Vitiligo Phototherapy

Vitiligo Phototherapy

  • Best Results6-12 months
  • Treatment Recovery0 days
  • Procedure Time2-8 minutes
  • Skin SpecialistDr Davin Lim
  • Duration of ResultsLong-term
  • AnaestheticNA
  • Back to WorkImmediately
  • CostNil (Medicare)

Vitiligo Phototherapy

Phototherapy is the mainstay for treating vitiligo. The most researched wavelength is 311 nm or narrowband. This treatment is covered under Medicare & has a success rate of up to 90%. This treatment should be combined with anti-inflammatory topicals as well as pigment cell stimulating creams. Most patients can expect to see a difference as early as 4 weeks after commencing therapy.

FactsFacts on Vitiligo Phototherapy

  • Phototherapy with UVB 311 nm is gold standard for vitiligo 
  • Phototherapy should be combined with topical therapy
  • Most vitiligo patients will have good to excellent responses
  • Poor prognostic indicators include long standing patches, acral vitiligo, absence of dark hairs, segmental vitiligo
  • Treatments take 2-8 minutes to perform
  • Phototherapy sessions are bulk billed with no expense for the patient

How successful is Vitiligo Phototherapy for treating?

The success rate of up to 90% can be achieved with phototherapy & medically prescribed creams. The prognosis for re-pigmentation in vitiligo follows a complex algorithm.

Good to excellent outcomes can be achieved in facial vitiligo & depigmentation of recent onset. The presence of pigmented hair follicles is a good prognostic sign. Within facial areas, better outcomes are achieved on areas away from the lips.

Moderate outcomes can be expected with vitiligo involving the trunk & proximal limbs. Poor prognosis (10 to 20% chance of re-pigmentation) for vitiligo on the hands & feet. 

What other treatments are combined with phototherapy?

Phototherapy is always combined with creams as this combination has the highest success rate for pigment formation. Creams such as corticosteroids, tacrolimus, & pimecrolimus can suppress the attack from immune cells. Topicals such as vitamin D & tacrolimus can aid pigment cell migration. 

Topical antioxidants including pseudocatalase, vitamin E, green tea & ginkgo biloba can reduce oxidative stress to cells. These can be combined with phototherapy.

How does phototherapy re-pigment vitiligo?

Narrowband phototherapy is one of the most understood treatments for vitiligo. It works by-

  1. Suppression of immune cells (T Cells) in the upper layers of skin.
  2. Stimulation of cells called melanocytes to produce melanin
  3. Migration of melanocytes from the hair follicle & adjacent skin.
  4. Activation of neural stem cells in the follicles to form melanocytes

The first signs that phototherapy is working occurs around the hair follicle, a phenomenon called perifollicular repigmentation

How much do treatments cost?

Phototherapy in Australia is covered under Medicare. There is no charge for patients who have a Medicare card. If you do not hold Medicare, sessions are $120 per week. Factor in 20 weeks of therapy.

Some private health insurance companies cover this treatment. 

Davin’s Viewpoint on Phototherapy

Narrowband phototherapy forms the mainstay of treating vitiligo. In Australia this treatment is bulk billed (most dermatologists). This is a tremendous saving for patients. I think we are one of the only countries in the World that does this.

Though phototherapy is the Gold Standard for treating vitiligo, not all patients will respond. A good prognosis can be expected for early vitiligo patches on the face & neck. This especially applies to areas with some pigmentation within the hair follicles as melanocytes are sourced from this area. Exceptions on the face include perioral/lips & pre-post ear areas as these areas are more resistant to therapy. Poor responders are profiled with vitiligo involving acral areas – namely hands and feet.

Phototherapy sessions are ideally spaced on alternate days, namely three times a week. I frequently prescribe two sessions per week (not on alternate days) as patients are sometimes too busy to attend during the weekdays. As per international guidelines, I perform 20 sessions, then review. Ideally patients should be on anti-inflammatory topicals as well as melanocyte stimulating creams, as well as phototherapy.

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