Therapeutic target
Improvement of the symptoms
Therapy recommendations (modified according to)
- Use of externals (drugs for external application):
- Glucocorticoids (topical glucocorticosteroids (TCS); topical steroids; preferably mometasone furoate and methylprednisolone aceponate) [guidelines: 1]) in combination with UV-B phototherapy* .
- No differences in efficacy were found between clobetasol (derivative of betamethasone) and tacrolimus.
- Calcipotriol (vitamin D analogue) in combination with UV-B phototherapy* .
- Pseudocatalase – in combination with heliotherapy.
- Calcineurin inhibitors (calcineurin inhibitors; topical calcineurin inhibitors (TCIs))
- Tacrolimus (topical immunomodulator; limiting therapy to the head and neck region) – in combination with UV-B phototherapy* .
- Pimecrolimus could be considered as an alternative treatment to clobetasol.
- JAK inhibitors (drugs that inhibit the activity of one or more enzymes of the Janus kinase family).
- Ruxolitinib as a cream (JAK-1/2 inhibitor; in patients with depigmentation of at least 0.5 percent of the face and at least three percent of the rest of the body) → marked improvement of lesions on the entire body and almost complete repigmentation on the face.
- Glucocorticoids (topical glucocorticosteroids (TCS); topical steroids; preferably mometasone furoate and methylprednisolone aceponate) [guidelines: 1]) in combination with UV-B phototherapy* .
- Afamelanotide (analog of the hormone alpha-MSH) (s.c.) in combination with UV-B phototherapy* .
- See also under “Further therapy“.
* If > 15-20% of the body surface is affected by pigment loss.
Notes on combination therapy
- Glucocorticoids (topical steroids, TCS) and phototherapy: the combination of TCS and UVB sources (narrow-spectrum UVB and 308-nm excimer lasers or lamps) may be indicated as appropriate for difficult-to-treat areas, such as over bony prominences.
- Vitamin D analogs and phototherapy: the use of vitamin D analogs in combination with UV radiation is not recommended, as the benefit of combination therapy appears to be very limited at best.
- Phototherapy and other treatments: Provision of antioxidants may help restore the intracellular redox status, which is intrinsic and impaired by UV. The combination of phototherapy and oral antioxidants may be beneficial, but the preliminary need must be confirmed before such a combination can be recommended.
- Phototherapy after surgery: there is good evidence that phototherapy (narrow-spectrum UVB or PUVA) should be used 3 or 4 weeks after surgical procedures to improve repigmentation.
JAK inhibitors
- A vitiligo patient was helped by the Janus kinase inhibitor tofacitinib (JAK-1/3 inhibitor): after 5 months, her face and hands were virtually completely repigmented, with only 5% of her body surface remaining white. Note: Tofacitinib led to partially fatal pulmonary emboli in patients with rheumatoid arthritis (RA), at an increased dose ( 10 mg twice daily; recommended dose: 5 mg twice daily), which is not approved in patients with rheumatoid arthritis (RA).
- Ruxolitinib as a cream (JAK-1/2 inhibitor; used in patients with depigmentation of at least 0.5 percent of the face and at least three percent of the rest of the body) resulted in marked improvement of lesions over the entire body and almost complete repigmentation of the face.
Phytotherapeutics
- The data on natural products (e.g., ginkgo, golden stipple fern) in the therapy of vitiligo is poor, so no further comments are made.
Supplements (dietary supplements; vital substances)
Suitable dietary supplements should contain the following vital substances:
- Vitamins (A, C, D3, E, B1, B2, B3, B5, B6, B12, folic acid, biotin).
- Trace elements (iron, copper, manganese, molybdenum, selenium, zinc).
- Fatty acids (omega-3 fatty acids: eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA); omega-6 fatty acids: gamma-linolenic acid (GLA)).
- Secondary plant compounds (eg, beta-carotene; green tea, grape seed / olive polyphenols; lycopene).
- Other vital substances (silica; coenzyme Q10).
Note: The listed vital substances are not a substitute for drug therapy.Dietary supplements are intended to supplement the general diet in a given life situation.