Therapy with topical and systemic steroids
Steroids have been used to treat vitiligo locally on isolated patches and in various compositions: 1-2.5% hydrocortisone for sensitive areas (such as face or armpits); 0.05% clobetasol dipropionate or 0.1% betamethasone valerate for other areas. Even if results are considered positive, the topical steroid therapy involves a number of side effects (telangiectasias, skin atrophy, striae) and may cause relapses. Therefore it is not considered as a valid therapy both for its negative benefit/side effects ratio -for the low patient response- and for the difficulty in treating widespread areas. The same applies to the oral intake of steroids (e.g. triamcinolon, ACHT, prednisolone): these have provided scarcely conclusive results and collateral phenomena (skin atrophy, telangiectasias).
Therapy with folic acid and vitamin B12
A 1992 research on the oral intake of folic acid combined with the parenteral administration of vitamin B12 provided good results without side effects observed. Anyway, this kind of study still needs to be confirmed.
Total skin depigmentation
This treatment is only recommended for extreme cases: widespread vitiligo, affecting over 40% of the total skin surface and proved to be resistant to every other treatment. In such cases patients should be informed that total skin depigmentation is irreversible and permanent, it requires a constant use of efficient sun filters to prevent re-pigmentation and, most of all, it can cause serious contact dermatitis, xerosis, erythema, hypochromic patches, blackish patches after long periods of treatment, irritant dermatitis of various degrees, burning and itching. Residual skin pigmentation is eliminated through a cream containing either 20% monobenzyl ether of hydroquinone (MBEH) or hydroquinone, two powerful skin sensitizers. The excessively white skin color is reduced with the oral intake of beta-carotene.