Vitiligo on the Hands

  • Best Results6-12 months
  • Treatment Recovery0 days
  • Procedure TimeVariable
  • Skin SpecialistDr Davin Lim
  • Duration of ResultsVariable
  • AnaestheticNA
  • Back to WorkImmediately
  • Cost$0 (Medicare)

Vitiligo on the Hands

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?

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.

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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