The Vit Pro (A Vitiligo Blog)
My Vitiligo Story
The Vit Pro (A Vitiligo Blog)
Treatments & Solutions

Combination therapy for vitiligo

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Last Updated on 16th July 2024 by Caroline Haye

Puzzle

What is it and why do most specialists prefer it?

If you stay abreast of the medical literature you may have heard of combination therapy for vitiligo (sometimes called polytherapy). Most experts seem to agree that this approach is more effective than using just one type of treatment in isolation (monotherapy). In other words, a joint approach consisting of more than one kind of modality usually delivers better results.

There are numerous treatments that dermatologists use in combination with each other, the majority of them incorporating UV light (phototherapy). As with all vitiligo therapies, certain combinations work better for one individual than another. And results vary widely on a case by case basis. For some, topical creams plus phototherapy can be effective. Others evidently do better with oral medications plus UV treatment. And, in some instances, switching from one combination of treatments to another at different times achieves optimal results. (Dr John Harris, Professor and Chair of Dermatology at the University of Massachusetts, has even developed a treatment algorithm to determine which combinations of therapies he will use with patients in different scenarios and when to change or adapt them.)

Of course, the terms combination therapy and polytherapy usually refer to medical treatments. But you could equally apply them to natural and complementary ones. For example, in my own case, combining nutritional supplementation and sun exposure was the winning formula that led to my repigmentation. For some individuals certain other dietary or lifestyle changes might form part of a successful natural combination therapy.

Why does vitiligo respond best to combination therapy?

I am not remotely qualified to give a scientific analysis of why vitiligo responds better to combination therapies. But the most obvious reason might be that, since vitiligo is what doctors call a multifactorial condition (i.e. one involving multiple different factors), it calls for a multifactorial treatment. In other words, a complex health issue involving multiple causes and effects is more likely to require a range of fixes. Whatever the specific reasons may be, there does seem to be a synergistic effect of using more than one vitiligo therapy at a time.

Why is UV light important in combination therapy?

Presumably, the importance of UV light in polytherapy is either that it provides the trigger for the pigmentation process, while the other modalities are busy enabling the skin to respond properly to that trigger… Or, else it simply acts to accelerate repigmentation while other treatments take effect… Or perhaps both theories are true. In other words, UV light literally has a synergistic relationship with other effective therapies, whereby one reinforces the other simultaneously and in equal measure.

From my own experience of vitiligo recovery, it seemed like it was the nutritional supplementation that triggered the process and sun exposure simply accelerated that process. But who knows? The fact remains that exposure to UV light is a common factor in the majority of effective polytherapies. So it is definitely one to bear in mind if you are still searching for your winning repigmentation combination.

Does monotherapy ever work for vitiligo?

Based on my own vitiligo journey (as well as anecdotal reports and the medical literature I have read), the answer to this question looks like a qualified yes. For example, I have heard of individuals who have successfully repigmented simply by removing particular vitiligo triggers from their life. Something as straightforward as cutting out gluten, for instance, or correcting an imbalance in gut flora. (That is, if a gluten intolerance or gut dysbiosis respectively happen to be the cause of their autoimmune response.) Simple steps like these have been known to halt or reverse de-pigmentation. And, given enough time, I believe that recovery is sometimes even total and permanent… Just as long as the person continues to avoid their particular trigger.

Of course, knowing what triggered your vitiligo in the first place isn’t easy. So discovering whether or not there might be some simple steps you could take – like those I mentioned above – to turn your vitiligo around for good is likely to require some considerable amount of experimentation. And, realistically, it is possible that you may never find out… However, you will certainly never know unless you try.

Long-lasting success is rare

But, assuming the cause or mechanism behind your pigment loss is more complicated, then it seems likely that the solution would be more complex too… Especially if you are to stand a chance of long-lasting success. As far as I am aware, most monotherapies (like phototherapy alone) hardly ever lead to complete re-pigmentation or lasting results. The medical and anecdotal reports I have read on this subject all suggest that phototherapy is one of the more successful single vitiligo treatments available. But results range from no improvement to complete, but temporary, re-pigmentation (with most patients falling somewhere in the middle of this scale).

However, when combined with other medical or pharmaceutical treatments, phototherapy (in particular, narrowband UVb) achieves better results than on its own. Yet, even then, these tend to last a year or so at best once treatment ends, at which point depigmentation usually recurs. [See Our Skin Has a Vitiligo Memory.]

Can other therapies work without UV light?

I have no idea if any medical treatments can restore lost pigment permanently when used in isolation. I have certainly never heard of one that does. (Perhaps one or another of the new vitiligo drugs being developed will achieve this in the future.) However, my personal experience demonstrates that it is possible – for some individuals, at least – to reverse vitiligo, and keep it at bay, by adopting a daily routine of relevant nutritional supplementation.

And, whilst UV exposure definitely helps to accelerate the process, it may not be absolutely necessary. The reason I say this is because even parts of my body that never see the light of day (!) have fully repigmented over the past decade or so. Admittedly, they took longer than the areas of skin that were exposed to sunlight and / or narrowband UVb phototherapy. But they still got there eventually… A fact that should be of some comfort to anyone who is unable to tolerate therapeutic levels of UV exposure.

Key points I have concluded from preparing this post

  • One therapy, used in isolation, rarely reverses vitiligo for long, if at all.
  • One therapy used alone sometimes halts, or even reverses vitiligo. But it usually isn’t as fast, effective or long-lasting as using more than one at a time.
  • Complex conditions call for complex solutions, which is probably why combination therapy for vitiligo has become a popular approach with dermatologists.
  • A common component in most combination therapies for vitiligo is UV light. But, as effective as it is, it may not be absolutely essential in every case.
  • Permanent diet or lifestyle changes (e.g. avoiding known triggers or correcting an existing imbalance in the gut or in nutritional status) might offer a simple solution for some individuals. So it could be well worth exploring this possibility in case you happen to be one, like I was.
  • Whilst medical research shows that combination therapies have a better success rate than monotherapies, currently available options are likely to produce only partial and temporary results at best. This – in my opinion – is because they do not permanently address the key cause of de-pigmentation… (A situation that will likely change for the better with future generations of pharmaceuticals.)

Here are a few of the sources I used…

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