It really depends on the addition of other adjunctive treatments. The fastest re-pigmentation according to clinical papers is with the addition of chemotherapy, namely 5FU. Results are seen as early as one month.

A more realistic outcome is 15 to 30% improvement after 4 months (conducted twice a month for 8 sessions in total). Adding medical grade phototherapy & topicals can accelerate this process. 

As with all vitiligo therapies, facial involvement responds better than vitiligo of the hands & feet (acral vitiligo).

1-3 days, even if it is done by my team. This is because we don’t exceed 0.2 mm (the same length as DIY microneedling). There is no requirement to go deeper. I am treating melanocytes that live at 100-150 microns, not scarring that is 3000 microns deep.

Post microneedling you will be a wee bit red. This usually dissipates within 12 hours. You can resume your normal activities the next day, including make up application if required.

No. If my clinical team performs microneedling we use topical anaesthetic beforehand. The procedure is entirely painless. Post treatment we infuse a combination of topicals including CS ointments, tacrolimus & other pigment stimulators.

It is the method of execution & not the device that counts. I use a roller for most of my work, my nurses & therapist like derma pens or the Skin Pen, however the safest is a stamping device if you are new to microneedling.

Rolling can give you ‘microtears’ especially if you don’t know what you are doing, or if you use long needles. A pen can do the same, especially if you drag it, or if the motor is stuffed, or if you use long needles. Hence for home use, stick with a stamp. Again, do not go longer than 0.2 mm.

Microneedling therapy is adjunctive, it is not first line. Progressive, acute, inflammatory vitiligo is a relative contraindication. If this applies to you, see a dermatologist. Do not microneedle the following-

• Genitals, eyelids, lips or your butt hole.
• Areas of infection
• If you have a history of cold sores & don’t have antivirals
• If you are unsure of anything
• Inflamed vitiligo as you can extend it/make it worse

If you don’t know what you are doing, this treatment can damage your skin. Risk includes-

• Infection. Ideally you should microneedle in a sterile environment.
• Worsening of vitiligo. This is called Koebner & is more common in progressive & inflammatory vitiligo.
• Scarring, also known as iatrogenic scars. This happens when you drag you needle, use blunt needles, use long needles, or because you don’t quite know what you are doing.
• Contact dermatitis from the topicals can occur. This is because the skin barrier is compromised.

Most of our microneedles are clinical grade. You can source sensible needle lengths from many online stores. Don’t exceed 0.2 mm. Buy a stamping device. They are far safer than pens or rollers.

Medical therapy is the mainstay of treatment. This gives the highest chances of success. Dermatologists employ the following methods-

1. Creams: include tacrolimus, pimecrolimus, CS, 5FU, PGE analogues, vitamin D creams.
2. Narrowband phototherapy is the Gold Standard. 2-3 sessions per week. This treatment provides the fastest rate of re-pigmentation. It is covered under Medicare with no out of pocket expenses.
3. Lasers & surgery. These are last line treatments.

Supplements & diets are aimed at reducing inflammation & oxidative stress to the melanocytes.  Diets that are low in acidic food & gluten free are trending on Google searches ATM. They are harmless, so if you are inclined, go ahead.

Vitamin B deficiency can be associated with pernicious anaemia. This is an autoimmune disease, like vitiligo. There are low quality studies that have demonstrated the benefits of Vitamin B3, B6 & B12.

Vitamin C is the most potent antioxidant in the body. It is a water-soluble vitamin. If you would like to supplement ascorbic acid, take a tablet and don’t use a cream. Topical vitamin C suppresses your melanocytes, hence will slow down re-pigmentation.

Vitamin D can be used with oral and topical supplementation has shown to be beneficial in some cases of vitiligo.

Ginkgo biloba is another well accepted herbal supplement, there are some studies in the dermatology literature.

Indian gooseberry or Phyllanthus emblica fruit extract, vitamin E, carotenoid combinations can be useful. Given the banal nature of berries, fruits & tocopherol, supplementation may be indicated, as adjunct to phototherapy.

Polypodium leucotomos (PL) is a tropical fern that has been shown to protect against UV radiation– induced damage.

Green tea is another potent antioxidant. Studies are weak, however, as placebo can be useful, supplementation can be considered.

Natural sunlight can be useful as UVB encourages melanin production & melanocyte migration. It can also cause sunburn, making your vitiligo worse. The problem with sunlight is that it also contains UVA, UVB (unlike narrowband UVB) as well as the visible spectrum of light.

If you want maximal UVB, it will be found in the midday sun (UVA is relatively constant). Hence you will require exposure for 2 to 40 minutes depending on where you live.

A more sensible & practical approach is clinical narrowband phototherapy as this gives precise doses of UVB without other spectrums of radiation. This treatment is also bulk billed in Australia for Medicare card holders.

Ideally you should see a dermatologist if you are contemplating this treatment. Most dermatologists won’t know about this, unless they read the literature. It has been in print for the past 3 years.

I do believe that microneedling should be viewed as adjunctive therapy and not primary. The use of CS, calcineurin inhibitors & PG analogues with prescribed 311 nm computer controlled narrowband phototherapy is gold standard.

I can assess your vitiligo & decide if this treatment is in you. I have your best interest in mind. I do not do online assessments, either by email or Skype. If you are suitable for treatment, I will book you in.

Note: Microneedling is not covered under Medicare. The only vitiligo therapy covered is phototherapy. Microneedling sessions cost $390 to $590 per session.