Frequently Asked Questions
WHAT IS VITILIGO?
Vitiligo is a chronic (lifelong) condition caused by loss of pigment (color) in skin resulting in whitened areas. Vitiligo affects 1 to 2 out of every 100 people and it equally affects men and women and individuals of all ages and races. Although it may occasionally progress rapidly, many people do not develop new or worsening areas for many years or decades.
WHAT CAUSES VITILIGO?
At this time, the cause of vitiligo is unknown, but it is believed that your own body is destroying the cells in your skin that make pigment (color). This is known as an autoimmune reaction. It can also be triggered by a stressful event, illness, or injury to the skin. Vitiligo can also run in the family.
WHAT OTHER DISEASES ARE ASSOCIATED WITH VITILIGO?
There is an association with other known autoimmune diseases such as diabetes, thyroid disease, alopecia areata (hair loss) and anemia (low red blood cells). Most importantly, vitiligo is not a contagious disease.
WHAT TREATMENT OPTIONS ARE AVAILABLE?
Starting treatment when the condition first appears is more effective than when the disease has been present for a longer period. With all forms of treatment meant to restore the color, the face tends to respond best, followed by the trunk, arms, and thighs. When the tips of the fingers and toes are involved, treatment of these areas can be the most challenging.
Topical corticosteroids are a safe first line therapy. Head and neck areas have the best response rates. Combining topical corticosteroids with other treatments, such as light therapy, appears to enhance the results.
Protopic (tacrolimus) ointment and Elidel (pimecrolimus) cream are a class of topical medications that are effective treatment for localized vitiligo without many of the side effects that topical corticosteroids may cause, such as thinning of the skin. The best response is also seen in the head and neck. Like topical corticosteroids, combining it with other therapies improves results.
Calcipotriene is a topical medication that is a type of vitamin D. It is not usually used by itself, but rather with other treatments.
Ultraviolet light therapy (a part of sunlight) is the treatment of choice for patients with widespread vitiligo. It can also be used patients who fail topical therapy. There are several types as described below.
Narrowband Ultraviolet B
Narrowband Ultraviolet B (UVB) treatment is widely used all over the world. It involves exposing the skin to UVB light two to three times a week, with average treatments lasting between 10 weeks and 2 years. It may take 30 or more treatments for a response to become apparent. Unlike PUVA (see below) with which the medication (psoralen) is taken orally or applied to the skin, UVB treatment is strictly a light therapy. It is proven to be more effective than PUVA and without the potential side effects of psoralen.
The majority of patients (80%) that undergo ultraviolet light treatments will get a response, but individual degree of response varies. The typical response is seen as islands of freckles in the affected skin that will grow in size. Occasionally, the edges of the white area will tan and fill inwards. About half of the patients that respond to ultraviolet light will keep the new color.
Psoralen + Ultraviolet A or PUVA (pronounced pooh-vuh) is sometimes used in patients who do not respond to narrowband UVB. PUVA involves taking an oral or topical medication (psoralen) followed by being placed in a light booth and exposed to ultraviolet A light. Patients are treated two to three times a week. It may take 30 treatments or more to see a response.
The excimer laser is a form of ultraviolet B laser phototherapy that allows for targeted treatment of localized vitiligo areas. It is generally used for patients when vitiligo is localized to less than 10% of body surface (very small area). Excimer laser can be used as the only form of treatment for localized vitiligo, but better results have been observed when it has been used with other medical therapies, such as Protopic or topical corticosteroids (see above).
DOES INSURANCE COVER THESE TREATMENTS?
Treatment costs will vary based on the fee structure of the clinic or medical institution providing the service. You should check with your health insurance provider to determine if a particular treatment is covered. Ask your provider to give you the associated codes so you can call your insurance company to verify PRIOR to starting therapy.
WHERE ARE LIGHT TREATMENTS AVAILABLE?
You should check with your dermatologist on the location near your area.
WHAT ABOUT BLEACHING CREAMS?
Prescription bleaching creams are an option for those who have extensive involvement (80% or more of the body covered by vitiligo) and/or who do not respond to treatment. The skin with any remaining pigment can be bleached with bleaching creams; it usually takes 6-9 months of treatment (but can take 1-2 years) to have a noticeable result. This will result in the PERMANENT loss of any pigment in the skin. Your dermatologist should be consulted before attempting this option.
WHAT OTHER TREATMENTS ARE AVAILABLE?
Skin transplantation or grafting is another option available to individuals with stable vitiligo that only involves a small portion of the skin. This is called MKTP, or melanocyte-keratinocyte transplantation procedure. Surgical treatment for vitiligo is invasive and not without risks; however, it can be an excellent option for patients who fail non-surgical therapy. Ask your dermatologist if you are a candidate for surgical treatment.
There are also oral medications that can be taken to assist with return of color. Gingko biloba and alpha lipoic acid are the two that are most recommended. These medications can be found over the counter (a prescription is not needed) and are taken 1-2 times per day. These are often combined with other therapies above for the best response. Ask your provider for a list of accepted brands.
WHAT ABOUT TANNING TO RESTORE PIGMENTATION?
It is recommended that individuals with vitiligo wear sunscreen to avoid sunburn. The white skin of vitiligo has no natural protection from the sun and is very easily sunburned.
You must not treat vitiligo using tanning parlors. The light sources in tanning parlors are different from those used in the medical treatment of vitiligo. Furthermore, you do not receive any medical supervision in tanning parlors needed to control the amount of light and proper evaluation of your skin that you normally would receive in a medical institution.
WHAT ARE SOME ALTERNATIVES FOR IMPROVING APPEARANCE?
Cosmetic makeup, self-tanning compounds or dyes may be practical and quick options for some people to camouflage their skin color variations. Please note that this will not treat or stop progression of the condition. Dermablend, CoverFX, and CoverBlend are good brands of makeup often used by patients with vitiligo to even out skin coloration.
IS THERE A CURE FOR VITILIGO?
Unfortunately, no. While much progress has occurred in the treatment options for vitiligo, currently, there is no cure. Responses to treatment may vary and several types of treatments may be needed to get a response. Please consult your dermatologist to discuss your condition and treatment options.
WHERE CAN ONE GET MORE INFORMATION?
The group meets quarterly on Thursdays Virtually or Saturdays face to face. For more information email at firstname.lastname@example.org
For general vitiligo information, you may also contact your local dermatologist or go to the websites for The Global Vitiligo Foundation at (globalvitiligofoundation.org.), The Vitiligo Research Foundation (vrfoundation.org), VITFriends Incorporated (vitfriends.com )or Vitiligo Support International (vitiligosupport.org).