Protopic/Elidel – Both of these topicals require a prescription in the USA. They are Immunomodulators that suppress the immune system where applied, allowing the melanocytes to return. Protopic is regarded as slightly more effective, but both are commonly used. Protopic’s base is like a petroleum jelly ointment, while Elidel is a cream. Both are generally used twice a day, about 12 hours apart (typically morning and night). Only a thin layer is necessary and should be gently rubbed in – by the time you spread it around, it should be mostly absorbed. Either can be washed off after 30 minutes if desired. Makeup or sunscreen can be applied after the 30 minute period. Protopic is available in two strengths – a .03% for children and .1% for adults. Studies have shown that in most cases these medications have very little systemic absorption. As with most treatments, they are most effective on the face and less so on the hands and feet. Side effects can include stinging, soreness, a burning feeling, or itching of the treated skin. These side effects are usually mild to moderate and are most common during the first few days of treatment. Less common side effects include acne, swollen or infected hair follicles, headache, increased sensitivity of the skin to hot or cold temperatures, or flu-like symptoms [common cold and congestion (stuffy nose)]. Some people may get skin tingling, upset stomach, herpes zoster (chicken pox or shingles), or muscle pain. While you are using these medications, drinking alcohol may cause the skin or face to become flushed or red and feel hot for a short while; this is quite common and is disconcerting but not dangerous. There is a black box warning from the FDA concerning the extremely rare possibility of developing some form of lymphoma from using these medications. See the Protopic message board in the VSI community section for more information.
Topical Steroids – Commonly prescribed steroids are clobetasol, betamethasone and fluocinonide. Mild steroids are sometimes used more sensitive areas like the face while stronger ones are used for other parts of the body. Topical steroids suppress the immune system as well, but can have more systemic absorption than Protopic and Elidel. They are typically used for short periods of time or are alternated with other medications like Protopic/Elidel to decrease the potential for side effects. Potential side effects are skin thinning/atrophy,redness and possibly systemic immune suppression allowing infections to occur.
Vitamin D analogues – Typically Dovonex (calcipotriol), though other forms are sometimes used as well. Studies are mixed as to the efficacy of vitamin D applied topically to stimulate the melanocytes. There are no serious side effects of using vitamin D topically. Minor side effects can include dry skin, stinging, or burning. These can go away with continued treatment. These medications are typically used in combination with others like topical steroids or NB-UVB.
V-tar -V-tar is a crude coal tar product that has been formulated to be water soluble, so it won’t stain skin. It is applied once a week, left on for 5-6 hours (or overnight), then removed. Users must avoid sun exposure for 72 hours after treatment. Sun exposure is not required for treatment with V-tar, making it attractive to those who prefer to minimize the contrast between normal skin and vitiligo, as well as those who are unable to use light therapy due to other conditions. V-tar can be used by anyone, including children.
Pseudocatalase – There are 2 forms of pseudocatalase (PCat) – They are PC-KUS, developed by Dr. Karin Schallreuter, and PCAT, available only through a few compounding pharmacies in the US and Canada. Dr. Schallreuter’s formula is only available through an initial consultation at her clinic in Griefswald, Germany. The two formulas are similar in nature, though Dr Schallreuter’s formula is specific to the individual. PCat is typically applied to the entire body twice per day. NB-UVB is used for a very brief period of 15 seconds or so to activate the medication.