Topical Medication for Vitiligo

Corticosteroid creams are anti-inflammatory medications that may slow the progression of vitiligo or allow melanocytes to return. A potent formula of corticosteroids is required to treat vitiligo, and therefore dermatologists closely monitor its use when it is prescribed. Possible side effects include thinning skin, stretch marks, and acne.

Many people start to see results in a few months. Often, topical corticosteroids are prescribed as part of a long-term treatment plan that includes follow-up appointments with your dermatologist two to four times per year.

Calcineurin inhibitors are an immune-modulating medication, meaning that they work to prevent the body’s immune system from attacking pigment-producing melanocytes. Calcineurin inhibitors are typically prescribed only when topical corticosteroids are ineffective or when vitiligo affects sensitive areas of skin that cannot be treated with topical corticosteroids. These include the eyelids, lips, and genitals. 

Topical calcineurin inhibitors are available as an ointment called tacrolimus or as a cream called pimecrolimus. These medications are applied directly to the affected areas of skin once or twice a day and may begin to take effect within a few months. If effective, they are usually part of a long-term treatment plan. 

Topical calcineurin inhibitors have been safely used for more than a decade. They tend to produce fewer long-term side effects than corticosteroids and may be used safely for months or years. Side effects may include a stinging sensation when first used that generally fades over time.

Calcipotriene is a synthetic derivative of vitamin D that was originally developed for the treatment of psoriasis. It is available as a cream or an ointment. When applied twice daily, this medication may stimulate the production of pigment in areas of skin affected by vitiligo. It usually takes a few months of treatment to see results. 

Some people experience mild skin irritation after applying the medication, but other side effects are uncommon. Calcipotriene may be most effective for vitiligo in combination with other topical medications, phototherapy, or laser treatments.

If vitiligo covers more than 50 percent of your skin and other topical or light therapies are not effective in repigmenting the skin, your dermatologist may discuss the possibility of using topical medication to remove pigment from the rest of your skin. Depigmentation, or removal of skin color, can result in a consistent light skin tone all over your body. 

Depigmentation is a more intense form of treatment, and our dermatologists partner with you to make this decision and ensure that you have the information you need to consider this permanent treatment. If you decide to pursue depigmentation, our doctors provide both medical and emotional support.

To remove color from your skin, dermatologists prescribe a medication called monobenzone. You apply this medication twice a day to pigmented areas of skin. Gradually, this medication causes pigmented areas to fade, eventually matching the lighter patches of skin caused by vitiligo. Complete depigmentation may take years to achieve.

Depigmented skin is very sensitive to the sun. Diligent use of a broad-spectrum sunscreen with SPF 30 or higher and protective clothing are required every time you spend time outdoors. Sun exposure may activate pigment cells in hair follicles below the skin, causing undesirable spotting. Side effects of monobenzone include skin irritation and redness.