Immunosuppressives
As described earlier, autoimmunity plays significant role in the vitiligo. Although it is not the cause, its affect and plays significant role in cell destruction. One need immunosuppression in actively progressive vitiligo. The dose is minimal compared to other autoimmune disorders. Mainly oral steroids in pulsed dose (weekends) and methotrexate in very minimal dose (weekly once) either given together or alone. Dose, duration depends on the age, associated conditions, type of vitiligo, severity of vitiligo and other patient related reasons. It is not must in all cases. Decision taken on case to case basis. Proper explanation and guidance is given. Usually duration required is 6 months to 9 months. Conditions like autoimmune thyroiditis requires longer duration of treatment. Most of the patients have minimal , temporary and reversible side effects if they follow exactly the instructions given
Immunomodulators
These medicines either work alone or with immunosuppression. They are much safer options. In extreme ages we depend only these. However, in severe case they need to be combined with immunosuppression. These are continued for longer time even after patient recovers from vitiligo.
Antioxidants
Combination of medicines which exerts potent antioxidant activity are used to achieve better outcomes. Sometimes these are used alone or in combination of other systemic medicines. These are much safer options but they are mostly effective as adjuncts.
Vitamin and Mineral Supplements
A multi vitamin and multi mineral pill is used in combination with other medicines. They work only as adjuncts. They play a siginificant role in early maintannance period
