- Best Results4-12 months
- Treatment RecoveryNA
- Procedure TimeNA
- Skin SpecialistDermatologist
- Duration of ResultsVariable
- Back to WorkNA
Tablets For Vitiligo
Tablets including immune suppressive agents can be considered in extreme cases of progressive vitiligo. They work by suppressing the immune system & inflammation. Tablets are adjunctive to topicals including CS ointments, calcineurin inhibitors & narrowband phototherapy.
FactsFacts on Tablets for Vitiligo
- Sensible supplementation with vitamin B, E, D can be considered
- Ginkgo supplements have had some success
- Oral CS tablets in a short sharp taper can be considered for rapidly progressive vitiligo
- Other immunosuppressive drugs include methotrexate, azathioprine & cyclosporine
- Oral immune suppression requires careful assessment & follow up
- Tablets are not first line therapy for vitiligo
How do tablets treat vitiligo?
Medically prescribed tablets work by suppressing your immune system. They primarily target the T cell or immune cells known as lymphocytes. Lymphocytes are the cells that attack your pigment cells, causing white patches of vitiligo.
Dermatologists prescribe powerful drugs. We do not prescribe herbal or natural remedies (however you are encouraged to supplement your treatment. Refer to the section on natural remedies for vitiligo). Tablets are only considered in extreme & progressive cases of vitiligo. To put things into perspective, the tablets that we prescribe are used for treating various cancers. Some are chemotherapy drugs. You should try creams & phototherapy before contemplating chemotherapy for vitiligo.
What are corticosteroids and when are they used to treat vitiligo?
Oral steroids can be considered to treat aggressive, early & progressive vitiligo in some patients. The benefits should always outweigh the risks. CS orally can reduce the immune & inflammatory process that attacks pigment cells. CS are not prescribed orally for stable vitiligo, however, can be considered for early & rapidly progressive disease.
Side effects are frequently seen with CS therapy. They include weight gain, insulin resistance, elevation of blood sugars, high blood pressure, insomnia & many, many more. Careful monitoring is required. Phototherapy should be considered as adjunctive therapy.
What are other tablets that dermatologists use to treat vitiligo?
Depending on who you see, & what they read, other tablets may be considered. These tablets are immunosuppressive drugs that may be initiated at the same time as prednisone or later. The decision to prescribe earlier rather than later depends on your dermatologist. As a rule, most of us don’t like prescribing these medications, unless you have rapidly progressive vitiligo. Why? Because some of these tablets can cause bad cancers. Some may increase your blood pressure & kill your kidneys, others wipe out your bone marrow. Of course, with careful & timely monitoring, the risks of bad side effects can be reduced.
Tablets include cyclosporine, azathioprine, MMF, & methotrexate. These tablets are also used in chemotherapy patients & organ donors to stop autoimmune attacks. Your medical dermatologist will guide you accordingly.
What are psoralen tablets for vitiligo?
In Australia, psoralen tablets are largely historical. These tablets were used in the 80s. Side effects include nausea, photosensitivity, burning, & ocular problems. The UVA spectrum activates the chemical, either via natural sunlight or UV lamps were used.
Tables were replaced with 8MOP creams, then the current protocols of narrowband phototherapy.
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What factors should be taken into consideration before prescribing tablets?
Careful consideration should be given as the side effects may not warrant the use of these tablets. Your dermatologist will consider –
- The extent of vitiligo
- The progression of this disorder
- Your health
- How much vitiligo affects you mentally?
- Previous treatments
- Your understanding of the risks involved
- How complaint you are with blood tests & follow up
- Your insight
Do your research on methotrexate, prednisone, cyclosporine, azathioprine, & biologic therapy.
What are new treatments on the horizon?
IL-15 modulators & JAK inhibitors are somewhat novel. They can be used as standalone treatments or combined with narrowband phototherapy. In the context of when we will see them as mainstream therapy depends on the TGA in Australia. Possibly within 20 years.
As with other biologics, the costs are often prohibitive- ranging from $14,000 to $22,000 per year. These drugs do not cure vitiligo, so factor in 10 + years of treatments.
What are other ways to treat vitiligo?
Topical therapy coupled with phototherapy can give a good outcome in most patients. The safety & efficacy of this combination treatment is well studied and accepted by dermatologists.
Topicals including CS, calcineurin inhibitors & vitamin D reduces skin inflammation. Phototherapy stimulates pigment cells to migrate & repopulate areas of vitiligo.
What are some natural ways to treat vitiligo?
Natural remedies should, ideally be combined with medical therapy such as topicals & phototherapy. The flipside is that most supplements are harmless, so if you want to give it a go, here is how to do it.
Ginkgo biloba is a naturally occurring herb. There are reports in the literature that it can slow down the progression of vitiligo. Several large studies have confirmed the effectiveness of this natural remedy, including publications in dermatology journals.
Vitamin D has an intimate role in signaling pigment cells known as melanocytes. There are many large studies confirming the efficacy of vitamin D analogues known as calcipotriol. On this basis vitamin D supplementation may reduce activity of vitiligo.
Vitiligo can be associated with vitamin B12 deficiency, as pernicious anemia is an autoimmune condition. The role of vitamin B is controversial as there are conflicting reports in the literature. One study showed that vitamin B supplementation coupled with phototherapy showed a beneficial effect compared to narrowband UVB alone. Other studies did not support this. Given the fact that vitamins can be easily supplemented, popping a multivitamin, even if it is placebo, is a sensible option.
Davin’s Viewpoint on Tablets for Vitiligo
Many vitiligo patients can be treated with simple topicals combined with narrowband UVB light. Adding supplements such as Indian Gooseberry, Ginkgo, Green Tea, as well as vitamin D supplements may be helpful. Banal supplements such as Vitamin B, C, D, and E can psychologically help patients.
For rapidly progressive vitiligo, including inflammatory cases, oral immunosuppressive agents can be considered. My usual practice is to start on a higher dose of CS orally coupled with a steroid sparing agent such as methotrexate or cyclosporine.
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