- Best Results6-12 months
- Treatment Recovery0 days
- Procedure TimeVariable
- Skin SpecialistDr Davin Lim
- Duration of ResultsVariable
- Back to WorkImmediately
- Cost$0 (Medicare)
Vitiligo Hands Treatment
Acral vitiligo is common, affecting 30-50% of cases. In some it is the predominant site, whilst in others, focal areas on the face & trunk are present. If remaining pigmented hairs are seen within lesions, the prognosis is much better (though still poor).
FactsFacts on Vitiligo on the Hands
- This is called acral vitiligo
- The onset is usually in young adults
- Involvement on the feet is common
- Mucosal & lip involvement with hands is known as lip-tip vitiligo
- Topical creams & phototherapy is first line management
- Resistant cases can be treated with microneedling/lasers & 5 FU
- Stable resistant cases may be candidates for surgical treatments
What is acral & lip tip vitiligo?
Vitiligo Hands Treatment
Acral vitiligo refers to involvement of the hands and feet. Lip-tip vitiligo is a pattern that involves the lips (mucosal vitiligo) and the tips of the fingers. Focal vitiligo refers to multiple areas on the body & face.
What is the best treatment for vitiligo on the hands?
This vitiligo pattern is challenging to treat. My go to therapy is with topical ointments & phototherapy. As a guide, the chance of full re-pigmentation is as follows:
Facial vitiligo: 85-90%
Neck & trunk: 70%
Proximal limbs: 50-70%
Distal & acral: 10-20%
Most vitiligo patients will have a mixture of focal & acrofacial vitiligo, hence we are going to get most wins on facial areas. For patients who do not respond to topicals, we do have the option of surgical modalities (see below) providing vitiligo is stable for over 18 months.
What creams do I use?
For acral vitiligo I use a mix of potent CS ointments & calcineurin inhibitors on a rotational basis. PGE analogues & vitamin D derivatives are usually weaker than the above combination. I have not used pseudocatalase since the early 2000s. Recalcitrant vitiligo can be treated with microneedling plus 5 Fluorouracil.
What is phototherapy?
Phototherapy, using narrowband UVB, is the gold standard for treating vitiligo. This treatment is covered under Medicare in Australia. UVB can help restore lost colour by suppressing the immune attack on pigment cells & at the same time awaken resting pigment cells. 2-3 sessions are conducted over 15 to 25 weeks.
Different sites affected with vitiligo will have varying degrees of re-pigmentation success. For example, facial vitiligo will have 80-90% chances of re-pigmentation. The flipside is that acral vitiligo (hands & feet) only have 10-20% chances of pigmentation.
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What is the go with excimer laser & vitiligo?
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.
What are the chances of getting pigmentation back?
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).
When is surgery indicated?
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.
- 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.
- 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.
- FUE transplantation is a novel way of transferring pigmented cells to vitiligo areas.
How do you hide vitiligo on your hands?
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.
How do you look after your hands?
Apart from camouflage, there are simple methods to look after your hands.
- 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.
- 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.
- Phototherapy. Remember to take off all your camouflage, including fake tan before phototherapy. This will ensure optimal doses are delivered.
- 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.
What natural diet & supplements are there?
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 –
- 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.
- Gluten free diet. 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.
How much are treatments?
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.
Davin’s Viewpoint; hand vitiligo treatments
This is one of the harder areas to re-pigment. I still follow the European Standards guidelines of light therapy and topicals. If one has poliosis (absence of pigmented hairs), the prognosis is poor- 5-10% chance of re-pigmentation.
Failing phototherapy my next step is microneedling & 5FU, spaced 4 to 6 weeks apart. If vitiligo is stable, we can consider split grafting, suction grafts & FUE. This is limited by surface area.
Camouflage creams especially felt markers are useful in this area.
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