How is vitiligo treated?

Topical treatments, namely creams, are most commonly used in the treatment of vitiligo. Some of the creams used and their effects are as follows:

Corticosteroid Creams

Corticosteroid creams reduce the body's reaction and alleviate the effects of vitiligo. Especially the strong ones (potent corticosteroids) are the first treatment option. While it gives better results in areas exposed to the sun, the response is less in areas such as hands and feet.

Side effects such as thinning of the skin, cracks, visible veins and acne may be observed with long-term use. In order to reduce these side effects, treatment should be interrupted or switched to milder creams.

Calcineurin Inhibitor Creams

These drugs revitalize the pigment cells (melanocytes) in the skin. Since they have few side effects, they are preferred in the face and neck area. It is recommended to apply twice a day and use for at least 6 months. Treatment can be supported with light sunlight. The face and neck areas are the areas with the best results, while the results are weaker in the hands and feet.

Vitamin D Creams

Vitamin D regulates the immune system and supports the development of pigment cells. Although it is not very effective on its own, it is beneficial when used in conjunction with other treatments.

Pseudocatalase and Superoxide Dismutase

Vitiligo is thought to occur due to the accumulation of harmful substances (hydrogen peroxide) in the skin. These creams help prevent pigment loss by reducing these harmful substances.

5-Fluorouracil (5-FU)

This drug is usually used to treat certain lesions on the skin. However, it has been noted that it has pigmentation-enhancing effects and can help restore coloration in vitiligo.

Methotrexate (MTX)

Methotrexate regulates the immune system and reduces inflammation. It can increase coloration (repigmentation) in patients with vitiligo. It has been found to be effective, especially when the 1% gel form is applied twice a day and used with folic acid supplementation for 12 weeks.

Prostaglandin F2 Alpha Analogs

These drugs are generally used in the treatment of glaucoma. However, darkening around the eyes has been observed in glaucoma patients. This has led to its use in the treatment of vitiligo as it increases pigment formation.

Fibroblast Growth Factor (bFGF)

This treatment helps to activate pigment cells (melanocytes) in the skin and can be used in the treatment of vitiligo.

Janus Kinase (JAK) Inhibitors

JAK inhibitors reduce inflammation in the skin by regulating the immune system and support pigment cells.

Tofacitinib and Ruxolitinib are drugs in this group.

Ruxolitinib cream, 1.5%, is used twice a day on the face and other areas. Lesions on the face respond better to this treatment.

Side effects include redness, itching, mild darkening and sometimes temporary acne.

Systemic Treatment Methods for Vitiligo

Vitiligo treatment requires the use of drugs that will spread throughout the body, especially in patients with rapidly spreading vitiligo lesions. The drugs used systemically are as follows;

Corticosteroids

Corticosteroids suppress the immune system, stop the progression of the disease and support skin coloration. They are generally preferred for rapidly spreading vitiligo. Loading treatment is frequently used: For example, betamethasone or dexamethasone is taken at a dose of 5 mg 2 days a week. Treatment continues for 4 months or until complete recovery is achieved.

Apremilast

Apremilast is a drug that regulates the immune system. It reduces inflammation by affecting intracellular enzymes. It may have side effects such as headache, nausea and abdominal pain.

JAK Inhibitors

This group of drugs regulates the immune system and can increase skin coloration. Drugs such as Tofacitinib and Ruxolitinib are used.

Minocycline

Minocycline is an antibiotic. It protects skin cells from oxidative stress and can be effective in the early stages of the disease. 

Statins

These cholesterol-lowering drugs are also being tried in the treatment of vitiligo due to their inflammation-reducing effects.

Methotrexate (MTX)

Methotrexate is a drug used in inflammatory and immune system-related diseases. It can support coloration in the treatment of vitiligo.

Azathioprine

It is an immune system suppressant drug. It can have positive effects on vitiligo by slowing down cell renewal.

Cyclosporine

It is a powerful drug that regulates the immune system. It both stops the progression of the disease and can increase coloration in the skin.