What are the treatments for vitiligo?

All patients want to know how to effectively treat vitiligo, because these diseases have seriously affected the patients' lives, work and daily communication. Now there are many treatments for vitiligo, including drug treatment, which usually uses some steroid hormones, or drugs such as levamisole. Of course, light therapy is also effective.

1. Drug treatment

Drug treatment mainly includes corticosteroids, levamisole and calcipotriol. Corticosteroids can be used in conventional low-dose or pulse therapy. The former can last up to 4 months. It is more effective and has fewer side effects for male patients under 15 years old with a disease course of less than 2 years. The pulse therapy generally uses betamethasone 5 mg/d, 2 to 3 times a week; or methylprednisolone 500 mg, for 3 consecutive days, once a month, which can control the progression of the disease and promote pigmentation recovery. Levamisole is a safe and effective treatment for slowly progressive vitiligo. Studies have shown that when 150 mg of the drug is taken 2 days a week, 94% of patients stop developing the disease after 2 to 4 months of treatment. Some patients develop pigmentation, and the effect is better when combined with topical hormones. In recent years, people have found that topical use of calcipotriol is effective in treating vitiligo, but its mechanism still needs to be confirmed by further research.

2. Surgical treatment

Surgical treatment of vitiligo was first carried out in the early 1950s. It is suitable for patients in the stable stage (i.e., those with no expansion of skin lesions within 4 to 6 months). It can also be used appropriately for patients in the progressive stage depending on the patient's condition, but the possibility of recurrence is greater. Surgical treatments include microskin grafting, autologous split-thickness skin grafting, negative pressure blister grafting, and cultured melanocyte transplantation. Microskin grafting is used to treat stable segmental and localized vitiligo. It involves transplanting 1-2 mm skin grafts of normal skin color in rows in the white spot area. The donor area is generally the lumbar sacral region. 3-6 months after the transplanted skin flap takes effect, the pigmented area can increase to more than 25 times its original size. This procedure takes a short time but may cause unevenness in the skin in the treatment area. Autologous split-thickness skin grafting began in the 1960s. A dermatome was used to harvest split-thickness skin grafts from areas with normal pigmentation and transplanted to areas with white spots. The epidermis of the white spots had been removed in advance using dermabrasion. The advantages of this surgery are that it can treat a large area and the operation time is short. The disadvantage is that it causes greater trauma and may leave scars.

3. Light therapy

Phototherapy for vitiligo has a history of many years. The traditional method is oral or topical 8-methoxypsoralen (8-MOP) combined with PUVA irradiation. About 50% of patients respond well to this therapy, and the face and trunk respond better to treatment. The disadvantage of this type of treatment is that it has large side effects. The side effects of 8-MOP include nausea, vomiting, skin itching and erythema, and the long-term side effect of PUVA is skin cancer, etc. Therefore, it has certain limitations. Other phototherapy methods include using 5-MOP instead of 8-MOP and narrow-band ultraviolet therapy.