Topical corticosteroids are creams or ointments which contain corticosteroids that you apply onto your skin. Some doctors might refer to them as topical steroids or topical glucocorticoids. Corticosteroids are synthetically made drugs that act like cortisol, a hormone naturally produced by the body, specifically by the adrenal glands which are small organs right on top of your kidneys. The main function of corticosteroids is to reduce inflammation and suppress the immune system (NICE, 2022). Some commonly prescribed topical corticosteroids for vitiligo include betamethasone, fluticasone, hydrocortisone and clobetasol (NHS, 2021; Gawkrodger et al., 2008).

There are very specific criteria that need to be met for your GP to be able to prescribe you topical corticosteroids. Your vitiligo must be non-segmental (the patches appear on both sides of your body) and on less than 10% of your body, you cannot be pregnant, and you must understand and accept the risk of side effects (NHS, 2021). If you do not meet these requirements, corticosteroids are likely not the most effective way to manage your vitiligo and you will be referred to a dermatologist. Corticosteroids are not prescribed for lesions on the face or large areas of vitiligo due to a higher risk of side effects, and there are more adequate treatments for those areas, such as phototherapy or calcineurin inhibitors (Taieb et al., 2012). If your vitiligo is segmental (occurring on only one side of your body), corticosteroids are not as effective (Haddadi et al., 2022), potentially because this type is thought to be caused by a different mechanism than generalized vitiligo (Alikhan et al., 2011).

Topical corticosteroids are often the first line treatment for vitiligo (Haddadi et al., 2022; Gawkrodger et al., 2008). Vitiligo is generally thought to be an autoimmune disorder, where the immune system mistakenly attacks and destroys the body’s own pigment cells, resulting in white skin patches. Corticosteroids are immunosuppressive drugs which may stabilize and stop this process in active vitiligo. It’s important to note that corticosteroids are not a cure for vitiligo but rather a way to control the disease’s progression. While you might experience some degree of repigmentation, it is very unlikely to be 100% of your vitiligo. New or spreading lesions usually respond better to corticosteroids treatment than old and stable ones (Haddadi et al., 2022). Vitiligo on non-hairy surfaces such as the palms of the hands, soles of the feet, face and ears does not respond to the treatment as well as other areas (Taieb et al., 2012).

If you meet all the treatment criteria, you will be prescribed a daily dose of a corticosteroid cream or ointment for up to 2 months. The treatment will be reviewed after a month, looking for any improvements, such as repigmentation or relief of itch, and at whether you are experiencing side effects. If there is a good response or any suspected side effects after 1 month, the GP will consider discontinuing the treatment, otherwise it will be continued for up to 2 months. If there is no response and no side effects after 2 months, you will be referred to a dermatologist who will consider using a stronger corticosteroid or an alternative treatment. If you have a good response to topical corticosteroids, a maintenance plan might be introduced – for example you will use the ream or ointment for 3 weeks and then take 1 week break. It is very important not to use corticosteroids for more than 2 months straight due to increased risk of side effects. Before and throughout the treatment your GP might wish to monitor your response by taking photographs at regular periods of time (Gawkrodger et al., 2008). This is very helpful with monitoring progress since it can
happen too slowly to notice on a day-to-day basis. You might wish to take photographs yourself too.

Researchers have found corticosteroids to be moderately effective for treating vitiligo. The response is very individual, with very few patients experiencing full repigmentation and some not seeing any results at all (Whitton et al., 2015; Gawkrodger et al., 2008). Side effects occur very rarely if you adhere to the treatment, but some patients might experience a burning or stinging sensation, skin atrophy (skin thinning with some bruising and blood vessels being visible), stretch marks, hair growth, acne and reddening of the skin being treated. These, however, occur mostly on the face, in skin folds, and in areas that are treated for over 2 months, which is why topical corticosteroids are not prescribed for the treatment on face and neck, or used for over 2 months without a break (NICE, 2022; Taieb et al., 2012). Topical corticosteroids are a good option if your vitiligo is localized to a small area and you wish to try a different treatment than sun protection and skin camouflage. The creams and ointments are also one of the most practical and inexpensive treatments that you can apply in comfort of your home.

References
Alikhan, A., Felsten, L. M., Daly, M., & Petronic-Rosic, V. (2011). Vitiligo: A comprehensive overview: Part I. Introduction, epidemiology, quality of life, diagnosis, differential diagnosis, associations, histopathology, etiology, and work-up,. Journal of the
American Academy of Dermatology, 65(3), 473–491.https://doi.org/10.1016/j.jaad.2010.11.061

Gawkrodger, D., Ormerod, A., Shaw, L., Mauri-Sole, I., Whitton, M., Watts, M., Anstey, A.,Ingham, J., & Young, K. (2008). Guideline for the diagnosis and management of vitiligo. British Journal of Dermatology, 159(5), 1051–1076.
https://doi.org/10.1111/j.1365-2133.2008.08881.x

Haddadi, N.-S., Rashighi, M., & Harris, J. E. (2022). Vitiligo. In Treatment of Skin Disease (6th ed., Vol. 252, pp. 876–880). Elsevier Inc.

NHS. (2021, November 18). Treatment: Vitiligo. nhs.uk.https://www.nhs.uk/conditions/vitiligo/treatment/

NICE. (2022, June). Corticosteroids – topical (skin), nose, and eyes. National Institute for Health and Care Excellence.

Taieb, A., Alomar, A., Böhm, M., Dell’Anna, M., De Pase, A., Eleftheriadou, V., Ezzedine, K., Gauthier, Y., Gawkrodger, D., Jouary, T., Leone, G., Moretti, S., Nieuweboer-Krobotova, L., Olsson, M., Parsad, D., Passeron, T., Tanew, A., van der Veen, W., van Geel, N., . . . Picardo, M. (2012). Guidelines for the management of vitiligo: the European Dermatology Forum consensus. British Journal of Dermatology, 168(1),5–19. https://doi.org/10.1111/j.1365-2133.2012.11197.x

Whitton, M. E., Pinart, M., Batchelor, J., Leonardi-Bee, J., González, U., Jiyad, Z., Eleftheriadou, V., & Ezzedine, K. (2015). Interventions for vitiligo. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd003263.pub5