by Lauri Vargo, MD, assistant professor of dermatology at the University of Nebraska Medical Center in Omaha, told Susan Bernstein
Vitiligo is largely a chronic disease with an unpredictable course, so treatment can be challenging for many people. Everyone responds differently to different drugs. First, I identify their treatment goals and expectations.
The main treatments for vitiligo include different topical creams, light therapy, and oral steroids. But the world of dermatology is constantly evolving, so there are now new treatments for vitiligo. If needed, we can turn to a toolbox of new treatments. There is a lot of good research and evidence behind some of our older vitiligo remedies, and most dermatologists will start with these remedies.
Vitiligo may be autoimmune
The causes of vitiligo are still largely unknown. We think it has an autoimmune component. Vitiligo is often associated with other autoimmune diseases. Reviewing your medical history is very important for vitiligo. Autoimmune thyroid disease is one of the most common diseases we see in vitiligo patients.
There are some newer treatments for vitiligo that I usually use when we don’t see any improvement from older treatments. We must weigh all the risks and benefits of any treatment. We have to consider the potential side effects of any treatment, and for some patients, cost is also a big issue.
Dermatology has many new and exciting drugs, but getting them can be a big hurdle. Older treatments are better covered by insurance. I don’t want to offer someone a topical cream that they can’t afford when they go to the pharmacy to pick up.
Start with topical and light therapy
For vitiligo, we start with topical and phototherapy. We develop each treatment plan on an individual basis, as vitiligo can be a difficult and frustrating disease to treat. People often suffer from lifelong illnesses that must continue to be treated.There is no guarantee we will be able to recover [skin] Pigmentation or your skin will return to normal.
A newer vitiligo drug is a janus kinase inhibitor, also known as a JAK inhibitor. None of these are currently approved by the FDA to treat vitiligo, but that may change soon.
With this new class of oral and topical drugs, we must address the potential side effects of treatment.
Excitingly, we do have a topical version of a drug called ruxolitinib that is currently used for eczema treatment. There has been some encouraging research for the treatment of vitiligo, including facial vitiligo.
Usually, when we use topical drugs, we don’t worry about systemic side effects.However, for these topical JAK inhibitors, including ruxolitinib, we remain uncertain [how much of the drug you absorb through your skin] and how it relates to potential side effects. This is still an issue.
Protect eyes and skin
People with vitiligo also have other health risks. Our melanocytes are the cells that give us our pigment and protect our skin from the sun. Therefore, when you lack pigment-producing cells, you have a greater risk of sunburn. I talk to all my vitiligo patients about how important it is to keep the skin covered and protected from burns. People with vitiligo do not have a barrier to protect the skin from sunlight.
I recommend a sunscreen with SPF 30 or above, broad spectrum and water resistance for anyone with vitiligo or anyone. It is very important to apply enough sunscreen to the skin and reapply. Most people don’t apply enough sunscreen to their skin. You need to apply 1 ounce of sunscreen at a time. That’s enough to fill a small wine glass. You should reapply every 2 hours or after sweating or swimming.
UV protection factor or UPF clothing is another thing I recommend. You can find these clothes in many stores these days. This garment provides extra sun protection. It’s also really popular with kids. Children wear rash protection clothing when playing outdoors. Because our eyes also have pigment-producing cells, it is also important for vitiligo patients to use sunglasses to protect their eyes when they are in the sun.
More than just a “cosmetic” condition
Our skin is our largest and most visible organ. People with any skin condition are at risk for low self-esteem and reduced quality of life due to the skin condition. People with vitiligo are often affected by this. I think it’s important for me to educate my vitiligo patients, especially children, so they can explain to others what vitiligo is, for example on the playground or at school. I want them to be comfortable with the skin they’re in. Adults with vitiligo and all of us are prone to self-esteem issues when it comes to the appearance of our skin.
I’ve noticed a lot of people refer to vitiligo treatments as “cosmetic treatments” or vitiligo as a “cosmetic condition”. I feel like the word “cosmetics” indicates that we are taking something normal and enhancing it. But with vitiligo, we are treating your skin condition just like we would any other health condition of yours.
If you have symptoms of vitiligo, it is important to see a dermatologist for a diagnosis. That’s because other skin conditions can mimic or look like vitiligo. Let’s rule out some rare cases first. There are some allergic skin conditions that can look like vitiligo.
Makeup and Self-Tanning
One of the things I talk about with my patients is a cosmetic called Dermablend to cover the skin. You can also use self-tanning products that contain dihydroxyacetone. If you have vitiligo, it’s perfectly fine to use a self-tanning product. You can use it to mask skin damage if you want a more even look. If you go out for a tan, you’re only tanning the rest of your skin.
I often recommend phototherapy to vitiligo patients. This is one of my favorite treatments for this condition. It is also called light therapy. This is a treatment method that uses directed UV light. Sometimes, when I recommend light therapy, my patients say, “Aren’t you a dermatologist? I thought the sun was bad for your skin!” But this type of light therapy should only be done as directed by a dermatologist.