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Vitiligo Treatment Creams: What Are the Differences?

Posted on October 12, 2022
Article written by
Maureen McNulty

  • Topical medication is usually the first treatment doctors prescribe for vitiligo.
  • Some topical treatments should be used alongside phototherapy to increase their effectiveness.
  • In July, the U.S. Food and Drug Administration (FDA) approved the first repigmentation cream to treat vitiligo called Opzelura, a formulation of ruxolitinib.

There are several forms of treatment for vitiligo, including creams, pills, phototherapy, and surgery. Each of these treatments may be helpful for treating vitiligo in certain circumstances or at certain times.

While oral medication can help stabilize vitiligo that is rapidly spreading, doctors typically first recommend topical medications (applied directly to the skin) as treatment. These may include different creams or ointments. Topical medication may help reduce vitiligo symptoms and improve your quality of life.

Topical Repigmentation Creams

Vitiligo occurs when your immune system attacks the body’s melanocytes (pigment cells). Some experts believe the condition can also develop when the melanocytes become damaged by other factors, or as a result of genetic factors that cause abnormalities in these cells.

Topical vitiligo treatments suppress the immune response that attacks melanocytes, leading to more pigment within your vitiligo patches. Applying these creams or ointments to areas of vitiligo make them darker. The process of restoring melanin (pigment) in your skin is called repigmentation. This type of treatment may work best if you have smaller areas of skin that are affected by vitiligo.

Topical Corticosteroids

Corticosteroids are anti-inflammatory medications that help calm the immune system. They may help stop vitiligo from spreading, and they may also allow your body to produce more melanocytes that can make pigment. Both adults and children can use these medications. They are often one of the first treatments used for vitiligo.

Topical corticosteroids for vitiligo include:

  • Clobetasol propionate (available in brand names like Clobex and Olux)
  • Betamethasone dipropionate (available in brand names like Beta-Val, Dermabet, and Diprolene)
  • Fluticasone propionate (Cutivate)

This treatment may lead to side effects such as stretch marks, acne, or skin that becomes thin, saggy, or fragile and prone to tearing. For this reason, doctors typically recommend using topical corticosteroids for shorter time periods.

Topical Calcineurin Inhibitors

Calcineurin inhibitors used for vitiligo include topical tacrolimus (Protopic) or pimecrolimus (Elidel).

Calcineurin is a protein that helps activate the immune system. Medications that block this protein, called calcineurin inhibitors, are often used to treat autoimmune diseases like vitiligo because they can help prevent your immune system from attacking your healthy tissues.

Your doctor may recommend topical calcineurin inhibitors alone or in combination with topical steroids. This treatment may also be a good choice for thinner, more sensitive areas of skin, such as the lips, eyelids, or genitals. Furthermore, calcineurin inhibitors can be used for longer periods of time than corticosteroids, so some doctors recommend these during the initial treatment of vitiligo.

This treatment has been well-studied in people living with vitiligo. A meta-analysis of 46 studies on people with vitiligo showed that topical calcineurin inhibitors have at least some effect for more than half of those with the condition. Additionally, 73.1 percent of people had improvements in face and neck patches. Topical calcineurin inhibitors were also effective for 72.9 percent of people when combined with phototherapy (light treatments). The medications also work for nearly half of children with vitiligo.

The most common side effects of topical calcineurin inhibitors include burning, itching, and redness. These side effects are usually mild and typically go away with continued use.

Topical Vitamin D Analogs

Calcipotriene (sold under brand names like Dovonex and Sorilux) is a vitamin D analog. This medication was developed as a psoriasis treatment, but some doctors may recommend calcipotriene to help repigment the skin for people with vitiligo. However, research into this medication is mixed — some studies show it may help, while others have not found it to be useful as a vitiligo treatment.

Calcipotriene may help activate melanocytes. However, it doesn’t work well when used on its own. Calcipotriene may help strengthen repigmentation and lead to quicker results when used along with a topical corticosteroid cream. It may also be more effective when combined with light therapy.

It is important to know that only a few studies have analyzed the effects of calcipotriene in people with vitiligo. More research is needed to understand how effective vitamin D treatments are for vitiligo, and in which groups of people they are most helpful. Not all experts agree that people with vitiligo should try calcipotriene.

Calcipotriene may lead to dry, irritated, or itchy skin. It can also make you more likely to get sunburned. However, these side effects are generally mild, and more severe problems are rare.

Topical PUVA

Psoralen plus UVA (PUVA) phototherapy is a treatment that combines two components:

  • Psoralen, a medication that makes your skin more sensitive to light
  • Light therapy involving ultraviolet A light from the sun or a phototherapy device at your doctor’s office

Psoralen can be taken topically or orally. This drug may work in a couple of different ways. It may cause gene damage in immune cells, preventing them from attacking melanocytes. Psoralen may also help melanocytes grow and make copies of themselves.

PUVA leads to many side effects, such as dark spots that don’t match your normal skin color. It can also increase your risk of developing skin cancer. Furthermore, studies show that PUVA is not more effective than narrowband ultraviolet B (also called narrowband UVB or NB-UVB) treatment, a type of light therapy. Therefore, PUVA is rarely used as a vitiligo treatment anymore, although it may be helpful in more severe cases of vitiligo that cover large areas of the body. Doctors typically recommend narrowband UVB treatments alone.

JAK Inhibitors

In July, the FDA approved a new medication to treat vitiligo: Opzelura, a formulation of ruxolitinib. This drug belongs to a category of medications called Janus kinase (JAK) inhibitors.

JAK inhibitors block processes in your skin that cause immune cells to attack melanocytes. They can prevent immune cells from gathering in your skin, keeping your melanocytes alive and preventing your skin from losing pigment.

Ruxolitinib can be given as a topical cream to treat vitiligo. You may be able to use this treatment if you are at least 12 years old and have nonsegmental vitiligo (vitiligo predominantly caused by immune attack of melanocytes).

In two clinical trials, ruxolitinib was found to provide repigmentation for some people with vitiligo. After six months, facial repigmentation improved by at least 75 percent for 3 out of 10 people. However, only 1 out of 10 people using a placebo (a nonmedicated cream) saw the same improvement. Topical ruxolitinib was effective for some people, although not everyone.

Ruxolitinib can sometimes cause side effects. You may experience acne, itching, skin redness, headaches, colds, fever, or urinary tract infections.

Topical Depigmentation Creams

Depigmentation therapy works in the opposite way as repigmentation treatments — it prevents the skin from making pigment. This type of therapy, also called bleaching treatment, may be recommended for people with extensive vitiligo that covers more than half of the body. A depigmentation cream is applied to areas of skin unaffected by vitiligo to make them match your white patches.

There is only one type of FDA-approved depigmentation cream for treating vitiligo: Benoquin, a formulation of monobenzone. Monobenzone can permanently remove pigment from the skin. Your skin may not make pigment ever again in the treated areas. On the other hand, your skin may also get spots of repigmentation, and these spots can be very difficult to treat. If you use monobenzone, you may switch from worrying about developing light spots to worrying about having new dark spots.

Although it’s not entirely clear how monobenzone works, researchers believe it can make melanocytes get rid of their pigment and then die.

In a clinical study, nearly 3 out of 4 people who used 20 percent monobenzone cream had their pigment completely removed in areas of skin where they applied the treatment, showing that this treatment can be very effective.

Side effects of monobenzone are usually mild and may include:

  • Skin irritation, such as swelling, blistering, or scaling
  • Depigmentation in areas of skin further away from where you applied the cream
  • Brown pigmentation in the clear layer of tissue that covers the eyes

Monobenzone can start working within a couple of weeks or months. However, it may take several years before you see complete loss of pigment. When you lose pigment in an area of skin, you will need to make sure to use sunscreen and carefully protect the area from the sun for the rest of your life.

Using Vitiligo Treatment Creams

If your current vitiligo treatment isn’t meeting your needs, you may want to ask your dermatologist about other potential options. This may be especially important if it’s been a while since you last had this conversation with your doctor — new medical treatment options have been approved in recent years. You may have more choices now for the management of vitiligo than you did in the past.

Your doctor can help you understand the potential benefits and side effects of different treatment creams. You may need to try more than one therapy before you find something that works well for you. Additionally, topical creams often take several months to start working, so you will have to use a treatment for a long time before you know for sure whether it will work. During this time, make sure to attend all of your follow-up appointments so your dermatologist can track your progress.

It’s important to use your topical treatments exactly as directed. If you don’t use them as often as directed, or if you don’t use the correct amount, the therapy may not work as expected. If you’re not sure how to use your cream, ask your doctor for details or request that they show you exactly how it should be applied.

Talk With Others Who Understand

MyVitiligoTeam is the social network for people with vitiligo and their loved ones. On MyVitiligoTeam, members come together to ask questions, give advice, and share their stories with others who understand life with vitiligo.

Which vitiligo treatment creams have you tried? Share your experiences in the comments below, or start a conversation by posting on your Activities page.

References
  1. The Effectiveness of Topical Calcineurin Inhibitors Compared With Topical Corticosteroids in the Treatment of Vitiligo: A Systematic Review and Meta-Analysis — Journal of the American Academy of Dermatology
  2. Vitiligo: Causes — American Academy of Dermatology Association
  3. Vitiligo — Cleveland Clinic
  4. FDA Approves Topical Treatment Addressing Repigmentation in Vitiligo in Patients Aged 12 and Older — U.S. Food and Drug Administration
  5. Janus Kinase Inhibitors in the Treatment of Vitiligo: A Review — Frontiers in Immunology
  6. Topical Medication for Vitiligo — NYU Langone Health
  7. Vitiligo: Diagnosis and Treatment — American Academy of Dermatology Association
  8. Efficacy of Tacrolimus Versus Clobetasol in the Treatment of Vitiligo — Cureus
  9. Vitiligo — Yale Medicine
  10. The Role of Calcium-Calcineurin-NFAT Signaling Pathway in Health and Autoimmune Diseases — Frontiers in Immunology
  11. Treatment Outcomes of Topical Calcineurin Inhibitor Therapy for Patients With Vitiligo: A Systematic Review and Meta-Analysis — JAMA Dermatology
  12. A New Era in the Management of Vitiligo: Facts and Illusions — Expert Review of Dermatology
  13. Calcipotriene Skin Cream — Cleveland Clinic
  14. Photochemotherapy (PUVA) in Psoriasis and Vitiligo — Indian Journal of Dermatology, Venereology, and Leprology
  15. Treatments — UMass Chan Medical School
  16. Benoquin Cream 20% — U.S. Food and Drug Administration
  17. Successful Treatment of Extensive Vitiligo With Monobenzone — The Journal of Clinical and Aesthetic Dermatology
  18. Monobenzyl Ether of Hydroquinone 20 and 40% Cream in Depigmentation of Patients With Vitiligo: A Randomized Controlled Trial — Journal of the Egyptian Women’s Dermatologic Society
  19. Depigmentation Therapy for Vitiligo — DermNet
    All updates must be accompanied by text or a picture.
    Victor Huang, M.D., Global Vitiligo Foundation is the director of phototherapy at UC Davis Health. Learn more about him here.
    Maureen McNulty studied molecular genetics and English at Ohio State University. Learn more about her here.

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