How to halt the progression of vitiligo?

Vitiligo is a conspicuous and sometimes socially debilitating skin disease that affects between 0.5 and 2% of the global population. It manifests as a depigmentation of the skin, varying in extent across the body, due to the selective loss of melanocytes, the cells responsible for the synthesis of melanin, the brown pigment that colors the skin. Vitiligo is a multifactorial pathology, involving an autoimmune mechanism as well as genetic and environmental factors. Like all autoimmune diseases, it often progresses in a chronic and episodic manner.

Halting the vitiligo when it is in its active phase, that is during flare-up periods, is crucial. This is simpler than repigmenting a lesion and allows for a rapid improvement in the patient's quality of life.

Active vitiligo is characterized by various clinical signs, such as itching or the appearance of small "confetti" depigmentations or clear but not fully depigmented borders around pre-existing lesions. In over 90% of cases, it is possible to halt the progression of vitiligo by combining a short course of cortisone treatment and UVB phototherapy. Cortisone works by modulating the immune response, particularly by reducing the activity of T lymphocytes, which are responsible for attacking melanocytes. This corticosteroid therapy, prescribed orally at a low dose two days a week, is sufficient to control inflammation without causing major side effects associated with prolonged use.

In parallel, narrowband UVB phototherapy complements this protocol by playing a dual role. On one hand, it stimulates the melanocytes still present in the affected areas to promote gradual repigmentation. On the other hand, it helps regulate local inflammation and limit excessive immune activity. Phototherapy sessions, often conducted two to three times a week, are adjusted according to the patient's skin type and skin tolerance.

If the initial treatment fails to stabilize the vitiligo, it may be possible to turn to immunosuppressive creams, such as tacrolimus or pimecrolimus. These molecules, belonging to the class of calcineurin inhibitors, act directly on local immune mechanisms by blocking the activation of T lymphocytes. This action helps to reduce inflammation at the lesion sites and create an environment conducive to repigmentation. These creams are often applied twice a day to the affected areas and are generally well tolerated. Like oral corticosteroids, their effectiveness is enhanced when combined with UVB phototherapy.

To halt the progression of vitiligo, it is crucial to quickly consult with a dermatologist.