Vitiligo affects 1–2% of the global population. This guide covers phototherapy (NB-UVB), topical treatments, melanocyte transplantation surgery, and emerging therapies like JAK inhibitors — with cost comparisons across India, Thailand, and the US.
Understanding Vitiligo
Vitiligo is an autoimmune condition where melanocytes (pigment-producing cells) are destroyed, creating white patches on the skin. It affects 1–2% of the world's population regardless of ethnicity, though it's more visible on darker skin tones.
Types include:
- Non-segmental (generalised) — symmetrical patches; most common; unpredictable progression
- Segmental — affects one side/area; stabilises within 1–2 years; best surgical candidate
Medical Treatments
- Narrowband UVB (NB-UVB) phototherapy — gold standard; 2–3 sessions/week for 6–12 months; 70% of patients see >50% repigmentation on face/neck
- Topical corticosteroids — first-line for limited vitiligo; clobetasol for body, desonide for face
- Topical calcineurin inhibitors — tacrolimus 0.1% ointment; preferred for face/eyelids (safer than steroids long-term)
- Excimer laser (308nm) — targeted UVB for small, localised patches; faster repigmentation than whole-body NB-UVB
Surgical Options
Surgical treatment is considered for stable vitiligo (no new patches or expansion for 12+ months) that hasn't responded to 6+ months of medical therapy:
| Procedure | How It Works | Best For | Repigmentation Rate |
|---|---|---|---|
| Suction Blister Epidermal Grafting | Thin skin from pigmented area transferred to depigmented area | Small, localised patches | 70–90% |
| Split-Thickness Skin Grafting | Thin skin layer from thigh grafted onto vitiligo patches | Larger areas (lips, fingers) | 65–85% |
| Non-Cultured Melanocyte Transplant (NCMT) | Melanocytes separated from donor skin and sprayed onto recipient area | Large areas; most advanced technique | 60–80% |
India is a global leader in melanocyte transplantation, with several centres (AIIMS Delhi, Amrita Hospital) having performed thousands of procedures.
Emerging Therapies
- JAK inhibitors — ruxolitinib cream (Opzelura) was FDA-approved in 2022 for non-segmental vitiligo; shows significant facial repigmentation in 50% of patients by 6 months
- Oral mini-pulse steroids — dexamethasone 2.5mg on two consecutive days/week to stabilise spreading vitiligo
- Afamelanotide implants — synthetic hormone that boosts melanin when combined with NB-UVB (in trials)
Cost Comparison
| Treatment | India | Thailand | USA |
|---|---|---|---|
| NB-UVB (per session) | $10–$30 | $30–$50 | $100–$300 |
| NB-UVB (6-month course, 72 sessions) | $720–$2,160 | $2,160–$3,600 | $7,200–$21,600 |
| Melanocyte transplant (per 100cm²) | $400–$800 | $1,000–$2,000 | $3,000–$6,000 |
| Ruxolitinib cream (Opzelura, 60g tube) | $80–$150 | $150–$250 | $2,000+ (US retail) |
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