Particularly if applied close to the onset of vitiligo, topical medication can be effective in repigmentation. It may be recommended in combination with phototherapy or laser therapy. Several different types can be recommended, depending on the size, pattern, and location of a person’s vitiligo.
Topical corticosteroids. These anti-inflammatory medications may slow vitiligo’s progression or even allow melanocytes to return, though they are potent and can cause side effects including thinning skin, stretch marks, and acne. If your doctor recommends this your treatment will be very closely monitored. Corticosteroids are often prescribed as part of a long-term treatment plan and many people see results in a few months.
Topical calcineurin inhibitors. Working on the theory that vitiligo is an autoimmune disease, this medication works to prevent the immune system from attacking and killing melanocytes. Available as an ointment or a cream, topical calcineurin inhibitors are typically prescribed when corticosteroids are ineffective or if vitiligo appears in sensitive parts of the skin (like eyelids or lips) that can’t be treated with topical steroids. Like steroids, they are often part of a long-term treatment plan. They also are responsible for fewer long-term side effects, though one short-term one could be a stinging sensation on first use.
Topical calcipotriene. This synthetic derivative of vitamin D, available as a cream or ointment, was originally developed to treat psoriasis. Over a few months of treatment for vitiligo, the medication can stimulate the production of pigment in affected areas of the skin. Other than mild skin irritation, side effects are minimal. The medication may be most effective in combination with other treatments.
Topical depigmentation medication. For severe cases of vitiligo or where other topical or light therapies have been ineffective in repigmenting the skin, doctors may suggest topical medications to depigment the skin completely, making it permanently light. Depigmentation is an intense treatment, both physically and emotionally. The medication used to do this is called monobenzone. Applied regularly over time—it can potentially take years—monobenzone causes the skin’s pigment to fade, becoming a uniform light color. Depigmented skin is extremely sun-sensitive (sunlight can cause spotting of activated hair follicles under the skin) and diligent use of a broad-spectrum sunscreen with an SPF of 30 or higher is required with any outdoor exposure. Skin can also be red and irritated during treatment.