Treatments try to restore melanocytes to the skin. Psoralen photochemotherapy (PUVA), the most effective medical treatment currently available in the US, stimulates the movement of melanocytes from adjacent pigmented skin into areas of vitiligo. It is a special medication applied topically or taken orally depending on the patient's age and the extent of depigmentation, followed by ultraviolet light. There is also a modified treatment called heliotherapy, which uses a similar medication and sunlight. Another approach to repigmentation involves daily application of topical steroids.
Surgical options for treatment include skin grafts (full or partial thickness) from pigmented areas of the body to areas of vitiligo. In addition, physicians use iron oxide pigment to "tattoo" the areas of vitiligo to match the surrounding pigmented skin. Several experimental techniques are under investigation including dermabrasion (roughing up the skin) and transplantation.
If attempts at repigmentation fail and the disease is particularly extensive or disfiguring, some people choose to have the remaining pigmented areas of their skin depigmented to match the patches of vitiligo. However, this depigmentation is permanent and irreversible, so the decision is not made lightly. To discuss treatment options specific for you and your brother, ask your primary care doctor to be referred to a dermatologist who has familiarity with this condition.