Pseudocatalase is a synthetic cream used in the treatment of vitiligo. It is thought to work by reducing hydrogen peroxide. This cream was trending in the 1990s, however today we have more effective topicals. If you would like to try a DIY application of pseudocatalase you can –

• Apply twice a day to the white patches of vitiligo
• Allow the Pseudocatalase cream to vanish into the skin and completely dry before applying any other topical agents.
• Expose the affected skin to narrowband phototherapy (Ideally clinical)
• Broader upper cheekbones means less dermal fillers.

If there is no response after 3 months, the therapy should be stopped, and other options evaluated. Treatment may be stopped if regimentation occurs. You can also add sensible microneedling prior to application.

Treatment with pseudocatalase is considered to be safe with no known systemic side effects. I personally do not prescribe pseudocatalase as there are many more effective creams.

Not a good idea to try. Various plants including lime, lemon, citrus fruits, bergamot contain furanocoumarins. These are essentially psoralens that react with sunlight to produce a phototoxic reaction. Post-inflammatory hyperpigmentation is a wanted side effect in the context of vitiligo. If you are so inclined to try natural stuff, review the section on this website. You are far safer with supplements like vitamin B, C, D, E & a tablet or two of ginkgo biloba. 

Psoralea corylifolia (used in India) & Ammi majus Linnaeus are plants that have been used in ancient times to treat vitiligo. They do have value in countries like India & Africa where narrowband phototherapy is limited (or super expensive). I know they can work; I have no experience in herbal or natural remedies. Discuss this with your village physician.

*Warning: If you have vitiligo, do not put vitamin C on the affected areas. Vitamin C is a potent antioxidant; however it is also a potent inhibitor of tyrosinase, the enzyme that produces pigment.

Accurate calibration of power (fluence) & wavelengths depends on the brand of home phototherapy. I have experience with German companies who manufacture home units. I do think they produce calibrated & consistent power levels; however the device is not reliable as in 20% of cases they break down within a year of use.

There are many other brands out there, ranging from cheap Chinese made devices all the way to more expensive US & European brands. The instructions will vary according to the manufacturer. A sensible way to start is to find a baseline then increase the time by 10% per application, aiming for treatments every second day – much like how we use clinical units.

In the past 2 years there has been an increase in the number of evidence-based publications on the use of microneedling to treat vitiligo. The results are promising.

To summarise –

1. Microneedling alone can improve vitiligo.
2. Microneedling coupled with medically prescribed topicals such as tacrolimus, PGE analogues & 5 Fluorouracil give better results than microneedling alone.
3. Microneedling is relatively safe & inexpensive.
4. This should only be done on stable, not progressive vitiligo. If you perform microneedling incorrectly, you have the potential to make your disease worse.

Read the above so you have a crystal-clear understanding. Obviously, my suggestion is that you undertake medical treatments in a dermatologist’s office as the first line. If you are stuck in a village in the middle of India or Africa, & the nearest dermatologist is 1000 miles away and if you can understand the risks, you can try this. Always take a baseline photo before you treat.

1. Buy a stamper if possible. This is safer than a derma roller. 0.1 to 0.2 mm needles, don’t use anything longer.
2. Stamp every 10 days. Clean the area, stamp 3-4 times over. If possible, obtain some tacrolimus online, if you can’t find any, get some Latiesse or bimatoprost eye drops. Another option is pseudocatalase cream (Amazon). Apply to stamped areas within 30 minutes.
3. Expose the stamped areas to sensible mid-day sun three times a week. The exposure times may vary depending on the latitude you live. This may range from 3 to 20 minutes.
4. Complete 10 cycles over 3 months, re-take the photos & compare.

Medically supervised microneedling can re-pigment between 20-50% of cases. The fastest response reported has been with a chemotherapy ingredient called 5 Fluorouracil.

For DIY home use, obviously you are not going to play around with chemotherapy. The use of PGE analogues or bimatoprost (resource search) is probably the easiest to obtain followed by tacrolimus from dodgy Indian online pharmacies. If you can get 30% pigmentation at 3 months, this is considered good. You need comparison photos to gauge progress. If you are too lazy to take a photo, don’t attempt any DIY procedures.

I suspect that in the next few years, studies will show that phototherapy combined with microneedling & topicals will yield great results.

Natural sunlight is a double edge sword. UVB can be beneficial for most cases, as it can encourage melanin production & melanocyte migration. It can also cause sunburn, making your vitiligo worse. The problem with sunlight is that it also contains UVA, all of the spectrum of UVB (unlike narrowband UVB) as well as the visible spectrum of light.

If you want maximal UVB, it will be found in the midday sun (UVA is relatively constant). Hence you will require exposure for 2 to 40 minutes depending on where you live. If you have no access to phototherapy, a sensible method of activating topical psoralen is exposure to natural sunlight. Be guided by your physician as they have experience in determining your ideal exposure time. This depends on your skin type & the latitude of where you reside. Do not spill over any phototoxic/photoactive agents to normal skin or these areas will look like crap (post inflammatory hyperpigmentation). You have been warned!

Disclaimer: I practice first world dermatology in Australia, though I am well versed in natural DIY treatments & home remedies, I am not in the position to advise you on application frequency & times. Your physician can do so.

Here is how I view DIY treatments & how I fit into the big picture of treating vitiligo. If DIY treatments are not harmful- go for it. If you respond, it is one less person that requires medical therapy.

For patients that see me, I do not prescribe you fairy dust. Dermatologists prescribe medications & clinical phototherapy. My standard of practice is to combine phototherapy with topical CS ointment, calcineurin inhibitors & other pigment stimulators. I am open minded; I encourage adjunctive therapy.