Because the process and cause of vitiligo is unknown, there is no known way to prevent the condition. Although difficult to treat, it may be treated by a dermatologist (skin specialist). The goal of treatment is to repigment skin and stabilize the depigmentation process. Aggressive treatment is typically not recommended in children. All patients respond differently to therapy and what works for one may not work for another.

There are many ways to mask vitiligo macules (patches), including:

• Cosmetics. Macules may be hidden or de-emphasized with cosmetics. A physician may recommend cosmetics with sun protection factors (SPF) to help prevent sun damage to depigmented skin.
  
  
• Tattooing (micropigmentation). Small macules or those in sites known to have a poor rate of repigmentation (e.g., lips) may be camouflaged by tattooing. However, the color frequently does not match perfectly with the surrounding skin and may fade over the years.
  

• Bronzers and skin stains. Products that stain the skin (e.g., self-tanning lotions) may be used to camouflage vitiligo macules. The color may not perfectly match surrounding skin, however, and typically fades over a period of weeks.

Corticosteroids are often used early in the treatment of vitiligo. Topical corticosteroids (e.g., hydrocortisone cream) are used most commonly. These seem to help stabilize the progression of depigmentation and may encourage repigmentation in small, localized areas. These are the simplest and safest actual treatment, though not the most effective.

Topical corticosteroids may be used with other treatments, but may thin the skin or cause dilation of blood vessels. They are not recommended for use on the face. In rare cases, oral corticosteroids may be used to stabilize depigmentation and induce repigmentation. However, these have significant potentials for serious side effects (e.g., loss of bone density), especially long-term use, and use in vitiligo treatment remains controversial.

Immunomodulators (drugs that suppress the immune system) have also been successfully used in very localized areas of vitiligo.

Phototherapy tends to provide the best results, though treatment may need to be long-term. These include:

• Psoralen and long-wave ultraviolet radiation (PUVA). The most common form used for vitiligo. It involves the medication psoralen followed by timed exposure to controlled ultraviolet A light. Psoralen makes the skin very sensitive to light and helps to stimulate melanocytes to divide and fill in areas where pigment was lost. It is usually taken in an oral form, but may be applied topically. However, special care must be taken to avoid severe sun damage with topical applications. Skin cancer is also a potential side effect of PUVA.
  
  

  According to the American Osteopathic College of Dermatology (AOCD), PUVA is partially successful in over 50 percent of cases, but total repigmentation occurs in only 15 to 20 percent. The treatment is least likely to work on the hands and feet. Older people and individuals with pigment loss for more than five years are also poor candidates.
  

• Narrow-band UVB (NB-UVB). Controlled treatment with intense ultraviolet B light is used to induce repigmentation. Advantages over PUVA include shorter treatment times and no need for medications. NB-UVB can be used in children, pregnant or breastfeeding women and people with kidney or liver dysfunction. However, it is not widely available.
  

• Focused microphototherapy. Ultraviolet B light is shone through a dark pad with tiny holes that is applied to the skin. This can be used to irradiate only the affected skin and results are typically good, but it requires expensive equipment and trained personnel, and is not widely available.

Certain areas have a poorer prognosis in terms of repigmentation. These areas include the lips, fingertips, toes and genitals.

When depigmented macules cover more than half of the body, patients and physicians may chose to depigment the remaining skin. A bleaching agent (e.g., monobenzone) is applied to the normal skin to match it with the depigmented skin. However, the patient’s appearance is significantly altered and the skin is made much more sensitive to sun damage. Many patients are allergic to the bleaching agents, so tests must be performed before widespread application. Side effects include contact dermatitis.

Vitiligo macules may occasionally be treated by transplanting (grafting) the patient’s own tissue when other treatments fail. This is typically only done on patients with small patches of stable vitiligo. Patients must have a positive minigrafting test, no tendency to scar and be over the age of 12 years.

Vitiligo macules are highly susceptible to sun damage and must be protected. Patients are recommended to wear sunscreens with a sun protection factor (SPF) of at least 30 over all exposed macules, wear protective clothing and avoid the sun during peak hours (10 a.m. to 4 p.m.).

Patients with widespread vitiligo may suffer from depression, embarrassment or other emotional distress. These individuals may benefit from including psychological counseling and/or support groups as part of their treatment.