Creams For Vitiligo

  • Best Results4-12 months
  • Treatment RecoveryNA
  • Procedure TimePhototherapy 3-7 minutes
  • Skin SpecialistDermatologist
  • Duration of ResultsLong lasting
  • AnaestheticNA
  • Back to WorkNA
  • Cost$

Creams For Vitiligo

Creams are the mainstay of vitiligo treatment and work by stimulation of the pigment cell & decreasing inflammation on your skin. Specialists use several types of creams to re-pigment white patches. The types of creams and strengths we use will depend on the location and extent of vitiligo. Creams are best combined with phototherapy for best results.

FactsFacts on creams for Vitiligo

  • Creams form the foundation of vitiligo treatment
  • Creams include anti-inflammatory creams, vitamin D, & special non-steroid creams called immunomodulators
  • The prescribed topical will depend on the location of your vitiligo and your skin sensitivities
  • Combining phototherapy with topicals gives more consistent results
  • Ruxolitiinib is a promising topical biological agent
  • Bimatoprost is useful for small areas of vitiligo
  • Pseudocatalase should be combined with phototherapy

How do creams work?

Creams work by suppressing attack by your immune system (corticosteroids), stimulating pigment production (tacrolimus, bimatoprost), or both (tacrolimus).

Another pathway is to reduce damaging hydrogen peroxide (pseudocatalase creams).

Creams are only part of the solution, as they should be combined with phototherapy for best results.

What are corticosteroid creams?

Corticosteroid creams or CS are the mainstay of treatment. They are safe, provided you follow the instructions given to you by your dermatologist. There are different types of steroids based upon their concentration, potency & vehicle.

CS suppresses skin inflammation & this reduces the amount of damage to your pigment cells. One of the side effects of corticosteroids is excess hair production or hypertrichosis. This is a wanted outcome as pigment is derived from the cells that hide within the hair follicles.

Are steroids safe?

Yes, however you will need to adhere to the directions. I choose an appropriate steroid preparation based upon the site of vitiligo. For acral patches, the concentration of corticosteroids is higher compared to facial vitiligo.

Side effects of steroid ointments & creams include- thinning of skin, acne eruptions, perioral dermatitis, bruising & systemic absorption. These side effects can be mitigated by following the instructions on the prescription. 

What does vitamin D cream do?

Vitamin D creams have been shown to improve patches of vitiligo. This vitamin can increase melanin production, hence re-pigment patches of vitiligo. Unlike corticosteroids, there are no long-term issues with vitamin D.

Davin’s Viewpoint on creams for vitiligo

Creams are useful for treating vitiligo. I do use them as first line therapy, in combination with narrowband UVB at 311 nm. My prefered combination is alternating a strong CS preparation & a calcineurin inhibitor. I do think that tacrolimus is better than pimecrolimus as the former has more melanocyte migrating properties. My third line topical is Bimatoprost, either compounded or Latiesse topically. This drug is useful for discrete patches in facial areas.

The old fashion PUVA can work for isolated patches of vitiligo, especially in darker skin types. I do not use psoralen anymore (I did prescribe it over 20 years ago).

Pseudocatalse was a trending vitiligo treatment in the 1990, as this reduced hydrogen peroxide. Fast forward to 2022 & beyond, antioxidants are trending. UV & environmental pollutants generate free radicals. These are termed ROS or reactive oxygen species. Antioxidants donate electrons to stabilise ROS, in turn reducing cellular damage. This family of topicals include vitamin C or ascorbic acid, ferulic acid, tocopherol as well as niacinamide (to a lesser extent).  If you are inclined to give trending things a go, a sensible combination of topicals does no harm (I suggest vitamin E). The downside of vitamin C is that it can slow down pigment production as it inhibits tyrosinase.

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