Treatment Options

At this time, there is no cure for vitiligo. Treatment for vitiligo is best thought of as controlling the condition by restoring and maintaining color. Achieving full repigmentation, with or without treatment, does not constitute a permanent cure.

There are three main goals for vitiligo treatment:
-stop or slow the spread of vitiligo patches
-bring color back (also called repigmentation)
-keep that color once it returns

Treating vitiligo is your choice. It is safe to leave vitiligo untreated. But there are related health conditions to monitor for, so it’s a good idea to see a dermatologist for regular screening.

A board-certified dermatologist, dermatology physician associate, or dermatology nurse practitioner are the best options for vitiligo treatment.  In some cases, a general practitioner or pediatrician can treat vitiligo, but a referral to a dermatology specialist is best.

Treatment works slowly and requires patience. The amount of repigmentation that you will experience depends on several things. First, consistent use of the prescribed treatment is the best predictor of success. Second, using the appropriate combination of treatments (often light therapy and a topical cream) improves the skin’s ability to repigment. Finally, the percentage of the body affected by vitiligo, distribution of the lesions (, and the length of time you have had the condition all play a part. Treatment results will vary by person and type of vitiligo. Some people will begin to see results within 3 to 6 months. Others may not see results for 8 months or more. Combination treatments will typically work faster than single (mono) therapy treatments. The rule of thumb is that you will need to allow at least 3 to 6 months before you begin to see results from ANY treatment. Additionally, you should expect to treat for up to two years or longer in order to see good results. It is vital to use any treatment consistently and correctly. If you don’t use a treatment as directed by your physician, it can take much longer to work or it may not work at all.

Areas with hair follicles repigment fastest and with best results (e.g. face, upper arms, upper legs, chest, back, buttocks). The wrists, hands, and feet are the slowest to respond to treatment.

Yes. Combined treatment is common and can be especially effective. As an example, light therapy is often combined with topical therapy for faster and more effective treatment.

Vitiligo can return is treatment if abruptly discontinued. Treatment is usually tapered as the skin begins to reach maximum repigmentation. At this point, if no new lesions occur, you may discontinue treatment. Vitiligo may return if the immune system is still active or later becomes active (e.g. triggered by stress, illness, or trauma). At that time, you may need to resume treatment.

Topical therapy is usually not very expensive. Both topical creams and in-office light therapy are often covered by medical insurance but usually require a small co-pay amount. However, surgical procedures are not covered by insurance at this time.

Research has shown that NB-UVB eyelid phototherapy is a safe and effective treatment and does not penetrate the eyelid. For their patients old enough to understand the importance of keeping the eyes closed, many doctors permit removing the goggles for part of the time to expose depigmented areas around the eyes. Care must be taken however, not to over expose the eyelid, as the very thin skin will not tolerate a high exposure time. Eye protection is always required when using any type of psoralen and/or UVA light, such as with PUVA therapy.

Most topical treatments prescribed for vitiligo can be used on the face; however, care must be taken to prevent them from getting into the eye. Due to their many potential side effects, potent topical steroids are generally not prescribed for use on the face, except for very short periods of time while under the careful supervision of the prescribing physician.

Some treatments can cause side effects, but most treatments (topical, oral, and phototherapy) do not cause pain. Surgical treatment can cause discomfort and might require topical anesthetics. It’s important to understand potential side effects and discuss any concerns with your treating physician.

Yes, makeup can be used while being treated. Foundation-based cosmetics and self-tanning products containing DHA (dihydroxyacetone) can reduce the contrast between depgimented patches and unaffected skin, and they are safe to use while undergoing treatment.

Topical therapies are applied directly to the skin. A dermatologist will prescribe a cream that a patient can apply at home.

The types of topical therapies available to treat vitiligo are topical corticosteroids; immunomodulator creams such as pimecrolimus and tacrolimus; and a JAK inhibitor ruxolitinib cream.

Topical steroids can cause skin thinning. Any topical treatment could cause itching or irritation at the site of application.

Phototherapy (also known as light therapy) exposes vitiligo patches to ultraviolent (UV) light.

Phototherapy works by exposing skin to a specific type of ultraviolet light, leading to restoration of the natural skin color. A dermatologist determines the exact dosage and timing for the light exposure.

Available phototherapy options are Narrowband UVB, Excimer Laser, PUVA, and PUVA-SOL.

Oral steroids are used to help stabilize active vitiligo, meaning that they help stop new spots of vitiligo from developing. These can be prescribed as pulse dosing, where they are only taken on a few days of the week, or with daily dosing. Oral steroids are typically tapered when they need to be stopped, meaning that the dosage and frequency is gradually reduced to prevent side effects. When taken by mouth, steroids can cause many side effects such as increasing blood sugar, increasing blood pressure, and weakening the bones. As such, monitoring is required when taking this medication. Oral steroids are usually combined with other treatments, such as light therapy.

Minocycline is an antibiotic that is used to treat many skin conditions. In vitiligo, it has been shown to stabilize active disease when taken daily. Side effects include abnormal pigmentation, increase in liver enzymes, abdominal discomfort, and increased sensitivity to light. Oral minocycline is usually combined with other treatments, such as light therapy.

There are multiple oral antioxidants that have been used to help stabilize active vitiligo. In vitiligo, melanocytes are more easily damaged by oxidative stress. Antioxidants can help prevent this. Side effects are dependent on the type of antioxidant, but are generally mild. Oral antioxidants are typically used with other forms of treatment, such as light therapy or topical medications.

Surgical treatment of vitiligo involves the transplantation of functional melanocytes (pigment cells) or skin graft to the depigmented area. This transplantation can be done through one of several methods, each of which harvests the melanocytes or skin in a different way.

Although medical therapy has improved considerably in the last years, some people fail to sufficiently repigment through medical treatment. Surgical therapy can provide higher re-pigmentation rates for difficult-to-treat localized areas in selected patients, and can be used to treat generalized disease as well. Those considered the best candidates and most likely to experience a high rate of repigmentation from surgical therapies are those with stable, segmental, or localized vitiligo.

No, surgical treatment of vitiligo is a highly specialized therapy that is performed by a limited number of vitiligo specialists.

Depigmentation is the intentional destruction of melanocytes in the skin.

Depigmentation is usually explored by patients who have exhausted all other vitiligo treatment options without success and would like to achieve an even skin tone.

Depigmentation options include topical agents and laser treatments.