaching it to the peeled skin spot with stitches and pressure dressings. This method is effective; however, it is often accompanied by a difference in skin color between the graft and its surrounding skin. Graft rejection and shrinking may also occur.
- Epidermis transplant – this method involves creating a blister over the skin in the donor area. The top of this blister is then cut off and transplanted onto the affected area after its external layer is removed. This method is effective, yet very painful, and can be used to treat only very small areas.
- Puncture transplants – mini transplants measuring 2-4mm in diameter which are inserted using a designated device which punctures the skin at the donor site. The same punctures are then made in the vitiligo-affected area, into which the punctured transplants are introduced. While this is a fairly simple and effective methods, it has multiple side effects, primarily a non-uniform skin appearance.