Vitiligo is a chronic skin pigmentation disorder that causes white or lighter patches of skin to develop on the body. Vitiligo is an autoimmune condition in which the immune system mistakenly attacks its own healthy melanocytes (the cells that give color to skin, hair, and nails).
On its own, vitiligo is usually not painful and is not life-threatening. Some people with the condition choose not to treat it because it does not affect their health or self-esteem.
For people who do choose treatment, the goal is usually to reduce the appearance of the patches if they are affecting a person’s quality of life.
Oral and topical prescription medications, light therapy, surgical procedures, and some lifestyle changes can help people manage vitiligo. There is no cure for the condition, but a dermatologist (a doctor who specializes in skin, hair, and nails) can help you develop a treatment plan that meets your needs.
Topical and oral prescription medications (or a combination of both) are among the first treatments that are usually tried for people with vitiligo. Prescription medications may slow the progression of the discolored patches of the skin and may potentially restore some of the pigment in small areas, though the results of these treatments vary.
Steroid creams or ointments can be applied to the affected areas of the skin to help change how the immune cells work. They may also prevent excessive tissue damage by fighting inflammation.
Creams are typically prescribed to be used on small areas of skin and may work best for people with darkly pigmented skin.
Some research has shown that prescription creams are more effective on the face, rather than on other areas like the hands or feet. People who use potent topical corticosteroids often regain at least some skin pigmentation after six months.
While these creams might be helpful for some people with vitiligo, they do come with side effects. For example, topical corticosteroids have been known to cause skin thinning or stretch marks when they are used long-term.
If you’re pregnant or planning to become pregnant, talk to your doctor before using topical corticosteroids. Mild to moderate versions of these drugs are preferred over more potent versions while you are pregnant.
If you have severe vitiligo, lower doses of corticosteroids, such as Prednisone, taken by mouth are sometimes used as a first-line treatment to help slow the spread of skin discoloration. Using oral corticosteroids for vitiligo can help by targeting inflammation, which can lead to fewer pigment cells.
Corticosteroids work by suppressing the immune system. They are approved by the Food and Drug Administration (FDA) to fight inflammation.
Common side effects of corticosteroids include high blood sugar and fluid retention. More serious side effects like infection and weight gain are considered to be rare.
It’s important to know that corticosteroid therapy is not considered a long-term treatment option for vitiligo. It can also take up to three months to see results.
Topical Vitamin D Analogs
Your dermatologist may recommend a class of medications known as vitamin D analogs, such as calcipotriene and tacalcitol. These topical ointments are synthetic vitamin D derivatives and are used to lessen an inflammatory response in the skin’s pigment cells. They can also be used in combination with phototherapy (light therapy) or a corticosteroid.
Vitamin D analogs are approved by the FDA to treat psoriasis, but dermatologists may prescribe them off-label for vitiligo and other skin conditions.
While they’re considered to be safe for most people with vitiligo, vitamin D analogs can have mild side effects, such as stinging, swelling, itching, and burning skin.
Topical Nonsteroidal Anti-Inflammatories
Topical nonsteroidal anti-inflammatories pimecrolimus and tacrolimus (also known as topical immunomodulators) are FDA-approved to treat atopic dermatitis (or eczema).
These medications work by down-regulating the immune system, causing a decrease in the immune response where they are applied topically (to the skin). In theory, this could allow the melanocytes, and therefore skin pigmentation, to return to areas of skin affected by vitiligo.
The most common side effect of topical immunomodulators is a burning or itching sensation on the area of the skin where applied. You might also experience brief flushing of your skin after you drink alcohol. There are also less common but serious side effects that you should discuss with your doctor.
Black Box Warning
In 2006, the FDA issued a black box warning to alert consumers of the rare possibility of developing lymphoma when using these medications. Further research submitted to the FDA in 2013 found no evidence of an increased risk of lymphoma among hundreds of thousands of people who used the drugs during the study period.
Some professional dermatology and immunology organizations have criticized the decision to keep the black box warning in light of the updated data. The medication is still prescribed with caution if appropriate for some vitiligo patients.
A black box warning does not mean that topical immunomodulators definitely increase the risk of lymphoma, but there could be a potential risk.
Surgeries and Specialist-Driven Procedures
There are procedures that can be done in a dermatologist’s office that may help restore color to vitiligo skin patches. These procedures might be recommended if topical treatments have not worked, if the vitiligo is widespread, or if the vitiligo is having a significant impact on a person’s quality of life.
The outcomes of these procedures vary. Your dermatologist may recommend combining more than one type of therapy to get the best results.
Phototherapy (or light therapy) is a procedure performed by a dermatologist to carefully expose your skin to small amounts of ultraviolet A or B (UVA or UVB) light. The depigmented areas of the skin are targeted by the light using a special lamp or laser to help promote repigmentation.
Phototherapy tends to work best on the face and is least effective on the hands and feet.
Two to three treatments per week for several weeks to months are usually necessary to see any significant improvement. It’s also important to know that the results are not always permanent, and restored color can be lost each year after stopping treatment. Your dermatologist will discuss with you the risks of exposure to UVA light, which may increase the risk of skin cancer.
Always ask your doctor before starting any type of light therapy. The light therapy that is used in the dermatologist’s office is not the same as the at-home sunlamps that consumers can purchase (which are not regulated and have not been proven to be safe or effective).
PUVA Light Therapy
Phototherapy can be done on its own, but you might also be prescribed an oral or topical medication called psoralen, which makes your skin more sensitive to light. This combination treatment is referred to as PUVA (psoralen and UVA light), and it appears to be most effective for treating large areas of vitiligo-affected skin.
PUVA treatment is done at a hospital or outpatient center, usually twice a week for about a year. Studies have shown that it’s about 50% to 75% effective for the face, trunk, upper arms, and upper legs, but less effective on hands and feet.
People undergoing PUVA therapy are monitored closely to prevent serious side effects, as psoralen can sometimes affect the eyes.
Another form of phototherapy (specifically the excimer laser) can be used to treat smaller vitiligo patches. This type of laser produces ultraviolet radiation at specific wavelengths that have been shown to promote skin repigmentation. You will usually undergo a series of laser sessions over the course of several weeks or months.
While many people see results with the excimer laser, occasional touch-up sessions might be needed.
Different surgical procedures can take unaffected skin from one area of the body and replace an area of skin that is affected by vitiligo (similar to skin grafting). If light therapy and topical medications do not work, repigmentation procedures might be considered.
Not every person with vitiligo is a candidate for these procedures. A person’s vitiligo must have been stable (unchanged) for at least six months before the procedure. If a person scars easily or develops keloids (scars that rise above the skin), they should not have repigmentation procedures.
There are also possible complications to the procedures, include scarring, infection, or failure to repigment.
Depigmentation removes the remaining pigment from the skin, turning all the skin the same color as the white or light patches (therefore making the vitiligo patches less noticeable).
The FDA has approved a drug called monobenzone for depigmentation. It does have side effects, however, including itching, stinging, and the risk of repigmentation.
Depigmentation procedures are a last-resort option used only when the majority of a person’s skin has already lost pigment from vitiligo. Some experts recommend the procedure for depigmenting small sections of skin on areas that cause concern or affect a person’s self-esteem, such as the face.
Micropigmentation is a tattooing technique that is usually performed on smaller areas of skin to help blend vitiligo patches to match the rest of the skin. It’s similar to permanent makeup, but is done for a medical condition and not solely for cosmetic purposes. Micropigmentation is not recommended for larger areas of skin.
Up to four treatments are needed for a small area, and each treatment takes a few hours to complete. Immediately following the procedure there can be swelling, but it’s usually manageable with ice packs.
Full results can be seen in three weeks. Micropigmentation does come with risks, including infection, inflammation, keloid development, and allergic reactions.
Over-the-Counter (OTC) Therapies
Your doctor may also recommend over-the-counter (OTC) products to help manage certain aspects of your vitiligo, though these products are not made for actively repigmenting the skin.
Some people experience pain, discomfort, or itching on the areas of skin where the vitiligo appears. If the pain is mild, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or Aleve can be effective.
Check with your doctor to make sure the pain relievers you use will not interfere with any other medications you take or affect any other medical conditions you may have.
All vitiligo patients can benefit from sun protection, as the condition comes with a severe risk of sunburn. Your dermatologist will recommend a topical sunscreen with an SPF of 30 or higher to help protect against damage on the skin patches that do not have enough melanin to protect from the sun’s damaging rays.
Vitiligo can affect a person’s self-esteem because there is a social stigma related to the skin’s appearance. Your dermatologist might recommend trying a drugstore self-tanner or concealing cream to add color and help match your natural skin color.
Hypoallergenic concealers such as Dermablend and Covermark are brands that are available in drugstores. Make sure you select a waterproof product.
Home Remedies and Lifestyle
In addition to prescription medications and medical procedures, there are some potential dietary and lifestyle changes that can help people with vitiligo care for their skin and overall health and well-being.
Home remedies are not a replacement for vitiligo treatment, and more research is needed on their potential benefits.
People with and without vitiligo can benefit from eating a nutritious diet, staying hydrated, and consuming plenty of immune system–boosting foods that contain phytochemicals, beta-carotene, and antioxidants. These nutrients can help promote healthy skin.
“Vitiligo-specific” diets have not been clinically studied enough for experts to recommend them.
Research has pointed to a potential connection between the bacteria that live in the digestive tract (gut flora) and autoimmune diseases. You might want to discuss your overall diet with your doctor or a registered dietitian to see if there are ways you can improve your overall gut health.
Complementary and Alternative Medicine
While there has been some research on complementary and alternative medicine (CAM) treatments for vitiligo, there is not yet solid, reliable clinical trial evidence on their safety or effectiveness. Most experts do not feel comfortable recommending them broadly.
Under the guidance of their doctor or dermatologist, some people with vitiligo may want to explore CAM approaches to vitiligo treatment in conjunction with traditional therapies.
Scientists have been interested in complementary supplements because of their antioxidant, anti-inflammatory, and immunomodulatory (modifying or stimulating the immune system) activity.
Vitamin and mineral supplements are being investigated as potential supportive treatments for vitiligo when used in combination with other methods (such as light therapy).
Several complementary treatments being studied include:
More studies are needed to further explore and solidify the impact that supplements may have on vitiligo management.
While they are not yet recommended for widespread use, research on a class of medications known as JAK inhibitors (Janus kinase inhibitors) has shown promise as a potential treatment for vitiligo.
JAK inhibitors target a type of immune communication pathway that has not previously been targeted in vitiligo. These pathways are believed to work by reducing the levels of inflammatory chemicals that lead to vitiligo progression as well as stimulating regrowth of the pigment cells.
Studies involving two specific types of JAK inhibitors—tofacitinib and ruxolitinib—showed effective results for treating vitiligo when used in combination with UVB therapy.
More research needs to be conducted and these drugs need FDA approval, but preliminary data has suggested that repigmentation (particularly on the face) might be possible.
A 2021 study showed that long-term treatment with ruxolitinib cream significantly increased repigmentation of vitiligo patches, and was well tolerated by patients.
JAK inhibitors are currently considered off-label as a treatment for vitiligo and can be expensive if not covered by insurance.
A Word From Verywell
Vitiligo looks and feels different for everyone—and treatment outcomes will vary, too. What works well for someone else might not be the best option for you.
It’s not possible to predict how someone will respond to a particular treatment, but your dermatologist can help you adjust and modify your treatment plan as needed.
If you choose not to treat your vitiligo patches, that’s completely OK. Vitiligo on its own is not life-threatening or contagious. Medical treatment is not always necessary if the condition is not associated with another autoimmune condition or affecting a person’s quality of life.
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