Vitiligo Treatment 101: How Topical Steroids Work

Looking to treat your vitiligo? Today, there are a wide variety of vitiligo treatment options available – including pills, creams, light therapy and more. One of the most frequently used forms of vitiligo treatment are topical steroids, also known as topical corticosteroids, or topical glucocorticosteroids.

Medically reviewed by Dr. Richard H. Huggins, dermatologist at Henry Ford Hospital in Detroit, MI

How topical steroids work

What are topical steroids and how do they work? Do they have side effects? This guide will answer these questions and give you a better understanding of this common, first-line treatment for vitiligo.

Remember that no single treatment for vitiligo is best – the goal of vitiligo treatment is to find the method that will work best for you. Of course, this article doesn’t take the place of a doctor’s advice, so talk with your dermatologist about which treatment might work best for you, and what to expect if you are using topical steroids.

What are topical steroids?

Topical steroids are an anti-inflammatory treatment that can help slow the spread of, or allow for   repigmentation in vitiligo. To understand how this treatment works, let’s review why vitiligo exists.

Vitiligo is an autoimmune disease in which the body’s immune system – which is supposed to attack invaders like bacteria, and cancer – instead attacks melanocytes, the cells that produce pigment in the skin. 

How do topical steroids fit in? Studies have shown that areas with vitiligo have high levels of inflammation, with a variety of immune cells all working to destroy the incorrectly targeted melanocytes. Topical steroids help treat vitiligo by working against this process. The steroids suppress inflammation by preventing the production of inflammation-promoting chemicals and by preventing destructive immune cells from entering the area to cause more damage. If the melanocytes are not being destroyed, they can grow and spread like normal and the old color can return. 

How are topical steroids used as a vitiligo treatment?

Topical steroids are available in a variety of strengths, or potencies, and in a variety of forms, including creams, ointments and gels. Commonly applied to the skin once or twice daily, they may be used alone or together with another type of treatment, such as light therapy. They are often chosen early on for localized vitiligo because they’re relatively cheap, easy to apply, and can provide positive results. 

The exact type of topical steroid chosen is often tailored to each person’s particular skin needs. For example, areas of depigmentation on the face, which is more sensitive,  will likely call for a lower potency topical steroid than depigmentation on the body. They are the most effective when used on small, freshly depigmented areas. They also seem to work best in sun-exposed areas of the skin, such as the face.

Since topical steroids are applied by rubbing the product onto the depigmented areas of skin, they are often used in cases where  vitiligo is limited to small areas of the body – usually areas that take up less than 10% of the body’s skin. 

What are the side effects of topical steroids?

Much like any treatment, topical steroids can have side effects. However, since topical steroids work locally, and are not taken as a pill, they have fewer side effects than oral steroids. 

The most common side effect of topical steroids is skin atrophy, or thinning, which can result in the skin being more easily damaged and bruised. This side effect can occur as early as 2-3 weeks into daily use. Thinner areas of skin, such as the eyelids, are particularly sensitive to this side effect. Additionally, topical steroids can cause increased acne or acne-like rashes, skin streaking, stretch marks, as well as increased hair growth. 

Regular follow up with your dermatologist can allow for these side effects to be identified early, and pausing treatment often provides resolution. Treatment holidays, which are periods of time in which  topical steroids are used for a few months followed by a month break, are also frequently used to prevent side effects. 

What has your experience with topical steroids been like?

Disclaimer: This list is provided for informational purposes only. Please consult your dermatologist to determine the best treatment options for you.