- Best Results8-12 months
- Treatment Recovery6-12 days
- Procedure Time60-120 minutes
- Skin SpecialistDr Davin Lim
- Duration of ResultsLong-term
- Back to Work6 days
- Cost$$ Medicare
Vitiligo- Genital areas
Vitiligo frequently affects the genital areas, including the penis. It is NOT sexually transmittable, nor does it affect sexual function. Vitiligo in this area also affects the pubic hair turning it white. The mainstay of treatment is with the use of appropriate prescription creams & narrowband phototherapy. Surgical procedures including pigment transfer grafting is not recommended in this area.
FactsFacts on vitiligo in genital areas
- Genital & pubic area involvement is seen in up to 20% of vitiligo cases
- Most cases occur in young adult life
- Mucosal vitiligo also affects the lips
- Treatments are modified given the delicate areas involved
- Prescription creams are designed to reduce inflammation & stimulate pigment production
- Narrowband phototherapy is useful
- Re-pigmentation often takes 6-12 months
Is genital vitiligo a venereal disease?
No, genital vitiligo is not a venereal disease, so don’t stress out. You cannot ‘catch’ vitiligo, nor can you pass it on to others.
What is the best way to treat?
A combination of creams & phototherapy gives the best results. With this combination, you have up to 70% chance of getting some of your pigmentation back. It takes several weeks to notice changes.
Topical creams include anti-inflammatories & creams that assist in migration of melanocytes. Special formulations are used in the genital area due to thin skin.
What is phototherapy?
This procedure delivers filtered light in the 311 nm spectrum. Light reduces skin inflammation in vitiligo & stimulates pigmentation cells to migrate into the white areas & produce pigment.
Phototherapy sessions are bulk billed & take 1-4 minutes to perform. Patients undertake 2-4 sessions per week. Phototherapy is available at Clinic Cutis
Can lasers treat vitiligo?
Yes. Excimer lasers can be useful for treating smaller areas of vitiligo. I did use excimer 308 lasers in the past, however by definition it does not fulfill the Medicare criteria for narrowband phototherapy, hence it costs patients over 1500 dollars per month (with excimer) compared to no out of pocket charge for narrowband.
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How safe are treatments?
Treatments are safe, providing you follow the directions outlined. Topical anti-inflammatory creams are adjusted accordingly as skin is more sensitive to irritation. My usual prescription is a lower concentration of calcineurin inhibitors.
Phototherapy for vitiligo has a long safety record. PUVA or psoralen with UVA is not used in this area due to concerns over carcinogenic effects long term.
What is vitiligo of the penis & is it common?
Yes, the genital areas are frequently involved. The main signs of vitiligo are patches of white skin. Vitiligo of the penis usually appears on the foreskin & shaft however the glans or head of the penis is frequently involved. This is more noticeable if you have dark skin. Involvement of the pubic hair is common & presents as grey or white hairs.
What other areas of the body are commonly involved?
You might also notice symptoms not related to your genitals, such as:
- White patches involving other areas such as the face, nipples, trunk & limbs.
- Gray or white hair
- Loss of colour in your mucus membranes, such as the linings of your mouth and nose
At what age does vitiligo develop?
Vitiligo can develop at any age; however genital involvement is usually seen before the age of 25. Some cases develop much later.
Can vitiligo affect fertility?
Nope. Fertility is not affected by vitiligo. This includes male & female patients. Additionally white patches on genital areas do not reduce sperm or egg counts.
Does genital or penile vitiligo cause any symptoms?
Nope. Vitiligo does not cause any symptoms including erectile dysfunction, painful urination, premature ejaculation, or difficulty urinating. If you have any symptoms, it is unrelated to your condition- see a urologist or discuss with your GP. A dermatologist is unlikely to help you.
Can I pass on vitiligo to my children, is it inherited?
Yes & no; the question is complex. Your offspring are not likely to get vitiligo, however they are at increased risk of developing vitiligo & other autoimmune conditions like diabetes, vitamin B12 deficiency, & thyroid disease. These conditions usually manifest after the teenage years.
Will a wank worsen vitiligo?
Hard one to answer; no pun intended. Here is the scientific answer; in some cases, friction & trauma can worsen the disease. This is called Koebner. Google it. Areas such as the knees & elbows are prone to white patches. The same applies to areas of friction in the genital area. Get it?
How is penis vitiligo diagnosed?
Vitiligo is usually diagnosed during a thorough physical exam. If it’s affecting your penis, your doctor will likely examine the rest of your body as well. In most cases vitiligo can be diagnosed without the need for special tests. Other conditions that may mimic vitiligo include BXO & lichen sclerosis. These conditions are best treated by either a urologist or general dermatologist.
Can surgery be performed on the genital areas?
I do not perform surgery on genital areas due to the high incidence of scarring in these areas. This means no surgical procedures on the penis. I do consider surgery for extensive areas around the nipples that fail vitiligo creams & phototherapy.
Foreskin vitiligo can be treated with circumcision, see a urologist for this, not a dermatologist.
Can lasers help?
There are reports of fractional lasers in the literature. They can work in 5-10% of cases & are not first line treatment for vitiligo. Lasers for vitiligo are best attempted in a public hospital setting as it is classed a novel & experimental. This includes the excimer 308 laser.
What washes can help?
You can’t wash away vitiligo, however it is important to use a non-irritating wash in this area- especially if you are combining phototherapy (which gives you sensitive skin) & topical creams. Recommended washes include- Cetaphil, QV Gentle Wash & Cerave.
If in doubt, look for the word gentle.
What DIY or home remedies are there for genital vitiligo?
This is one area you do not want to get wrong with DIY skin care or home-made remedies. The genital area is prone to both allergic & irritant contact dermatitis. You have been warned.
If the diagnosis is certain, you can try to use tacrolimus 0.03 to 0.1% ointment as tolerated. The most common brand is Protopic. Resourceful patients can source this online. Don’t try psoralens at home.
What foods should I avoid?
A diet that is low in acidic foods can reduce inflammation. How much it helps with vitiligo is still unknown. Regardless it is simple to follow. Type is the term ‘acidic foods’ in Google, don’t eat these foods. Examples include citrus fruits & tomatoes.
Food high in antioxidants such as legumes, & leafy green vegetables are advocated. Even if they have no impact on vitiligo, they can help your overall health. Do it. Placebo works in over one quarter of cases.
Can vitamins help treat genital vitiligo?
Much like diet, there is no harm trying, though the evidence is low. It’s worth giving it a go as vitamins & supplements have little or no side effects. Supplements include vitamin B12, folate & iron. There are some reports that multivitamin B capsules can help.
Herbal supplements like ginkgo biloba can be beneficial in some cases of vitiligo. Antioxidants include resveratrol, ginseng & green tea.
What’s the outlook for genital vitiligo?
The appearance of penis or genital vitiligo will initially make you uncomfortable, but the condition itself is harmless. While it may take a new sexual partner a little time to get used to it, you both will get to the point where the appearance of vitiligo no longer registers. Medical therapy can help some, but not all cases.
How to get an appointment?
Dermatologists do require a real time appointment, so do not send photos of your genitals. These photos make good Christmas cards to fellow colleagues.
Book an appointment with our dermatologists at Clinic Cutis. You will require a referral from a GP.
How much are treatments?
Vitiligo treatments are largely subsidized by Medicare. This saves over $7500 per year for patients. Phototherapy sessions are bulk billed, hence do not cost anything (apart from time). Creams cost approximately 50 to 90 cents a day.
Davin’s Viewpoint on genital/penile vitiligo
This is a sensitive & potentially embarrassing type of vitiligo & is classed as flexural vitiligo or lip tip-mucosal vitiligo. Isolated patches on genital areas are not uncommon, however in most cases it is associated with white patches elsewhere on the body or mucous membranes.
Treatments can be challenging as the genital areas are sensitive to strong topicals. The current consensus is that rotational therapy with calcineurin inhibitors & moderate strength cs ointments are safe. Start off with either tacrolimus 0.03 to 0.1% or pimecrolimus, alternating with methylprednisolone ointment. In the absence of contraindications, one can add narrowband phototherapy. In Australia, we tend to avoid PUVA due to the carcinogenic nature of this treatment.
Unlike vitiligo on the face & upper limbs, surgical procedures are limited due to the higher incidence of scars. This includes micrografing & melanocyte repurposing treatments such as ReCell. An exception is with foreskin vitiligo whereby elective circumcision by a urologist can be helpful.
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