I did use excimer laser 308 nm and focal 308 in the past. The downside is that Medicare does not reimburse for this treatment, hence one week of excimer therapy amounts to $600, compared to zero dollars for narrowband.

In the context of outcomes, they offer similar benefits. I do acknowledge that excimer is focal, with minimal UV / laser dosing of normal skin. Factor 20 weeks of treatments & the difference is over $12 K in treatments.

There’s good news & bad news. The bad news is that re-pigmentation of the hands is slim (without surgery). It is in the order of 10-20%.

The good news is that if you do have face involvement, the chances of getting pigment back is very high, in the order of 85% or more (excluding pure mucosal vitiligo).

Surgery can be contemplated when all else fails & if your vitiligo is stable for longer than 12-18 months & the absence of trauma induced vitiligo (Koebner).

Autologous melanocyte transfer. The most common method I employ is via Recell liquid skin. This means harvesting cells from a donor site, arm or leg, then transferring pigment cells to abraded vitiligo affected skin. Complex procedure that requires phototherapy post operatively.

1. Blister, split & punch grafting. This can be effective, however cobble stoning can occur. I often perform test spots prior to grafting the entire area. Only small sections can be grafted.
2. Culture melanocyte transfer. This is offered overseas, not done in Australia. Essentially involves growing your own melanocytes in a petri dish then transferring to areas of vitiligo.
3. FUE transplantation is a novel way of transferring pigmented cells to vitiligo areas.

A neat hack is to use a marker pen. Magic Styl’o produces a semi-permanent pen which can be used for colouring small areas of skin. This is ideal for vitiligo areas on the hands, including fingertips.

The pens are easy to use & the colour does not rub off.  There is a range of colours available, including three different shades of brown, but you are unlikely to get as good a colour match as you can with camouflage. These pens are available on Amazon & many more online stores.

Camouflage creams can be used. Covermark, Dermacolor, Veil, & Vichy Dermablend are some companies. You will need to colour match for best outcomes.

Apart from camouflage, there are simple methods to look after your hands.

1. Washing. To protect yourself from harsh chemicals that may make vitiligo worse, use cotton gloves, then rubber/latex gloves when washing up. Reducing trauma to your hands can limit the spread of vitiligo.
2. Sunscreen. An SPF of 2-3 is present in DHA or dihydroxyacetone, also known as fake tan. If you are out in the sun, remember to protect vitiligo patches from sunburn.
3. Phototherapy. Remember to take off all your camouflage, including fake tan before phototherapy. This will ensure optimal doses are delivered.
4. Hand creams are best used at night. A sensible treatment protocol is to apply topical creams before sleeping & occlude the area with cotton gloves. This gives ample time for topicals to work, whilst you are sleeping.

Dietary supplements can be useful adjunctive treatments. Vitamin B, C, E, D & Ginkgo biloba can be purchased from pharmacies & health food stores. See the dedicated section on diet & supplements for more information.

You can supplement your diet with –

1. Antioxidants. A diet high in antioxidants can reduce oxidative stress. Green leafy vegetables, fruits, nuts, seeds and spices are all high in antioxidants.. Foods high in omega-3 such as fish, nuts & seeds, and green tea are good sources of antioxidants.
2. Gluten free diet.  This diet is harmless & in extremely rare cases, it can be beneficial. Gluten is thought to be pro inflammatory.
3. 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.

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.