Everyone is unique and therefore a dermatologist is the best person to assess and manage vitiligo. Earlier treatment commencement is ideal to help prevent further spread of vitiligo and may involve a combination of treatment modalities as listed below as well as providing ongoing psychological support. However, as vitiligo predominately affects the skin without causing other health risks, some people choose to embrace their vitiligo and opt for no treatment.
Camouflage can be achieved with make-up and topical dyes to conceal the areas affected by vitiligo as well as reduce the stark contrast between the white depigmented skin and the surrounding skin. Camouflage including specialised medical camouflaging products designed to conceal skin conditions, a range of cosmetic make-up or foundation and self-tanning lotions (sunless tanners). Microtattooing/micropigmentation is a procedure which involves implanting pigment under the skin to camouflage it with the surrounding skin (like a tattoo) can be useful for small stable areas of vitiligo such as face, lips and hands.
To re-pigment the skin, new pigment cells must be produced from existing ones. These pigment cells come from the base of hair follicles, from the edge of the lesion or from the patch of vitiligo itself if depigmentation is not complete. Treatment includes topical corticosteroids, light therapy with photosensitising psoralen drugs applied topically or given systemically in conjunction with sunlight exposure or UVA phototherapy (PUVA ), narrow band UVB phototherapy, and other topical agents-calcipotriol, pimecrolimus and tacrolimus. Approximately 75% of patients who undergo light therapy respond to some extent. Even for these individuals, complete repigmentation rarely occurs. Patients initially look worse with light treatment since the contrast between light and tanned skin increases. With time, repigmentation begins, and the appearance of the skin will improve. If patients stop the treatment, most will retain the achieved repigmentation.
Surgical treatments should only be considered when medical therapies fail. They should only be performed on patients with stable non- progressive vitiligo, ideally localized or segmental. These procedures can be used in combination with medical therapies. A number of surgical techniques for repigmentation of vitiligo have been developed. They involve transfer of a patient’s own melanocytes from unaffected skin into vitiligo affected skin (autologous melanoycte transplantation). Techniques available include mini-grafting using for example punch grafts, non-cultured epidermal suspension, cultured melanocyte suspension and cultured epidermal grafts Very good results can be achieved with these procedures.
Lasers such as the 308nm xenon chloride excimer laser have been used to treat vitiligo. Excimer lamps producing UV light at 308nm (such as VTRAC, Excilite-µ and Quantel) are also being used which provides phototherapy via a hand held device.
Treatment with monobenzyl ether of hydroquinone can be used in patients with extensive vitiligo, involving more than 80% of the skin. This process may take 6 months to 2 years to achieve. Strict sun protection is required after depigmentation. Pigment removing lasers can also be used.