By Lauri Vargo, MD, Assistant Professor of Dermatology, University of Nebraska Medical Center, Omaha, as stated by Susan Bernstein
Vitiligo is largely a chronic disease with an unpredictable course, so treating it can be challenging for many people. Every person reacts differently to different medications. First, I determine your goals and expectations for your treatment.
The mainstay of treating vitiligo initially includes various topical creams, light therapy, and oral steroids. But the world of dermatology is constantly evolving, so new treatments for Vitiligo are now emerging. If necessary, we can draw on a toolbox with newer treatments. There is a lot of good research and evidence behind some of our older therapies for vitiligo, and most dermatologists will start with these treatments.
What causes vitiligo is still largely unknown. We believe there is an autoimmune component. Vitiligo is typically associated with other autoimmune diseases. Going through your history is extremely important with Vitiligo. Autoimmune thyroid disease is one of the most common conditions we see in someone with vitiligo.
There are some newer therapies for Vitiligo and I usually use these when we haven’t seen any improvement with the older treatments. We must weigh all the risks and benefits of each treatment. We have to think about the possible side effects of each treatment and the cost is also a big issue for some patients.
There are many new and exciting drugs in dermatology, but access to them can be a major barrier. Older therapies are better covered by health insurance. I don’t want to sell anyone a topical cream they can’t afford to pick up at the pharmacy.
For vitiligo, we start with topical and light therapies. We customize each treatment plan because vitiligo can be a difficult and frustrating condition. Patients usually have a lifelong illness and need to continue their treatment. There is no guarantee that we can restore [skin] pigmentation or that your skin returns to normal.
One of the newer drugs for vitiligo are Janus kinase inhibitors, also known as JAK inhibitors. None of these are currently FDA approved for the treatment of vitiligo, but that is likely to change soon.
With this new class of oral and topical medications, we need to address the potential side effects that come with treatment.
Excitingly, we have a topical version of one of these drugs called ruxolitinib that is currently used in the treatment of eczema. There have been some encouraging studies on the treatment of vitiligo, including facial vitiligo.
When we use topical agents, we usually don’t worry about systemic side effects. However, we are not yet sure about these topical JAK inhibitors, including ruxolitinib [how much of the drug you absorb through your skin] and how it might relate to possible side effects. That’s another question.
There are other health risks for people with vitiligo. Our melanocytes are cells that give us our pigment and protect our skin from the sun. So if you lack pigment-producing cells, you are at a higher risk of sunburn. I talk to all of my vitiligo patients about the utmost importance of keeping skin covered and protecting your skin from burns. People with vitiligo don’t have this barrier to protect their skin from the sun’s rays.
I recommend people with vitiligo or anyone else to use a sunscreen with SPF 30 or higher, broad-spectrum and waterproof. It is really important to apply enough sunscreen to the skin and to reapply it. Most people don’t put enough sunscreen on their skin. You must apply 1 ounce of sunscreen at a time. That’s enough to fill a shot glass. You should reapply it every 2 hours or after sweating or swimming.
UV protection factor or UPF clothing is another thing I recommend. Nowadays you can find these clothes in many shops. This clothing offers extra protection from the sun. It is also becoming increasingly popular with children. Children wear rash guards when playing outside. Because we also have pigment-producing cells in our eyes, it’s important for people with vitiligo to wear sunglasses to protect their eyes even when they’re out in the sun.
Our skin is our largest and most visible organ. People with any skin condition are at increased risk of low self-esteem and reduced quality of life due to their skin condition. It often affects people with vitiligo. I find it important to educate my patients with vitiligo, especially children, so that they can explain what vitiligo is to other people, for example at the playground or at school. I want them to be comfortable in their own skin. Even adults with vitiligo and all of us tend to have self esteem issues when it comes to the appearance of our skin.
I’ve noticed that a lot of people talk about vitiligo therapies as “cosmetic treatments” or vitiligo as a “cosmetic condition”. I feel like the term “cosmetics” suggests we’re taking something normal and making it better. But with Vitiligo, we treat your skin condition just like any other health condition you have.
If you have vitiligo symptoms, it’s important to get a diagnosis from your dermatologist. That’s because other skin conditions can mimic or look like vitiligo. There are some rarer conditions that we want to rule out first. There are some allergic skin conditions that can look like vitiligo.
One thing I talk about with my patients is a makeup product called Dermablend to cover the skin. You can also use self-tanner with dihydroxyacetone. Using a self-tanning product is perfectly fine for Vitiligo. You can use it to cover skin lesions if you want a more even appearance. If you go out and tan, you will only tan the rest of your skin.
I often recommend light therapy to people with vitiligo. This is one of my favorite treatments for this condition. It is also called phototherapy. It is a treatment that uses directional ultraviolet rays. 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 used as directed by a dermatologist.