Treatment guidelineFirst-line Treatments: Topical Medicines

Treatment guideline

Here are some of the vitiligo treatment protocols that must be further adjusted to suit a patient’s situation and local drug availability:

  • If an adult patient just has a few, relatively stable spots, topical steroid – such as 0.1% betamethasone valerate – is commonly tried first, b.i.d. It is often alternated with tacrolimus every two weeks for six months, to minimize the risk of skin atrophy. For spots on an adult’s face, eyelids, genitals, breasts or underarms a less irritating medicine like 0.1% tacrolimus, b.i.d., is preferable, and 0.03% tacrolimus is reserved for the sensitive skin of kids aged 2-15 years.
  • If a patient does not respond to the previous option, then high-potency drugs such as 0.05% clobetasol propionate can be used b.i.d. for up to 8 weeks, after which it should be slowly reduced to a lesser strength. On sensitive areas like face, neck or groin it should be used once daily. A pulse treatment with 0.1% clobetasol, alternating with 0.1% tacrolimus ointment in a one week on/one week off regimen is often reported to provide good repigmentation.
  • If a patient has rapidly expanding vitiligo, with new spots appearing every week or existing ones getting bigger, a dermatologist may suggest taking oral steroids until the disease is stabilized. Adults may be prescribed an oral minipulse dexamethasone 4 mg, to be taken after a meal, two days a week for 16 weeks. Children get a half dose for 12 weeks.

Although still frequently prescribed, vitamin D analogs, particularly calcipotriol and tacalcitol, demonstrate only a partial efficacy.

The results of the first line therapy are moderately successful. Topical treatments have the best effect on the upper body, with dark skin, and with recent lesions. Nearly half of adult patients and three-quarters of children report vitiligo stabilization and substantial repigmentation, especially in the sun-exposed areas.



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