Well first off, vitiligo is an autoimmune disorder…. And so I would start with what I usually do with all autoimmune issues:
A)remove any obvious “stoking” to the autoimmune “fire” (like living in a water damaged home as an example), as I usually see something like mycotoxins as able to make things worse faster than I can work to make things better. Said another way, even if I am doing good work with a patient….. we are still usually not making forward progress if their immune system is still being inappropriately over-stimulated.
B)heal the gut!!! (you knew I was going to say that!)
Remove foods that make them feel worse (and those they don’t realize are doing this like GMO/glyphosate, and pesticide laden foods), BPC-157 (+KPV would be great), butyrate, NO constipation (as this alone causes colonic inflammation), consider betaine HCL (for food digestion as opposed to letting food rot/ferment), and prebiotics (FOS, GOS), for starters.
C)And TA1 would likely be my first injectable peptide.
I would measure the lesions, and take pictures. And I would remember (and remind the patient), that our goal is to stop the progression of the pigment changes.
(Of course WE also know that the biggest goal is to stop the underlying immune dysregulation that will likely show itself in more health altering ways in the future than just pigment changes if allowed to go unchecked.)
As for using Melanotan II in this setting, that would make me nervous… as I cannot promise which skin will choose to darken (as you mentioned). Maybe someone else has experience using it in this way successfully? But I would not use that… and instead would start as I mentioned above.
Hope this helps.
Warmly, Cynthia
.