As reflected in the literature, up to 20 sessions over a course of 8-10 weeks is required to notice a difference. The first signs that phototherapy is working can be seen around hair follicles. This treatment ‘wakes up’ the pigment cells that hide in the deeper layers. Over time the edges of lesions will move to the centre, resulting in re-pigmentation of patches.

During your initial visit I will take photos of some (not all) of vitiligo affected areas. This will act as a reference point during latter follow ups. Remember, the chances of re-pigmentation is highest on the face, intermediate on the trunk & lowest for hands/feet.

Ideally phototherapy should be conducted three times a week. Studies have shown that alternate day sessions give the best results.

There are pros and cons regarding laser treatments for vitiligo. The major advantage is the fact that we can specifically target areas of vitiligo without treating unaffected areas. This reduces cumulative doses of UV. Lasers do not provide superior outcomes compared to narrowband phototherapy.

The major disadvantage of lasers is that they take up a lot more time for both patient & dermatologist. Costing is also prohibitive, at $200 per treatment, or up to $600 per week. Most patients require 50 sessions. It adds up. Phototherapy is bulk billed, hence there is no out of pocket expenses for the patients.

The biggest difference between home & specialist phototherapy is precision of wavelength, & energy. Specialist units are calibrated by technicians to deliver one specific wavelength of light, namely 311 nm. Home devices deliver a wider range of spectrums that are non-calibrated.

The energy delivery of our phototherapy units is highly efficient, delivering over a hundred millijoules in less than ten seconds. This energy is precisely quantified & incrementally increased in units of five millijoules.

One gives you cancer & the other does not. Reason enough? Tanning beds deliver mixed wavelengths including UVB (broad spectrum) as well as UVA (tanning wavelength). UVA also destroys collagen & accelerates skin aging.

Phototherapy is delivered with one wavelength, namely 311 nm, omitting other damaging wavelengths. That’s the difference.

Side effects are uncommon with clinical narrowband phototherapy as the computer controls the doses. Reported side effects include-

• Skin darkening (more common)
• Dry itchy skin (more common)
• Cold Sore re-activation (rare)
• Burning (rare)
• Blisters (very rare)

There are two types of protocols for phototherapy.  One involves sub erythemal dosing calculated via MED or more accurately 50-70% of minimal erythema dose.  This means that you are not red/slightly burnt following this treatment. This is a safer end point in the context of vitiligo.

The second protocol requires more understanding & patient follow up (hence more expense), this is called minimal erythema dosing. This means you are on the edge of a very mild sunburn reaction. Hence you may be red & ever so slightly ‘burnt’ after each session. This is a higher risk treatment as your vitiligo can worsen if you receive a burn. If you are risk averse don’t push me for this protocol as I will need to follow you up more frequently (from a safety point of view).

Guidelines will vary depending on what papers you read. For skin type 1-2 up to 200+ sessions are the upper limit. For skin type 3+, there is no upper limit.

Investigations to date have shown that skin cancer rates are not increased following narrowband phototherapy. Accelerated photoaging is minimal as the action spectrum is in the UVA (deeper) wavelength.

There is no evidence that prophylactic maintenance of phototherapy increases remission time for vitiligo (unlike psoriasis). Once you have achieved full remission or 85% plus, I will decrease your intervals then stop.

You can safely recommence narrowband UV phototherapy if vitiligo comes back, albeit at a lower dose.

No. I do not test dose as I am experienced in starting this treatment. I am well aware of protocols using MED or minimal erythema dosing. In the vast majority of cases I can calibrate phototherapy based upon skin type.

These tips & tricks can ensure that your treatments go smoothly with the highest chances of re-pigmentation.

1. Be motivated. It takes up to 20 sessions to notice an improvement. Medicare gives you this treatment for free, turn up to your sessions.
2. Wear the same clothing. If you expose hidden areas to UVB midway through your phototherapy sessions, you may burn.
3. Use the creams I have prescribed as directed.
4. Moisturising before phototherapy increases light transmission. This improves outcomes.
5. Exfoliation once a week reduces dead cell build up, further enhancing this treatment.
6. Covering unaffected areas will reduce delayed tanning.

It is a safe treatment for most, but not all. You cannot have this treatment if you have-

• A personal history of any light sensitive condition. This only pertains to conditions that are in the UVB action spectrum. I can modulate some doses to harden your skin prior to full dose.
• A personal or family history of melanoma, this is different from skin cancers.

This treatment is safe if you are breastfeeding, pregnant or taking medicines including doxycycline & Accutane. I just modify the dose. Most medications have the action spectrum in the longwave UVA.

These are largely historical, however in some third world countries older UV sources are still used. They include broad band UVB & UVA lamps. The latter requires 8MOP creams or psoralen.

Newer UVA1 devices are available. They require 10 to 15 times longer dosing. This wavelength penetrates deeper into the skin & are of limited value in the management of vitiligo.

Excimer 308 can be delivered as monochromatic lasers, or condensed light. They are useful for treating isolated patches of vitiligo, however they are costly to the patient as it is not covered under Medicare.

As per Medicare guidelines, you will require a referral to see me prior to phototherapy. Reception can guide you through this process. During the consultation I will –

• Take a history
• Order investigations if required
• Prescribe topicals
• Order a starting & escalation phototherapy program based upon your skin type

In the majority of cases, you can commence on phototherapy the same day as the consultation. Phototherapy treatment is bulk billed, the initial consultation carries an out-of-pocket contribution.