A mixture of various vitamins and minerals which exert better anti-oxidant effects locally is used in addition to other modalities. These are used daily base and used for a longer duration. Preferable to spread over usual surrounding areas along with the patches.
Topical calcineurin inhibitors like Tacrolimus are used in the night-time as ointment or lotion. This medicine is used for a more lasting time. It mainly gains stability of the patch with a bit of re-pigmentation-inducing property. It can be used for a longer duration without significant side effects. Advisable to apply over re-pigmented areas to prevent a recurrence. Minimal spill over surrounding area is acceptable. They are preferably kept in the refrigerator to avoid slight irritation, especially in the initial days.
A concoction of different growth factors is used as an adjunct with other modalities, either daily or at regular intervals, either at home or in the clinic, with interventions to achieve better drug delivery.
Topical Steroids are the mainstay of topical vitiligo treatment during the initial phase. They mainly help in stopping the disease activity. They are primarily applied in the morning. Different cream/ointment/lotion used according to the type of vitiligo, site of the patches, previous use of steroids, and age of the patient. Steroids will be gradually removed once desired results are achieved. It should be applied only on the patches in small quantities without massaging or spreading to the surrounding normal area.
Topical Vit D analogues are used either alone or in combination with topical steroids once in the morning. These can be continued a bit longer than topical steroids. Small quantity to be applied over the patches. Minimal spill over to usual surrounding areas acceptable.