Vitiligo Medicine

Vitiligo can affect the quality of a person’s life and lead them to develop anxiety and depression in some cases. Thus, many people with the condition seek medication for vitiligo to get an even skin tone. Although not many treatment options are not available for people with vitiligo to choose from, the scientific community offers few efficient medicines to treat these people.

Here, you will find the latest vitiligo medicines along with insights into upcoming drugs for treating vitiligo. However, this information should be just used for educating people. Since a lot of these medicines contain steroids and have side effects, one should always consult a doctor before starting any medication to avoid making the condition worse.

Understanding vitiligo

Vitiligo is believed to be an autoimmune disease that leads to the formation of white or discoloured patches on the skin or hair on a body. The first of these white patches, also known macules, occur under the age of 30 and usually progress slowly over time. Vitiligo does not cause any other trouble to the person except for changing their appearance and making their depigmented skin sensitive.

The skin gets its colour largely from the pigment ‘melanin’, which is produced by melanocytes. These cells are damaged or malfunction in people with vitiligo. It is a rare condition affecting about 70 million people worldwide (1% of the total population). The following factors increase the likelihood of a person developing vitiligo:

1. Family history of vitiligo
2. Severe sunburn
3. Immunotherapy (suppressing the immune system to treat a disease)
4. Exposure to toxic chemicals
5. Exposure to ultraviolet (UV) light for long

Vitiligo is characterised into mainly two categories—segmental and non-segmental. If a person has segmental vitiligo, only a part of their body gets macules (for example, the complete left side, one arm, both feet, face and neck, and back). On the other hand, people with non-segmental vitiligo have white patches on their body in a random fashion. However, this is not an absolute categorisation, and sometimes, people with segmental vitiligo get random white patches/spots here and there on their body.

What are the symptoms of vitiligo? How is it diagnosed?

Vitiligo only has one symptom—the white spots and patches on a person’s body. In the early stages, people often report having macules on their face, hands, arms, or feet. The hair on the affected patch also loses its pigment and turns white, grey, or silver. In rare cases, people also see their irises lose pigment, and depigmented patches might appear on the insides of their mouth, nose, and ear canal. The depigmented patches of the skin also sunburn easily and might itch sometimes.

When a person notices first set of white patches, they should consult their general physician who would then recommend them to visit a certified dermatologist. The dermatologist will use a ‘Wood’s lamp’ to accurately diagnose the condition by shining different lights on the affected skin. In addition, they might also recommend skin biopsy and blood tests before prescribing any tablets for vitiligo treatment. It is important to confirm the diagnosis with a dermatologist.

Medication for vitiligo

Although vitiligo does not cause any health problems for the affected person, it can be a source of discomfort and social problems. This is why people seek vitiligo medicine, but vitiligo has no cure as of yet. Fortunately, different approaches are available for treating the symptoms of vitiligo—(a) restoring the lost colour of the skin, (b) stopping the progression of macules, and (c) removing the remaining pigment from the skin.

The following drugs are useful in restoring the skin’s colour:

1. Topical steroids
   Steroids, such as fluticasone propionate, betamethasone valerate, corticosteroids, and calcipotriene, usually come in the form of a cream or an ointment to be applied to the affected area of the skin. The doctor will recommend the dosage in FTU—fingertip units. Topical steroid squeezed along an adult’s fingertip amounts to one FTU, and it is enough for the area equal to twice the size of their hand. Doctors would recommend these steroids in the following cases:
   a. A case of non-segmental vitiligo on less than 10% of the body
   b. The patient is not pregnant
   c. The patient is okay with the side effects, including streaks or lines in the skin, thinning skin, excess hair growth, inflammation, and acne
2. Topical tacrolimus or pimecrolimus

Although these are known for treating eczema, they may help restore the skin’s colour in some people. Pimecrolimus and tacrolimus, also known as calcineurin inhibitors, are unlicensed for vitiligo treatment. The side effects of these vitiligo medications include burning or painful sensation on application, increasing the skin’s sensitivity towards sunlight, and irritation or redness.

There are certain medications, including prescription drugs and topical creams/lotions (usually based on hydroquinone), that can achieve the even skin tone by removing the remaining pigment on the body—depigmentation. This technique is only recommended to people who are bothered by their condition and have more than 50% of their body covered with macules. Please note that this is a permanent procedure and cannot be reversed.
Besides, other medications are useful in stopping Vitiligo from spreading further. Drugs such as azathioprine are used to suppress the immune system and achieve the desired results.

Vitiligo medicines for children

Usually, medications that have immunomodulating properties (such as the ones recommended for adults) are used to treat vitiligo in children. However, the dosage might be adjusted depending on factors such as the child’s age. Before prescribing any medicine or creating a care plan, the dermatologist will check with the child’s parents to discuss possible treatment options, their results, and their side effects.

Alternative medication—homeopathy/Ayurveda for vitiligo

People at times, opt for alternative options such as homeopathy or Ayurveda instead the mainstream allopathic treatment. Other times, people fed up with allopathic treatments who see no visible results also try alternative medicine. However, it is important to consult with a doctor about the complementing the treatment as some of these remedies may affect a person negatively.

A study tested the effects of Ayurvedic medication for vitiligo, such as Shvitrahara kashaya, Shvitrahara lepa, Bakuchi, and Khadija, on a group of people for about 6 months. The results indicated about 50%–80% improvement in different patients based on the drugs they were given and other factors. Astonishingly, there were no side effects in people who underwent treatment with Ayurvedic medicines. Although there isn’t enough research on the matter yet to classify these drugs as standard treatment options for vitiligo, the benefits cannot be ignored.

Another study was conducted over a different cohort of people who were given individualised homeopathic care plan to follow for about 58 months (as homeopathy works slowly). There were impressive improvements in people with the early stages of vitiligo. More research is needed to see if homeopathy can be a long-term solution for people with vitiligo. It is important to note that homeopathy, with medicines based on plants, animals, and mineral compounds, has no side effects either.

Emerging vitiligo medicine

New drugs are being developed for treating vitiligo as most of the medication prescribed to people with this condition are unlicensed drugs. This basically means that the medicine manufacturer does not have a license for synthesising that particular medicine as treatment option for vitiligo. Since the benefits of using these medications outweigh potential risks, doctors recommend them to treat vitiligo. However, the doctors should always inform you of this scenario.

Currently, some drugs are being studied for the following purposes:

1. To stimulate melanocytes (colour-producing cells)
   The potential medication will be planted under the patient’s skin to promote the growth of melanocytes; thus, restoring colour to the depigmented skin.
2. To help control melanocytes

Few drugs, namely prostaglandin E2 in the gel formate, are being tested to restore the skin colour in people whose vitiligo is neither spreading nor widespread.

Besides, the FDA has also recently approved Ruxolitinib for treating adults and children with the age of 12 years or more. This drug is available in the form of topical cream and can restore pigments in people with non-segmental vitiligo.

Living with vitiligo

It is generally a bit difficult for people with vitiligo to enjoy their social lives, but there are different methods that can be used to manage the condition better. Here are some tips for people with vitiligo:

1. If you are worried about going to a public place, wear makeup or conceal the macules to feel at ease.
   You can choose to wear makeup with high coverage to cover the white patches/spots on your skin or wear clothes that cover them. Getting a more natural appearance with makeup products might take some time and practice; so, don’t beat yourself up for it.
2. Protect your skin from direct sunlight
   The depigmented skin tends to burn easily and may also start itching under the sun; additionally severe sunburns can trigger vitiligo and make it worse. You can seek shade when outdoors, use sunscreen of SPF 50 PA++ or more in summers or SPF 30 PA++ in winters. Besides, you can also choose to wear full length clothes in lighter shades (white reflects the most sunlight).
3. Before using semi-permanent camouflage techniques for your skin, consult your doctor
   Products such as self-tanner or a skin dye might be lucrative as you will not need to reapply makeup every day. However, they might contain ingredients that can irritate your skin or cause your vitiligo to spread further.
4. Risks involved in getting a tattoo
   You might think about covering the macule with a tattoo or want to get a tattoo for other reasons, but the process of getting a tattoo might trigger your vitiligo to spread.
5. Follow a healthy lifestyle to optimise your immune system
   Eating a balanced diet and doing some form of physical activity regularly can help one maintain their overall well-being. Doing this and reducing stress will make the immune system efficient and help avoid new vitiligo patches.
6. If you are struggling mentally, consider counselling
   You are not alone with this condition; if you see your morale going down because of vitiligo, it is best to talk to a supportive friend or look for a community online. Besides, you can also consult a therapist to increase your mental well-being. It is important for parents to pay attention to their children with vitiligo and consider counselling as it can be difficult for the children to regulate their emotions in a healthy manner.
7. Learn more about the condition
   Some of emerging vitiligo medicines are promising and might be effective with few side effects. Thus, you should keep an eye out for any important updates on the matter. Additionally, many people find it helpful to have more knowledge of their condition and feel in control.

Conclusion

The vitiligo medicines mentioned here are the most recommended for people to even out their skin tone. But it is important to consult with a registered dermatologist who can create a suitable care plan for you considering different factors before starting any medication yourself. It is important to note that the results of these medicines are very subjective; a doctor will likely start with the gentlest treatment and move from there.

At present, there are several treatment options for people with vitiligo. However, not everyone is suitable for each type of treatment or medicine. Thus, there is a need for further research in this field. In the future, one can expect to have better medications for treating vitiligo.