Topical corticosteroids are a group of drugs similar to the hormones
produced by the adrenal glands (cortisone) that can be applied to the
the skin in creams or ointments in order to repigment the skin. These
creams and ointments are easy to apply but have limited effectiveness
and can only be used on small areas of Vitiligo.

Corticosteroids work best if started early in the condition. For example,
an "old" patch of Vitiligo that you've had for years will most likely not
respond and repigment as well as a "new" patch that recently appeared
would. Mild topical corticosteroid creams are available for children under
10 years old, while stronger prescriptions are available for adults.

Like PUVA therapy, corticosteroid therapy takes time and patience. It must
be applied to white patches of skin for at least 3 months before seeing
any results. Also notice that different parts of the body absorb different
amounts of corticosteroids:

Forearm absorbs 1%
Armpit absorbs 4%
Face absorbs 7%
Eyelids and genitals absorb 30%
Palm absorbs 0.1%
Sole absorbs 0.05%

Take caution when applying creams or ointments to different parts of the
body.

Instructions (from NetDoctor):

Wash affected area(s) of skin and rinse away all traces of cleanser.
Pat skin dry rather than rubbing it.
Apply cream or ointment thinly and evenly to affected area(s).
Gently massage cream or ointment into skin until it has disappeared.
Wash hands after applying, unless hands are the affected area.
Topical corticosteroids should not be applied more than twice a day
and once a day may often be sufficient. Follow instructions given by
your doctor.
If you have any other creams, ointments, or lotions to use on the
same area of skin, apply each in 30 minute intervals to prevent
mixing on skin.

How much to use (from NetDoctor):



One fingertip unit is the distance from the tip of an adult index finger
to the first crease of that finger. Squeeze out the required "length" of
cream or ointment from the tube according to the chart. Use less for
children.

Ointment or Cream?

Because ointments are more greasy than creams, they are preferable for
dry skin. Moist skin is best treated with creams.

Useful Advice:

Only use topical corticosteroids on affected areas of skin. Never
use them for moisturizers.
Some topical corticosteroid creams and ointments can stain clothes.
To prevent staining, cover affected area with a clean cloth or cotton
bandage.
Don't give your medicines to anyone else to use, even if they have
the same symptoms as you. They may be harmful to other people. Keep them
out of the reach of children.
Do not use cream or ointment after expiration date on tube.
If you forget to apply, apply the correct dose when you remember and
then carry on as before.


Side Effects:

Skin

Skin thinning and stretch marks.
Easy bruising and tearing of skin.
Rash around mouth.
Enlarged blood vessels.
Allergy to corticosteroid.



Internal

Adrenal Gland Suppression - Topical corticosteroid treatment can
suppress natural steroid production, which are essential for health.
Stopping the steroids suddenly may then result in illness.
Cushing's Syndrome - If large amounts of steroid are absorbed,
fluid retention, raised blood pressure, diabetes etc. may result.

(These side effects normally occur if more than 50g of clobetasol or
500g of hydrocortisone is used per week).

Here are some topical corticosteroid prescriptions commonly used for
Vitiligo: triamcinolone (Kenalog®, Aristocort®), betamethasone (Valisone®,
Diprosone®), and fluocinonide (Lidex®). Certain prescriptions can be
bought online.