Medications for Vitiligo

A pharmacist discusses your options

Medically reviewed by Mary Choy, PharmD

Vitiligo is color loss in patches of your skin due to an autoimmune condition, where your immune (defense) system attacks your melanocytes (color-making cells).

People might be at risk of vitiligo if it runs in the family, but environmental and other factors may also come into play as causes of vitiligo.

Other than topical and oral vitiligo medications, there are additional treatment options, such as phototherapy (light therapy) and surgery.

This article discusses more about some vitiligo medications—their side effects, precautions, and interactions.

What Medications Are Available for Vitiligo?

There are several medications available for vitiligo. Vitiligo medications include the topical (on the skin) ones you apply to your skin and the oral ones you take by mouth.

Vitiligo medications influence your immune (defense) system to stop attacking melanocytes (color-making cells) and restore skin color.

Topical Medications

Topical vitiligo medications include the following:

Corticosteroids: Topical corticosteroid (steroid) products work by lessening inflammation, an immune (defense) system response. They are first-line treatment options, especially for people with a dark skin tone and with a few new small vitiligo patches on areas of the body other than the face—like the neck area.

If a dermatologist (skin doctor) recommends this medication for you, it might be Elocon (mometasone furoate) once daily for three months. Another option is to use this topical steroid product once daily for 15 days with a 14-day break every month for six months.

Calcineurin inhibitors: Topical calcineurin inhibitors block the activity of the calcineurin protein. This prevents the immune (defense) system from making certain substances. Calcineurin inhibitors are typically used twice weekly as first-line treatment options. Still, they are likely more effective for vitiligo patches on the face and neck when compared to other body areas.

In addition, for use as an initial treatment choice, calcineurin inhibitors might be used as maintenance therapy after phototherapy (light therapy). Moreover, calcineurin inhibitors are safe for long-term use. Examples of calcineurin inhibitors include Protopic (tacrolimus) and Elidel (pimecrolimus).

Vitamin D analogs (D3A): Topical D3As work by lowering T-cell (a type of immune cell) function, increasing the number of melanocytes (color-making cells), and boosting melanogenesis (the process of making more pigment or color). Since D3As—like Dovonex (calcipotriene)—are not as effective alone, they are used weekly on 30 percent of your body for four weeks with other treatment options, such as the D3A and steroid combination topical product called Taclonex (calcipotriene and betamethasone).

Janus kinase (JAK) inhibitors: JAK inhibitors block JAK proteins, reducing your immune system activity. Opzelura (ruxolitinib) is a JAK inhibitor used twice daily on up to 10 percent of your body.

Side Effects

This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. Contact a pharmacist or healthcare provider if you experience other effects while using these topical vitiligo medications. You may report side effects to the Food and Drug Administration (FDA) at fda.gov/medwatch or 1-800-FDA-1088.

Side effects with topical vitiligo medications may include:

• Corticosteroids: Topical steroid products increase the risk of skin atrophy (thinning skin). Other—but less common side effects—are spider veins, excessive hair growth, stretch marks, and acne-looking skin conditions.

• Calcineurin inhibitors: Side effects are rare with calcineurin inhibitors—but may include a burning or itching sensation (feeling). After drinking alcohol, you may also experience redness.

• Vitamin D analogs (D3A): Side effects with a D3A called Dovonex (calcipotriene) may include itchiness, redness, and dry skin. You may also feel a burning, stinging, or tingling sensation. It's also possible to have serious side effects, such as rash and skin irritation.

• Janus kinase (JAK) inhibitors: The side effects of Opzelura (ruxolitinib) JAK inhibitors include hives, redness, pimples, or diarrhea. Other side effects may include a stuffy or runny nose, nose or throat pain, and infection symptoms—like ear pain and ear discharge (drainage or fluid). Possible serious side effects include abnormal bruising or bleeding.

Get medical help immediately if you develop a severe allergic reaction or serious side effects. Call 911 if your symptoms feel life-threatening.

Precautions

The following is a general—and may not be a complete—list of precautions. Discuss precaution concerns with a healthcare provider before using topical vitiligo medications.

• Corticosteroids: There's a risk for topical corticosteroids to be absorbed from your skin into the bloodstream if you use a highly potent topical steroid, especially in children, in skin folds, and on a large percentage of your body. In general, it's also problematic to use them on your face due to the side effects of topical steroid products. Other precautions with a topical steroid—like Elocon (mometasone furoate)—include eye-related side effects and effects on the endocrine system that makes hormones in your body.

• Calcineurin inhibitors: Calcineurin inhibitors—like Elidel (pimecrolimus)—aren't typically recommended in people with a weakened immune (defense) system. Moreover, these medications aren't typically used in people with certain skin conditions—like Netherton's Syndrome—that increase the risk of the topical medication being absorbed into the bloodstream.

• Vitamin D analogs (D3A): Avoid D3As—like Dovonex (calcipotriene)—if you have high calcium levels or vitamin D toxicity. Moreover, don't use this medication on your face.

• Janus kinase (JAK) inhibitors: Precautions with the Opzelura (ruxolitinib) JAK inhibitor include the potential risk of serious infections, non-melanoma skin cancers, and blood clots. Some people may also experience low red blood cells (RBCs), platelets, and specific white blood cells (WBCs).

Interactions

There is limited information about drug interactions for topical vitiligo medications. For example, there are no drug interaction studies for mometasone furoate. As for calcipotriene, the package insert doesn't list a drug interaction section for calcipotriene.

Moreover, Opzelura and calcineurin inhibitors don't have formal drug interaction studies. There are, however, cautionary warnings about using Opzelura and tacrolimus with CYP3A4-inhibiting medications, which block the CYP3A4 protein from breaking down Opzelura and the calcineurin inhibitors. This means potentially higher levels of Opzelura and calcineurin inhibitors in the bloodstream and a higher chance of side effects.

CYP3A4-inhibiting medications consist of the erythromycin antibiotic and Diflucan (fluconazole) antifungal. Another class of CYP3A4-inhibiting medications includes the calcium channel blockers (CCBs), such as Calan (verapamil).

This might not be a complete list of drug interactions. Before using any topical vitiligo medication, it's a good idea to make a healthcare provider and pharmacist aware of your medications, including prescriptions, over-the-counter (OTC) items, herbal products, supplements, and natural medications.

Oral Medications

There are fewer oral vitiligo medications than topical medications—just corticosteroids. Some examples include Decadron (dexamethasone), Medrol (methylprednisolone), and Deltasone (prednisone).

In general, corticosteroids work by suppressing the immune (defense) system to stop vitiligo from quickly worsening. In this case, you'll likely take oral corticosteroid therapy in mini-pulses on two back-to-back days per week for three to six months.

Mini-pulses of corticosteroids may also be combined with phototherapy (light therapy).

Side Effects

This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. Contact a pharmacist or healthcare provider if you experience other effects while taking oral corticosteroids. You may report side effects to the Food and Drug Administration (FDA) at fda.gov/medwatch or 1-800-FDA-1088.

Side effects with oral corticosteroids may include:

• Acne

• Excessive hair growth

• Insomnia (sleeping problems)

• Menstrual period changes

• Mood changes

• Weight gain

Get medical help immediately if you develop a severe allergic reaction or serious side effects. Call 911 if your symptoms feel life-threatening.

Special Considerations

The following is a general—and may not be a complete—list of precautions. Discuss with a healthcare provider about precaution concerns before starting oral corticosteroids (steroids), such as prednisone.

• Bone-related effects: Corticosteroids may inhibit bone growth in children and increase the risk of osteoporosis (weak and brittle bones) at any age.

• Bowel perforation (hole): There is a higher risk of bowel perforation in people with certain medical conditions, such as peptic ulcer, diverticulitis, ulcerative colitis (UC), and recent anastomoses surgical procedures.

• Cancer: In people taking corticosteroids for chronic medical conditions, there were reports of a cancer called Kaposi's sarcoma.

• Endocrine (hormone) system effects: Low cortisol (flight-or-fight) levels may occur if you abruptly stop corticosteroids.

• Eye-related effects: Steroids may increase the pressure in your eyes.

• Heart and kidney effects: Since steroids may cause the body to hold onto sodium (salt) and get rid of potassium, take steroids with caution in people with hypertension (high blood pressure), heart failure, and kidney impairment.

• Infections: People taking corticosteroids are at a higher risk of infections.

• Mood changes: Corticosteroids may affect your mood. The effects can be serious and may lead to psychosis, severe depression, etc.

• Muscle weakness: Corticosteroids in people with a myasthenia gravis neuromuscular condition may lead to general muscle weakness or involve your eye and breathing muscles. You may also experience muscle weakness in all your limbs.

Interactions

When taking oral corticosteroids, use caution with the following medications:

• Coumadin (warfarin): Corticosteroids might make the blood thinner warfarin less effective.

• CYP3A4 medications: CYP3A4 is a protein responsible for breaking down certain medications, such as corticosteroids. So, medications—like Dilantin (phenytoin)—that increase CYP3A4 activity may increase the breakdown of corticosteroids. And medications—like the HIV Norvir (ritonavir) medication—that inhibit CYP3A4 may increase the corticosteroid levels in the body. As for other medications—like the erythromycin antibiotic—broken down by CYP3A4, corticosteroids may reduce the levels of these other medications in the body.

• Digitek (digoxin): Since corticosteroids may cause low potassium levels, there might be a higher chance of abnormal heartbeat problems with digoxin.

• Dilantin (phenytoin): When taken with the dexamethasone corticosteroid, there were reports of phenytoin level changes, which may affect seizure control. Moreover, phenytoin may increase the breakdown of corticosteroids in the body, reducing the steroids' effects.

• Estrogen: Estrogen-containing medications—like certain birth control pills—might slow down the breakdown of certain corticosteroids in the body, which may increase the steroids' effects.

• Fluoroquinolone (FQ) antibiotics: Examples of FQ antibiotics include Levaquin (levofloxacin) and Cipro (ciprofloxacin). When taken with corticosteroids, there is a higher chance of a tendon rupture (tear) during or after FQ antibiotic use-especially in older adults.

• Questran (cholestyramine): Cholestyramine is used to help lower your cholesterol levels, but cholestyramine may also increase the body's ability to get rid of oral corticosteroids.

• Potassium-lowering medications: Since corticosteroids may lower potassium levels, taking corticosteroids with other medications—like certain water pills—with a similar effect may further worsen potassium levels, leading to heart failure.

• Nonsteroidal anti-inflammatory drugs (NSAIDs): Examples of NSAIDs include Aleve (naproxen), Advil (ibuprofen), and aspirin. Combining NSAIDs with corticosteroids may increase the chances of digestive system-related side effects. Corticosteroids may also increase the breakdown of NSAIDs and reduce the NSAID levels in the body. And if you stop corticosteroids, there is a higher risk of NSAID toxicity.

• Sandimmune (cyclosporine): Cyclosporine has several uses, which include preventing organ transplant rejection. When used with corticosteroids, both medications might have increased activity. There are also reports of seizures when both medications are used together.

• Seroquel (quetiapine): Corticosteroids may increase the breakdown of quetiapine in the body, which might require higher doses of quetiapine to control schizophrenia symptoms.

• Wellbutrin (bupropion): Since bupropion and corticosteroids may make it easier to have seizures, take both medications together cautiously.
  

This isn't a complete list of potential drug interactions with oral corticosteroids. Contact a healthcare provider or pharmacist if you're unsure whether oral corticosteroids will interact with your current medication.

It's also good to make them aware of all your medications, including prescriptions, over-the-counter (OTC) items, herbal products, supplements, and natural medications.

How is Vitiligo Diagnosed?

A healthcare provider may diagnose vitiligo by taking a look at your skin. The healthcare provider may also use a Wood's lamp (handheld ultraviolet light) to identify any vitiligo patches in a bright blue-white color.

While other tests and a skin biopsy are usually unnecessary, the healthcare provider may use these tests to rule out other medical conditions.

Nutrition for Vitiligo

While higher-quality clinical trials are still necessary, some studies showed that oral antioxidants may restore skin color. For example, when combined with phototherapy (light therapy), vitamin E, Polypodium leucotomos, and Ginkgo biloba might help.

In general, antioxidants may delay the damage of free radicals (unstable molecules) to specific components (parts) within your body, including your DNA genetic material.

Other Approaches

Other treatment approaches for vitiligo may also include:

• Different forms of light therapy

• Make-up

• Removing color from your darker skin to match the lighter vitiligo areas that are covering most of your body

• Surgery

Although additional extensive clinical trials are warranted, the following are a few alternative vitiligo medications or treatment options that might have some promise.

• Combination of certain types of light therapy and platelet-rich plasma injections

• Efudex (5-Fluorouracil) topical medication that's typically used for other skin conditions

• Latisse (bimatoprost) that's usually for eyelash hair growth

• Rheumatrex (methotrexate) that's typically used to treat autoimmune conditions—like rheumatoid arthritis (RA)
  

How is Vitiligo Treated in Children

Some vitiligo medications and treatment options used in adults are also appropriate in children. The following are some examples:

• Topical corticosteroids

• Calcineurin inhibitors

• Make-up

• Opzelura (ruxolitinib) JAK inhibitor

• Phototherapy (light therapy)

However, depending on your child's exact age, a dermatologist (skin doctor) might recommend some vitiligo medications and treatment choices over others. If you suspect that your child has vitiligo, contact a dermatologist to help evaluate the options available for your child.

Summary

Vitiligo is a medical condition that leads to patches of color loss in the skin. A dermatologist (skin doctor) can typically diagnose vitiligo by looking at your skin.

While there is no cure for this skin condition, several vitiligo medications and treatment options are available for children and adults.

Since there are some precaution concerns, side effects, and potential interactions, make sure to involve a healthcare provider and pharmacist to help you achieve the best results and limit the adverse effects.

Frequently Asked Questions

What is the best medication for vitiligo?

The best medication for vitiligo depends on various factors, such as your age, skin type, treatment preferences, and vitiligo's impact on your quality of life.

What is vitiligo?

Vitiligo is a medical condition that leads to patches of color loss in the skin.

What causes vitiligo?

Vitiligo is an autoimmune condition, where your immune (defense) system attacks your melanocytes (color-making cells). People might be at risk of vitiligo if it runs in the family, but the environmental and other factors may also come into play as causes of vitiligo.

Read the original article on Verywell Health.