- Best Results3-12 months
- Treatment Recovery0 days
- Procedure Time2-8 minutes
- Skin SpecialistDavin Lim
- Duration of ResultsLong-term
- AnaestheticNumbing to sedation
- Back to Work0 days
- Cost0 (Medicare)
This vitiligo program is designed to understand your pattern of vitiligo. It consists of simple supplementation, clinical phototherapy & a combination of prescribed creams. The majority of patients will improve with this program, with re-pigmentation rate of up to 90%.
FactsFacts on the Vitiligo Challenge Program
- This combines medical phototherapy & topicals
- The success rate is up to 90%
- Daily supplementation consists of vitamins B, C, E, D
- Anti-inflammatory & pigment inducing creams are prescribed
- You should expect to see progress within a few weeks of therapy
- Medicare covers most of this treatment
- The first signs of re-pigmentation are tiny dots around the hair follicle
- Migration of pigment cells comes from the edges of vitiligo
What is the science behind the Vitiligo Challenge?
This treatment protocol is based upon recommendations by a group of international dermatologists. It is based upon pure science. Essentially it consists of three arms.
- Phototherapy using clinical narrowband UVB. Ideally three times a week. This is covered under Medicare. NUVB suppresses inflammation & encourages pigmentation.
- Prescribed creams to stop immune attack, inflammation & at the same time encourage pigment cell migrations to the patches of vitiligo.
- Supplements. You can buy some multivitamins & ginkgo biloba from any health food shop.
Diet is optional – see more information down below.
When will I see results?
Most patients will notice a change in their vitiligo patches within 4 weeks. This is based upon combination therapy using both topicals, supplementation & most importantly narrowband phototherapy.
The first signs of pigmentation will occur around hair follicles. This is known as perifollicular re-pigmentation. From there, melanocytes will migrate towards the centre of the patches.
How much does it cost to treat vitiligo?
Australia is one of the only countries that subsidizes vitiligo therapy. Treatments are bulk billed if you have a Medicare card. As a guide-
- Phototherapy – no charge.
- Topicals creams- approximately $1.90 per day.
- Supplements- approximately $1.20 per day.
Some creams are available on the PBS, meaning one tube costs $4-8.
What is phototherapy & why is it the foundation for treating vitiligo?
Narrowband UVB is now the most common type of light treatment for the treatment of vitiligo. It uses light of a specific UVB wavelength in the 311nm spectrum & is the mainstay for the treatment of vitiligo. It works by stopping the immune attack & at the same time awakens pigment cells called melanocytes.
In summary, narrowband phototherapy
- Does not increase the risk of skin cancer.
- UVB treatment does not damage the skin nearly as much as UVA sources
- UVB is compatible in pregnancy, lactation & in treating vitiligo in children.
- Treatment studies suggest that it is a more effective treatment than PUVA.
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How often are you required to undertake phototherapy?
A minimum of two sessions per week. In accordance with literature guidelines, the optimal dosing is three times per week, namely every alternate day. Two sessions is the minimum.
Each session takes between one to seven minutes to perform. If you are having this done at Cutis Medical, you can park your car in the shopping centre 10 meters from the Clinic. Cutis is also open on Saturday mornings.
What creams do I prescribe for vitiligo?
The optimal combination of creams will depend on the extent & location of vitiligo. As
A guide, I use the following combinations-
- Corticosteroid- both creams & ointments, in various strengths.
- Calcineurin inhibitors- Tacrolimus over pimecrolimus.
- Vitamin D analogues- are useful if I need to cover large areas of vitiligo.
- PGE analogues- best combined with micro needling.
Some creams are covered under the PBS in Australia and cost only a few dollars, other topicals are more expensive as they require special compounding.
Can IPL be used on darker skin types?What supplements should I take?
The internet is trying to sell you everything in order to treat vitiligo. A cost-effective & evidence based approach is to supplement the 20 week challenge with-
- Ginkgo biloba.
- Ascorbic acid orally not topically.
- Vitamin B12.
- Vitamin E or tocopherol.
- Vitamin D tablets. It is advisable to see the advice of a professional before taking high strength vitamin D supplements. The dose needs to be balanced to avoid vitamin D toxicity. Too much vitamin D can lead to a build-up of calcium in the blood. As a guide, 150% of the RDI is fine.
What is the evidence with diet & vitiligo?
There are some studies that suggest dietary changes & supplements could have a positive impact on the course of vitiligo. As a guide plant-based diet rich in antioxidants, low in inflammatory foods may have a beneficial effect on vitiligo. I will divide this into three main food groups.
Antioxidants. A diet high in antioxidants can reduce oxidative stress. Vegetables, fruits, nuts, seeds and spices are all high in antioxidants. A good rule of thumb for eating enough antioxidants is to eat as many different coloured fruits and vegetables. Foods high in omega-3 such as fish, nuts & seeds, green tea are good sources of antioxidants. Plant-based diet has been shown to be very high in antioxidants
Gluten free. This diet is harmless & in extremely rare cases, it can be beneficial. Gluten is thought to be pro inflammatory.
Low acidic diet. Acidic Inflammatory foods make it harder for your gut to work and remain healthy. Fibre, probiotic and prebiotic foods, such as sauerkraut, can help improve gut health. Examples of pro-inflammatory foods include- sugar drinks, white pasta, bread, gluten foods, processed foods. Generally, it is in a packet, it is bad for you.
What other treatments do I use to treat vitiligo?
My approach to vitiligo is evidence based and scientific. My aim is to get you better in the safest, most effective, & cost-effective way possible. If your vitiligo does not respond, I will go up the treatment ladder. A simplified approach is outlined below.
Stage 1: Phototherapy & Topical as described (CS & calcineurin inhibitors)
Stage 2. Phototherapy & stage 1 +PGE analogies + diet + supplements
Stage 3. Phototherapy & stage 2 + vitamin D creams
Stage 4. Phototherapy & stage 3, option for fractional devices + 5FU
Stage 5. Phototherapy & consideration of surgery if indicated.
Phototherapy forms the cornerstone of management as it suppresses immune attack & at the same time stimulates pigment production.
How should you monitor your progress?
Photos, photos, photos. Take pictures using your camera phone. This will give you an unbiased opinion on how things are going. This is how vitiligo re-pigments-
Firstly, you will notice tiny dark dots. This represents hair follicles that have pigment cells. These cells escaped (hopefully) the immune system attack. Phototherapy awakens the sleeping cells to migrate from the base of your follicle to the skin. Over time these dots get bigger & touch each other.
Secondly you will notice the sides of vitiligo closing in. This is due to migration of melanocytes from normal skin. Coupled with perifollicular re-pigmentation, this results in re-pigmentation of your vitiligo patches.
When do I review your progress?
I normally review your progress from week 15 to week 20. This is because it takes time for you to re-pigment white patches. As to what to expect in this timeframe-
- Facial vitiligo, has at least 80-90% chance of improvement.
- Neck & chest, has 70+% chances of improvement.
- Body & upper limbs, approximately 50+% respond
- Hands & feet, only 10-20% respond.
- White hair to pigment hair- will be exceptional if it responds.
What are things you can do at home to help treat vitiligo?
Apart from supplementation, & possibly dietary supplements, there’s not much else to do. I don’t usually start you on micro needling in the early stages of treatment. The main reason is that I need to understand what works for you.
By eating healthy, limiting stress & excessive alcohol you will give your immune system a break, ensuring the best possible chances of re-pigmentation.
Davin’s Viewpoint on the Vitiligo Challenge Program
The very first step is to understand your pattern of vitiligo. If I were to approach this with every single vitiligo treatment, I (we) will not be able to understand what combinations work for you. Hence, I have limited the treatment protocol to 3 known variables, namely creams, light & vitamins.
Despite optimal delivery of phototherapy as well as immune modifying creams, the location of vitiligo still plays an important part in prognosis. Facial disease responds best, acral or hand/feet/finger/toes responds poorly to most therapies.
I take baseline measurements during the consultation; you should do the same. Comparison photos are taken during the follow ups. With compliance & persistence, most cases of vitiligo can be treated.
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