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| Vitiligo To Treat or Not to Treat An editorial in the Arch Dermatol Vol 143 May 2007 stated that “In the past 10 years, several new methods of treating vitiligo have emerged, including NB-UVB therapy, targeted phototherapy, topical calcineurin inhibitors, and topical calcipotriene …. the question when managing patients with vitiligo, especially that involving exposed sites, is no longer whether to treat or not to treat but to decide which treatment method is most appropriate for the individual patient". |
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At the moment there is no cure for vitiligo but there are treatments which can often slow down its progress or, in some cases, bring about repigmentation. Doctors can prescribe corticosteroid creams to be used for a limited period on the affected patches. With new areas or ones which have just started to spread, this treatment can slow down the rate of spread or even restore some of the lost colour, but unfortunately it does not work for everyone. There are concerns about the possible adverse effects of using steroid creams, such as thinning of the skin and stretch marks, but these are rarely seen when the creams are used correctly under medical supervision. Protopic cream (tacrolimus) which has recently been licensed to treat eczema is proving effective in restoring some skin colour especially on the faces of some people who have vitiligo, when the loss of pigment is relatively recent and still active. Protopic can be prescribed by GPs for vitiligo,  although it is not licensed. Often a dermatologist may recommend it but ask the GP to actually prescribe it.There is also another NHS treatment known as PUVA. This involves taking regular medication (Psoralen) and visiting a hospital for treatment (by Ultra Violet A light) two or three times a week for a period of many months. In many dermatology departments PUVA treatment for vitiligo is being replaced by narrowband UVB which involves treatment by ultra violet light at a hospital 2 or 3 times a week for a period of some months. The advantages of this are that no additional medication is required and exposure to the light is for much shorter periods. The different light source also reduces the possible risk of skin cancer. Both of these treatments may bring about repigmentation in some people but it may not be permanent. We are frequently asked about Pseudocatalase treatment used in conjunction with narrowband UVB. The lack of clinical trials for this treatment means that it is not available on the NHS and is therefore expensive. You can download information about this treatment via the Karin Schallreuter website There is also conflicting evidence about the effectiveness of laser treatments so these too are only available privately and can be even more expensive. It must be noted in respect of any of these treatments that if colour does return to the white patches it is still at risk of being lost again at a later stage. |