Treatment decisions UV light treatments Protopic & Elidel Steroid creams Other treatments Getting a second opinion
Treatments can be provided by the NHS. The main available treatments are:
- Creams, (steroids and Protopic) which can be prescribed by your doctor, which are used for up to 2 months or longer under close supervision.
- Light treatment, (narrowband UVB and PUVA) for which you would have to go to hospital 2 or 3 times a week. This is sometimes given with medication as well.
How effective are these treatments?
No complete cure for vitiligo has been discovered yet, but these treatments can be very effective in bringing back colour to the white skin patches, or at least slowing down the progress of vitiligo. The effects of treatment vary from one person to another. In some cases, treatment can bring about complete repigmentation.
Treatments may not work on all areas of the body and they do not work for everyone. If colour does return to the white patches, there is still a risk of the vitiligo coming back at a later date.
Recent research suggests that the effectiveness of treatments depends less on a person’s age than where the vitiligo is and when it started:
- Treating vitiligo on the face seems to be particularly effective.
- Children are more likely to be more responsive to treatment.
- Using treatments when vitiligo first develops is more effective than later on.
- Small areas are easier to treat than larger ones.
Bleaching (depigmentation treatment) and skin grafting are used very occasionally, in specific circumstances. More information on this is available in the Treatment Information Pack available HERE.
You may also have heard of various complementary treatments, which are not available on the NHS. More information is available HERE.
UV light treatments
PUVA light treatment
PUVA treatment is used in some hospitals. It involves taking medication as well as light treatment. The letters PUVA stand for Psoralen and Ultra Violet light A. Psoralens are chemicals found in plants, which make the skin more sensitive to light (either natural sunlight or UVA rays). Psoralen may be given as capsules to swallow, one or two hours before treatment. It may also be given as a lotion to paint on the white skin patches or to dissolve into bathwater (in which you have to soak for a short period before UVA treatment). You should not take psoralens if you are pregnant.
Because psoralen makes your eyes sensitive to sunlight, you need to wear dark glasses to protect your eyes for at least eight hours after taking the capsule. You also need to be careful that you are not taking or using other substances that are making your skin more sensitive to the UVA rays. These substances include some medicines, including complementary or herbal medicines. They also include coal tar or disinfectant soap and some deodorants, perfumes and aftershaves.
Narrowband UVB light treatment
Narrowband UVB is now the most common type of light treatment for the treatment of vitiligo. It uses light of a specific UVB wavelength, which has proved to be to be more effective than using standard UVB. There are a number of advantages over PUVA. Narrowband UVB treatment:
- Does not require additional medication, so you do not need to take special precautions before and after treatment.
- The normal skin does not develop the deep tan usual with PUVA treatment, so the contrast between normal skin and the treated vitiligo skin is less obvious.
- Exposure to the light is for much shorter periods.
- The different light source reduces the possible risk of skin cancer.
- UVB treatment does not tend to damage the skin nearly as much as PUVA can.
- It is a safer treatment for children than PUVA.
- Treatment studies suggest that it is a more effective treatment than PUVA.
Protopic & Elidel
Protopic (also known as tacrolimus) ointment is a treatment that has mainly been used for eczema. Recently, protopic has also been used in clinical studies for the treatment of vitiligo. It is made from a rare soil bacterium found only in Japan.
Protopic appears to have unique qualities in suppressing the immune response in vitiligo patches. It has a similar effect to steroid treatment, but without the side effects. Protopic ointment has proved quite effective on the faces of some people who have vitiligo, when the loss of pigment is relatively recent and still active. Like steroid creams, unfortunately protopic does not work for everyone.
Protopic is available in two strengths, the milder ointment (.03% strength) being usually for children. Protopic can be prescribed by GPs for vitiligo, although it is not licensed. Often a dermatologist may recommend it but ask the GP to actually prescribe it.
The treatment usually involves applying the ointment twice a day. Many doctors are also recommending that their vitiligo patients expose themselves to natural sunlight several times a week for 15 – 30 minutes. The usual procedure is to use protopic for six to eight weeks and then start it again after a break.
Current research is looking at the effectiveness of using protopic with Narrow Band UVB light treatment. In some studies, this combination has shown enhanced pigmentation but further work is needed to establish safety standards for this treatment.
Elidel (also known as pimecrolimus) is a similar product to protopic, but it is in a cream form.
The advantages and disadvantages of Protopic and Elidel
- It is an alternative to steroid creams and can also be done at home.
- It does not have the potential side effects of steroid creams.
- Protopic does not seem to be readily absorbed into the bloodstream, so the treatment is quite localised.
- It takes a long time for results to show (usually three to six months).
- Even when white patches have re-pigmented, they may relapse later.
The most common treatment offered on the NHS is steroid creams and they are known as corticosteroids. These are creams which are used to treat inflammatory conditions of the skin, other than those arising from an infection. They include such brand names as Betnovate, Cutivate, Dermovate and Synalar.
Vitiligo is considered to be an ‘autoimmune’ condition, in which the immune system attacks the body’s own tissues. Steroid creams can stop this happening and therefore stop the progress of vitiligo. They are classified as mild, moderately potent, potent or very potent. The doctor will generally prescribe the least potent cream that will treat the condition.
Treatment probably involves having a trial period of using the cream of up to two months. This is to make sure that there are no side effects. The usual procedure is to use the cream for six to eight weeks and then start the cream again after a break. It may be used for longer under close supervision.
The cream or ointment must be applied to the white patches of your skin thinly. It is important that you follow the instructions you have been given carefully. You also need continue with the treatment for some time (at least three months) before any results are likely to be seen.
The advantages and disadvantages of steroid creams
- Steroid creams are simple to use and a treatment you can do at home.
- Creams are quite safe, so long as instructions are followed.
- Steroid creams can be quite effective, especially with new areas of vitiligo, but they do not work for everyone.
- Overuse can lead to side effects such as skin shrinkage or stretch marks.
Complementary (non-NHS) treatments
Some treatments are not available on the NHS. You may feel that they are worth investigating if conventional treatments have not worked for you. However, The Vitiligo Society cannot recommend using any of these treatments, due to the lack of clinical trials to prove their effectiveness.
We would suggest that you check the qualifications and experience of private practitioners very carefully before paying for their procedures or products.
Recell is quite a new procedure that involves the practitioner taking a small sample of normal skin. The skin cells are separated out and then sprayed onto the white vitiligo patches, so that the pigment cells can develop. The re-pigmentation process takes several months. Although less intrusive than skin grafts, the procedure involves some skin trauma. Further research is required to find out how effective this treatment is, in the short-term and long-term.
Laser treatments are only available privately and can be very expensive. There is conflicting evidence about how effective they are.
Complementary medicines are heavily advertised on the Internet, but there is no reliable evidence of their safety or effectiveness. Current research indicates that most complementary medicine products to treat vitiligo are ineffective and expensive, except ginkgo biloba.
Vitamin and mineral supplements may be a good idea if for some reason you have to have a restricted diet, or if it is found that you have a specific deficiency. You should not take more than the recommended dose though. If you have a healthy, balanced diet it should not be necessary to take supplements. Check out our online magazine and Youtube channel for more information:
VitLife Article: A personal take on nutrition
VitLife Article: Vitiligo and mental well-being; food, mood and gut
The Vitiligo Society continues to monitor vitiligo research and treatments and will provide information on any proven product or treatment.
Getting a second opinion
It is very important that you have confidence in your doctor. If you are concerned that you have not been given sound advice, or you feel that your doctor has not listened to your concerns, you should do something about this.
Your options are:
Go back to your doctor to discuss your concerns further.
You should do this if you feel that your doctor did not have all the information about your condition. Perhaps you discussed more than one medical problem with him/her and not enough time was given to the particular problem that bothered you. Possibly you forgot to tell the doctor something important – easy to do if you are anxious. It may be helpful to write a note of everything you want to say next time, or take someone with you to remind you (and give support). This makes it easier for the doctor to give you an opinion based on all the facts available.
Ask for a second opinion from a doctor in the same GP practice.
If your doctor has been given all the information about your condition and you are not satisfied about the response, asking for a second opinion is the best option. A good doctor is not afraid of a second opinion, which might confirm the first diagnosis, or pick up on something that has been missed. Doctors are human – they have to know about a very wide range of illnesses and any individual GP will have more knowledge and skills in some areas of medicine than others.
Remember that you are registered with a Practice and not an individual doctor. The doctors in a Practice share responsibility for their patients and will want to do the best for them, so it is reasonable to ask to another doctor there for a second opinion. You may want to ask to speak to the Senior Partner or the Practice Manager for this opinion.
A second opinion may confirm that your GP is absolutely right and your concern is unfounded, but it is also possible that another doctor will have a different opinion. In this case, you will have to decide whether this second opinion is more acceptable to you (a second opinion is not necessarily going to be better than the first).
Seek advice from outside your GP practice.
If you feel that you cannot seek a second opinion from another doctor in the Practice, or you have done this and are still concerned, you can get help from your local NHS Patient Advice and Liaison Service (PALS). Information about this service should be available on all NHS premises. You can also find the contact details and a number to ring for your local PALS on the website www.pals.nhs.uk, or from the ‘Health Services Near You’ directory page on the NHS Choices website. Ask to speak to the PALS Officer, who will be able to help you.
Register with another practice.
This should be a last resort, if you really feel you have lost confidence in your doctor and cannot consult anyone else in the practice. There is no guarantee another doctor would do anything different or better, so you need to make sure that you want to take this step!