Treatment with local and systemic steroid drugs

Steroid drugs have been used for some time for the treatment of vitiligo in case of isolated patches and as compounds of various kinds of preparations: 1-2.5% hydrocortisone for sensitive areas, including the face and armpits, 0.05% clobetasole dipropionate or 0.1% bemetasone valerate for other areas.

While results have been relatively positive, the local steroid treatment involves a number of side effects (including telangiectasias, skin atrophy, striae) and may cause relapses. It is therefore not deemed as a valuable solution, both for its negative benefit/side effect ratio - since a response is only obtained in few patients - and for the difficulty in treating widespread regions.

The same applies to the oral intake of steroid drugs (e.g. triamcinolone, ACHT, prednisolone): these have provided poor results, including the onset of side effects (skin atrophy, telangiectasias).

Treatment with folic acid and vitamin B12

A research carried out in 1992 provided for the oral intake of folic acid combined with the parenteral administration of vitamin B12. While good results were achieved and no side effects were observed, these studies still need to be confirmed.

Total skin depigmentation

This treatment is only performed in extreme cases: widespread vitiligo affecting over 40% of the total skin surface and resistant to any other attempted treatment. In these cases patients should be informed that total skin depigmentation is irreversible and permanent, requires the constant use of powerful sun filters in order to prevent repigmentation and, most of all, may result into serious contact dermatitis, xerosis, erythema, hypochromic patches, blackish patches after long-term treatment, skin irritation of various degrees, burning, and itching. The residual skin pigments are eliminated by means of a cream containing either 20% monobenzyl-ether of hydroquinone (MBEH) or hydroquinone, two powerful skin sensitizing agents; the excessively white skin colour is reduced by combining these agents with the oral intake of beta-carotene.