Not all vitiligo creams are the same. Some help calm the immune system while others help restore skin color in targeted areas.

Topical creams (applied directly to the skin) may help reduce vitiligo symptoms and improve your quality of life. Topical medications are often the first type of treatment recommended before oral (by mouth) medications. Medication applied only to the skin is often safer and has a lower risk of side effects compared to systemic medications.

Understanding the differences in vitiligo treatment creams — including how they work, when they’re used, and their possible side effects — can help you and your dermatologist choose the treatment that’s best for you.

Corticosteroid Creams (Topical Steroids)

Nonsegmental vitiligo is an autoimmune disease that causes your body to attack melanocytes, the skin cells that produce melanin. Melanin gives your skin its natural skin color. As melanocytes are lost, depigmentation happens, leaving lighter patches of skin.

Corticosteroid creams are anti-inflammatory medications that help calm the immune system and reduce inflammation. They may help stop vitiligo from spreading by preventing the body from attacking melanocytes. This can help the melanocytes recover and start making pigment again.

Corticosteroid creams are often one of the first treatments used in both adults and children. A strong formulation of a corticosteroid cream is often required.

Topical corticosteroid creams for vitiligo include:

• Betamethasone dipropionate
• Clobetasol propionate
• Fluticasone propionate

Possible side effects of corticosteroid creams include:

• Stretch marks
• Acne
• Thinning skin

The greatest risk for these side effects comes with long-term use of very potent topical steroids. Always follow your doctor’s instructions to make sure you’re using them safely.

Many people start to see results with corticosteroid creams after three months. Keep your follow-up appointments so your dermatologist can track your progress and monitor for side effects. Since these creams can cause side effects, they’re usually used for short periods of time.

Calcineurin Inhibitors

Topical calcineurin inhibitors — such as topical tacrolimus (Protopic) ointment and pimecrolimus cream — help calm your immune system like corticosteroid creams. This allows repigmentation of your skin.

The biggest difference between corticosteroid creams and calcineurin inhibitor creams is that calcineurin inhibitor creams don’t cause skin thinning. Because of this, they can be a good choice for thinner, more sensitive areas — such as the lips, eyelids, or in folds of skin.

Calcineurin inhibitor creams are often used when corticosteroid creams no longer work or when vitiligo affects sensitive areas. They’re typically used up to twice a day. They’re just as effective as corticosteroid creams, with many people seeing results after three months.

Clinical trial research shows that calcineurin inhibitor creams help many adults and children with vitiligo. Many people notice their patches regaining pigmentation, especially on the face and neck. They also seem to work even better when used with phototherapy (light therapy).

Calcineurin inhibitor creams usually have fewer side effects than corticosteroid creams. Many people can safely use them for months or years.

Possible side effects include a stinging sensation when you first apply them. The sensation usually fades away over time.

JAK Inhibitor Creams

Janus kinase (JAK) inhibitor creams are a newer type of vitiligo treatment. They also work by calming down the immune system. However, they do so in a more targeted way that reduces inflammation. This gives the skin a chance to repigment.

Ruxolitinib (Opzelura) is the first JAK inhibitor cream approved by the U.S. Food and Drug Administration (FDA) to treat nonsegmental vitiligo. Nonsegmental vitiligo is the most common type of vitiligo and involves lighter skin patches on both sides of the body.

Ruxolitinib is usually prescribed to treat small areas of the body, often when other vitiligo treatment creams don’t work. It’s typically used twice a day.

Ruxolitinib takes time to work. Even if you don’t see much improvement at first, staying on treatment can lead to better results over time. Studies have shown that many people continued to regain skin color, with some having the best results after up to two years of treatment.

Possible side effects of ruxolitinib are:

• Itching where you apply the cream
• Skin redness or discoloration
• Acne

Ruxolitinib is currently the only FDA-approved topical JAK inhibitor for vitiligo. Researchers are also studying other JAK inhibitors to treat vitiligo.

Vitamin D Creams

Calcipotriene is a vitamin D analog. This medication was developed as a psoriasis treatment, but some doctors may recommend calcipotriene to help repigment the skin for people with vitiligo.

Research into this medication is mixed — some studies show it may help, while others have not found it to be useful by itself as a vitiligo treatment. When combined with topical corticosteroids or light therapy, it may be more effective at activating melanocytes to help with repigmentation.

Calcipotriene is typically used twice a day. It often takes at least three months to see results. Side effects are mild and may include skin irritation, dryness, redness, or discoloration.

Topical Depigmentation Creams

Depigmentation works in the opposite way as repigmentation treatments — it prevents the skin from making pigment. This type of therapy, also called bleaching treatment, may be recommended for people with extensive vitiligo that covers more than half of the body.

There is only one type of depigmentation cream approved by the FDA to treat vitiligo — monobenzone.

Depigmentation with monobenzone is hard to reverse. However, repigmentation can still occur and is then more difficult to treat. It’s important to talk to your dermatologist about the risks and benefits of this treatment before starting.

Monobenzone is typically used two or three times a day. It takes between one and four months to see results, and complete depigmentation can take years.

This treatment is usually applied to small areas of skin not affected by vitiligo. Possible side effects include:

• Skin irritation
• Dry or itchy skin
• Increased sensitivity to sunlight
• Depigmentation in other areas where the medication was not applied

Since your skin will have less natural pigment, wearing sunscreen every day is important to help protect it from sun damage.

What If Topical Creams Don’t Work?

Topical creams are only a part of the treatment of vitiligo. If creams aren’t effective, your dermatologist may recommend:

• Narrowband UVB (NB-UVB) phototherapy — It’s the most common type of ultraviolet light B therapy used to treat vitiligo.
• PUVA — This is a combination treatment that includes psoralen, a medication that makes your skin more sensitive to light, and ultraviolet A (UVA) light therapy. NB-UVB is safer and more effective, so PUVA is used less often today.
• Oral medications — These can help slow rapidly spreading patches and lesions.
• Transplantation procedures — Skin grafting is a surgical procedure where healthy skin is removed to cover a damaged area of skin or a white patch.

Finding the right treatment takes patience. There are more treatments for vitiligo today than ever before, and researchers continue to study new treatment options. With the help of your dermatologist, you can find a treatment plan that fits your needs.