Treatments and drugs

Many treatments are available to help restore skin color or even out skin tone. Results vary and are unpredictable. Some treatments have serious side effects. So your doctor may suggest that you first try improving the appearance of your skin by applying self-tanning products or makeup.

If you and your doctor decide to treat your condition with a drug or other therapy, the process may take many months to judge its effectiveness. And you may have to try more than one approach before you find the treatment that works best for you.

Medications

No drug can stop the process of vitiligo — the loss of pigment cells (melanocytes). But some drugs, used alone or with light therapy, can help improve your skin's appearance.

Creams that control inflammation. A topical corticosteroid may help return color to (repigment) your skin, particularly if you start using it early in the disease. You may not see a change in your skin's color for several months.

This type of cream is effective and easy to use. But it can cause side effects, such as skin thinning or the appearance of streaks or lines on your skin.

Milder forms of the drug may be prescribed for children and for people who have large areas of discolored skin.

A form of vitamin D. Topical calcipotriene (Dovonex) is a cream that can be used with corticosteroids or ultraviolet light. Possible side effects include dry skin, rash and itching.

Medications that affect the immune system. Ointments containing tacrolimus or pimecrolimus (calcineurin inhibitors) may be effective for people with small areas of depigmentation, especially on the face and neck. This treatment may have fewer side effects than corticosteroids and can be used with ultraviolet B (UVB) light. The Food and Drug Administration () has warned about a possible link between these drugs and lymphoma and skin cancer.

Combined medication and light therapy. This treatment combines a drug called psoralen with light therapy (photochemotherapy) to return color to the light patches. After you take psoralen by mouth or apply it to the affected skin, you're exposed to ultraviolet A (UVA) or UVB light. Because the drug makes your skin more sensitive to the light, your skin turns pink. As the skin heals, a more normal skin color appears. You may need to repeat treatments up to three times a week for six to 12 months.

Possible side effects include severe sunburn, blistering, itching, overdarkening of the skin, and an increased risk of cataracts and skin cancer. It may help if for one to two days after each treatment you apply sunscreen, wear UV-protective sunglasses and avoid direct sunlight. Oral psoralen with UVA radiation is not recommended for children under 12.

Light therapy. This treatment uses narrow band UVB light. You may receive treatment in a doctor's office up to three times a week. And unlike photochemotherapy, it doesn't require psoralen, which simplifies the process. The best results are achieved on the face, trunk and limbs.

Laser therapy. This procedure brings color back to patches of light skin by treating them with an excimer laser, which uses a specific wavelength of UVB light. It can be used only on small areas, and it's often used in combination with a drug applied to the skin. Side effects can include redness and blistering.

Removing the remaining color (depigmentation). This therapy may be an option if your vitiligo is widespread and other treatments haven't worked. A medication with monobenzone is applied to unaffected areas of skin. This gradually lightens it so that it blends with the discolored areas. The therapy is done twice a day for nine months or longer. You'll need to avoid skin-to-skin contact with other people for at least two hours after you've applied the drug, so you don't transfer it to them.

Side effects can include redness, swelling, itching and dry skin. Depigmentation is permanent, and you'll always be extremely sensitive to sunlight.

Surgery

Surgery may be an option for you if light therapy and drugs don't work. Surgery can also be used with those therapies. The goal of the following techniques is to even out your skin tone by restoring color.

Skin grafting. In this procedure, your doctor removes very small sections of your normal, pigmented skin and attaches them to areas that have lost pigment. This procedure is sometimes used if you have small patches of vitiligo. Possible risks include infection, scarring, a cobblestone appearance, spotty color and failure of the area to recolor.

Blister grafting. In this procedure, your doctor creates blisters on your pigmented skin, usually with suction. He or she then removes the tops of the blisters and transplants them to an area of discolored skin. Possible risks include scarring, a cobblestone appearance and failure of the area to recolor. The risk of scarring is less with this procedure than with other types of skin grafting.

Tattooing (micropigmentation). In this technique, your doctor uses a special surgical instrument to implant pigment into your skin. It's most effective around the lips, especially in people with darker skin. Drawbacks include difficulty matching the skin color, the tendency of tattoos to fade and their inability to tan. Also, the skin damage caused by tattooing may trigger another patch of vitiligo.