Vitiligo is a chronic skin condition that can be managed through a variety of therapeutic approaches. These include topical therapies, systemic therapies, phototherapy, and in rare cases, depigmentation therapy.
Topical therapies
- Corticosteroids: Topical corticosteroids are often recommended as first-line therapy, especially for patients with limited vitiligo and extrafacial involvement . The British Association of Dermatologists (BAD) 2022 guidelines suggest the use of potent or very potent topical corticosteroids once daily, while avoiding the periocular area . They also recommend intermittent regimens of once-daily application of potent or very potent topical corticosteroids with or without topical calcineurin inhibitors, especially in areas with thinner skin
- Calcineurin inhibitors: Topical calcineurin inhibitors, such as tacrolimus, are recommended as an alternative to topical corticosteroids . The German Dermatological Society (DDG) 2022 guidelines suggest applying topical calcineurin inhibitors twice daily for 6-12 months, depending on the response . The BAD 2022 guidelines also recommend offering topical tacrolimus 0.1% ointment twice daily in patients with facial vitiligo as an alternative to potent or very potent topical corticosteroids
Systemic therapies
- Corticosteroids: Systemic corticosteroids, such as dexamethasone, prednisone, or methylprednisolone, are recommended for patients with acute, rapidly progressing vitiligo. The DDG 2022 guidelines suggest administering these corticosteroids on 2 consecutive days per week for a duration of 3-6 months to achieve disease arrest . The BAD 2022 guidelines also recommend offering oral betamethasone 0.1 mg/kg twice weekly on 2 consecutive days for 3 months followed by tapering the dose by 1 mg/month for a further 3 months in combination with narrowband UVB in patients with rapidly progressive vitiligo
Phototherapy
- Narrowband UVB: The DDG 2022 guidelines recommend offering narrowband UVB to patients with generalized vitiligo if topical therapy is no longer feasible due to the extent of disease, and to patients with active, progressive vitiligo to arrest disease activity . They also suggest considering a combination of narrowband UVB with topical corticosteroids or calcineurin inhibitors to enhance the effect of narrowband UVB, particularly in the face and neck region
- Targeted phototherapy: The DDG 2022 guidelines suggest combining targeted phototherapy with topical and systemic medications (such as corticosteroids, topical calcineurin inhibitors) to enhance the effect
Depigmentation therapy
- Depigmentation therapy is considered only in extremely rare cases after all other therapeutic options have been exhausted. It is used very restrictively and only after a thorough discussion with the patient due to the irreversible destruction of melanocytes
In conclusion, the treatment of vitiligo involves a combination of topical and systemic therapies, phototherapy, and in rare cases, depigmentation therapy. The choice of treatment depends on the extent and progression of the disease, the patient's response to treatment, and the potential side effects of the therapies.