Question 19. What are the main side effects of vitiligo treatments?

Key points

  • Topical and systemic treatments of vitiligo may have different side effects in different subjects.
  • Topical potent corticosteroids are considered to be first-line therapy. Erythema, acne-form lesions, atrophy of the epidermis, teleangectasia, striae distensae and increased hair growth are commonly reported.
  • Topical calcineurine inhibitors (Tacrolimus, Pimecrolimus) commonly induce erythema, burning, and irritation. In spite of some circulating information, to date there is no convincing evidence suggesting that there is any increase in skin cancer after their use in vitiligo subjects.
  • Vitamin D3 analogs may only produce mild irritation on the treated skin.
  • Topical psoralens are highly phototoxic even in very low concentrations after UV exposure: blistering and skin necrosis may be seen.

Treatment of vitiligo is a complex issue which always requires a clear and exhaustive explanation of side effects of both systemic and local treatments.

Each vitiligo patient should ask the dermatologist about the length of the treatment(s) as well as possible side effects. The discussion of any systemic treatments of vitiligo requires always a discussion in private between the vitiligo patient and her/his dermatologist in a most empathic and cooperative setting based on clear questions and clear answers.

Author: Prof. Torello Lotti, MD

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