How to Treat Vitiligo: Ask a Dermatologist

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1What is vitiligo?

2What are some common misconceptions about vitiligo?

3How does a doctor treat vitiligo?

4How do doctors use light therapy to treat vitiligo?

5Why do some doctors use JAK inhibitors for treating vitiligo?

6Do JAK inhibitors work with light therapy?

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Dealing with vitiligo can be deeply disheartening and frustrating, especially since there are so many myths out there about the condition. The good news is that vitiligo treatments are extremely efficient and there is hope. Dr. Mohiba Tareen is a board-certified dermatologist, and she’s here to break down everything you need to know about your treatment options. From traditional medications to cutting-edge therapies, there are plenty of ways to curb your symptoms and get back to feeling great about your skin!

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Question 1

Question 1 of 6:

What is vitiligo?

1. 
   
   Dr. Mohiba Tareen: It’s an autoimmune disease where your cells attack the pigment-producing cells, which are caused melanocytes. This causes white patches to show up on your skin. They can appear basically anywhere on your body.

   • Some patients will just have a few patches, while other patients may have them all over their body.
2. 
   Additional Research

   The color of your skin and hair is determined by your melanin. For people with vitiligo, that melanin dies or stops functioning correctly. Vitiligo can affect people of all skin types, but you may not even notice the patches if you have really pale or light skin.

   • Vitiligo can also impact the color of your hair. If you have dark hair and the vitiligo attacks the skin cells on your scalp, you may have a spot or streak of white hair.
   • There isn’t technically a cure for vitiligo, but the treatments are really effective and you can get your pigment back. Luckily, there is a lot of research going on and it looks like there could be a cure in the future.

Question 2

Question 2 of 6:

What are some common misconceptions about vitiligo?

1. 
   
   Dr. Mohiba Tareen: I think there is a lot of confusion and misunderstanding surrounding vitiligo. A lot of people think it’s just a cosmetic thing, but it’s really deeper than that. Losing your pigment can feel like losing your identity, so it’s really not just a visual thing. I’ve also seen some people think that vitiligo is contagious, which is just wrong. It doesn’t spread from person to person like a virus.

   • Your ethnic identity is often tied to your skin. When vitiligo causes your pigment to disappear, it can be really traumatic. It’s really understandable that someone with vitiligo would be upset about it. Luckily, it’s extremely treatable!
2. 
   Additional Research

   While there’s still some debate, the prevailing theory is that vitiligo is caused by a large amount of stress being placed on your melanin cells. This can come from organ inflammation, but it looks like genetics and inherited traits play a role in it as well. In any case, don’t beat yourself up over it. This condition is entirely outside of your control—you didn’t do anything to cause the vitiligo.

   • There are certain chemicals, like monobenzone, that may contribute to the severity of vitiligo. Still, your genes and family history play the major role when it comes to the condition.

Question 3

Question 3 of 6:

How does a doctor treat vitiligo?

1. 
   
   Dr. Mohiba Tareen: Traditionally, dermatologists will use topical anti-inflammatories, topical steroids, and topical calcineurin inhibitors to keep the pigment from being destroyed. Another common treatment is light therapy, which is also known as phototherapy. JAK inhibitors are a new medication on the market that looks promising.

   • JAK inhibitors aren’t approved for vitiligo treatment by the Federal Drug Administration yet, but there are a bunch of studies taking place to determine how effective it is.
2. 
   Additional Research

   Topical steroids and calcineurin inhibitors are both equally-solid treatment options, and patients don’t typically have any side effects. If these traditional treatment options don’t work, dermatologists may use needling or skin grafts to treat the problem directly. According to some studies, over 90% of patients see serious improvement after direct treatment!

   • There are some herbal treatments, like green tea cream and Ginkgo biloba, that may be effective in curbing the spread of vitiligo. Ask your doctor about these options if you want to take a more holistic approach.
   • There isn’t a lot of compelling evidence that vitamins or dietary changes will have an impact on your vitiligo.

Question 4

Question 4 of 6:

How do doctors use light therapy to treat vitiligo?

1. 
   
   Dr. Mohiba Tareen: Light therapy has been around for nearly 100 years now. In recent years, we’ve used something called narrowband UVB, which is a special wavelength of light, to stimulate the growth of pigmentation and reduce inflammation. If a patient comes in for light therapy, it would look like I’m using a laser to draw on the affected skin.
2. 
   Additional Research

   If you have vitiligo covering a large portion of your body, your doctor may have you wear some goggles and stand inside of a light box for a few minutes. You typically have to get light therapy 3 times a week for at least 6 months to see a big improvement.

   • You can even purchase one of these booths to do your light therapy at home and skip the trips to the doctor’s office. These booths can be kind of expensive, though.
   • There are other forms of light therapy outside of UVB, but they’re considered riskier since they may increase your risk of skin cancer.

Question 5

Question 5 of 6:

Why do some doctors use JAK inhibitors for treating vitiligo?

1. 
   
   Dr. Mohiba Tareen: These medications were originally designed to treat rheumatoid arthritis. We started noticing that our patients who had rheumatoid arthritis and vitiligo tended to see a ton of improvement with their skin when they took JAK inhibitors. Us dermatologists all kind of looked at each other and thought, “Hey, there might be something here.” There are a bunch of ongoing studies looking at how effective it is, but it appears to be extremely beneficial.

   • The most popular brand name of JAK inhibitor is called Xeljanz.
2. 
   Additional Research

   JAK inhibitors are typically taken as an oral medication, but it looks like JAK inhibitor topical creams are effective at treating vitiligo as well. These treatment options appear to work by reducing the inflammatory chemicals that cause vitiligo to spread. On top of that, it looks like JAK inhibitors encourage dead melanin cells to regrow.

   • JAK inhibitors appear to be helpful in treating psoriasis, alopecia, and other skin conditions as well.

Question 6

Question 6 of 6:

Do JAK inhibitors work with light therapy?

1. 
   
   Dr. Mohiba Tareen: These two treatment options work really well together. If you take JAK inhibitors while you’re getting light therapy, you’ll see a ton of improvement. I’ve had patients get all of their pigment back in only a few months with this combination, which is really awesome!
2. 
   Additional Research

   There’s some evidence that the JAK inhibitors don’t work if the affected skin isn’t exposed to light. Most of the current research seems to indicate that a combination of JAK inhibitors and light therapy may be the most effective treatment option for a lot of people with vitiligo.

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