- Best Results1- 6 months
- Treatment Recovery6-9 days
- Procedure Time60-180 minutes
- Skin SpecialistDr Davin Lim
- Duration of ResultsLong-term
- Back to Work6 days
Vitiligo & white hairs
White hair or poliosis happens when the hair bulb is devoid of pigment producing cells known as melanocytes. This pattern of vitiligo can occur on the scalp, eyebrows, eyelashes, under the arms & in the pubic region. Some cases respond to creams & phototherapy. Resistant cases can be treated with hair transplantation.
FactsFacts on vitiligo & white hairs
- This is a common occurrence in conditions like vitiligo & alopecia aerata
- Pigment is loss due to destruction of pigment producing cells
- Some cases respond to medical phototherapy & anti-inflammatory creams
- Pigment stimulators including tacrolimus & bimatoprost can help
- Repurposing pigmented hairs via follicular transplantation can be effective
- Surgical treatments are only considered if vitiligo is stable
Why does white hair occur in vitiligo?
If your immune system targets the pigment cells residing in the hair follicle, the hair will be white, much like skin. Not all patients with vitiligo will have white hair. Conversely, not all cases of white hair patches will have vitiligo as there are other conditions that can cause this, including alopecia areata & halo naevi.
What does this mean in terms of vitiligo prognosis?
The bad news is that white hairs in patches of vitiligo, known as poliosis, heralds a poorer prognosis than pigmented cells. The main reason for this is that the source of pigment in the skin comes from migration of melanocytes from the follicle itself. I will discuss what this means for you during the examination.
What treatments are possible?
The treatment algorithm remains the same for white hairs & patches of vitiligo, albeit an adjusted prognosis. Treatments are as follows-
How can creams help?
Creams & lotions are the first step of management. I use a combination of anti-inflammatory topicals as well as pigment stimulators known as prostaglandin analogues & calcineurin inhibitors. Vitamin D analogues can be useful; however, I prefer vitamin D supplementation for patients who have vitiligo.
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Will vitiligo return if you stop using creams?
In some cases, yes, in others no. My usual practice to achieve full repigmentation prior to stopping creams & phototherapy. This is achievable for most cases of vitiligo without hair follicle involvement but is exceptional for white hair & vitiligo.
How does micrografting & epidermal grafts work?
Grafting, as the name suggests involves transferring pigment cells to the areas devoid of pigment. In cases of poliosis or white hairs, the pigment cells need to migrate from the skin into the stem cells / melanocyte bulb within the hair follicle. Re-pigmentation of skin starts to appear within 2-4 months, however it may take 6-12 months for the hair to re-pigment. Phototherapy speeds up the process.
How successful is surgery?
Surgery is successful in 80-90% of vitiligo patches, meaning skin is easier to repigment from the top down using micrografts. In the context of white hairs, repigmentation requires a time frame of 6-12 months. For faster & more reliable results, follicular unit transplantation of pigmented hairs can be considered as adjunctive treatment.
How long will it take to repigment hair involved in vitiligo?
Repigmentation is dependent on how fast your immune system reacts to transplantation of pigment cells. As a guide, micrografting of skin gives pigmentation within a few months, however for white hairs it can take 6 to 12 months before melanocytes migrate into the hair follicles.
With transplantation of hair follicles or FUE, pigmentation is seen within 2-3 months of the procedure & increases with time.
What are things that you can do to help repigmentation?
See the section on diet & supplements. These can be useful in the minority of cases. Eating healthy & reducing stress levels can help. In many cases I will prescribe adjunctive topicals & phototherapy. These treatments accelerate pigmentation production.
What is the role of narrowband phototherapy in vitiligo?
This is a natural way of encouraging pigment cells to both migrate & repopulate white patches of vitiligo as well as produce more melanin. Narrowband uses focused filtered light to get this done. Treatments are conducted at Cutis Medical. Treatment takes between 30 seconds to 3 minutes. An ideal regime is 2 to 4 times a week. Treatments are bulk billed as phototherapy is a recognised service through Medicare.
Vitiligo in hair bearing areas can also be treated with a UVB comb. Scalp margin involvement usually receives enough UV during clinical treatments.
What is the role of hair transplantation?
Hair transplantation can be effective in the management of white hairs or poliosis. It involves transplantation of pigmented hair from a donor area, usually the back of the scalp, to the affected area. Each hair follicle is meticulously transplanted by hand.
This procedure is reserved for patients who do not respond to creams & topicals. A test area is conducted to see if further transplantation is useful. It is only useful for stable vitiligo. This is defined as non-progressive depigmentation lasting over 12 months.
What is phototherapy & how does it work?
Narrowband phototherapy is a medical treatment designed to wake up pigment cells using filtered light. It is considered one of the best ways to treat vitiligo. A device delivers calculated incremental doses of UVB at 311 nm. This wavelength suppresses inflammation & stimulates the melanocyte to migrate as well as produce pigment known as melanin.
Do vitamins help?
Vitamins are useful as adjunctive therapy. They are cost effective with no side effects. A simple supplementation program includes vitamin D, B12, B complex, folate & iron. I normally start patients on ginkgo biloba midway through their repigmentation program.
What foods should you eat & avoid if you have vitiligo?
Dietary supplements & restrictions are increasing in popularity for patients with vitiligo. A sensible diet is as follows-
Eat the following: foods rich in antioxidants including legumes, green leafy vegetables, & omega fish oil. Green tea has antioxidant properties.
Eat less of the following: acidic foods including oranges, limes, lemons, & tomatoes. Consume less gluten & processed foods.
*My job is to treat your skin with topicals, phototherapy & surgical techniques. For a detailed vitiligo dietary plan, you can Google this topic or see a dietician.
Who to see for vitiligo treatments?
I will be more than happy to review your cognition & provide feedback. Note, I will follow the treatment algorithm, meaning you must trial creams & phototherapy, understanding the pros & limitations of this treatment. I only consider surgical techniques if your vitiligo is stable & if you do not respond to conventional therapy.
I am a specialist dermatologist, a referral from your GP is required. Reception can guide you through this process.
How much are treatments?
Topical creams are less than a dollar a day. In Australia, Medicare pays for all phototherapy sessions, saving patients over $7500 a year. Surgical treatments such as microskin SSG grafting carry a rebate.FUE – follicular unit transplantation is not covered under Medicare.
Here is a thought, are there two populations of melanocytes in the skin?
The theory is that there are two subtypes of melanocytes that reside in the body (probably more as the eye has melanocytes as do mucous membranes). With this theory, melanocytes in normal skin are more susceptible to destruction from your immune system, hence with repigmentation, resistant pigment cells derived from pigmented hairs replace this population found on the skin.
Davin’s Viewpoint on treating vitiligo & white hairs
This is one of the hardest patterns of vitiligo to treat. The primary reason is that during the initial inflammatory phase of vitiligo, melanocytes in the hair bulb are largely protected. Hence for patients that exhibit white hairs on the background of depigmentation, it is safe to say that most, if not all of the melanocytes have been destroyed. To naturally repigment this area, melanocytes need to either migrate from the sides or form from stem cells located in the hair follicles known as the area of the bulge.
I do prescribe creams & narrowband phototherapy as the first initial step. If you have subclinical melanocytes still present, pigmentation will occur over 6-12 months. The chances of this are approximately 10%. Failing this, surgical treatment can be contemplated.
Surgical techniques follow this logic-
- Transplantation of pigmented hairs into the bed of stable vitiligo. This involves FUE or follicular unit extraction. I normally conduct a test patch to ascertain survival prior to full translation.
- Micrografting with melanocyte transfer. This can be successfully performed, with or without FUE. For hair pigmentation to occur, melanocytes must migrate from the surface to the follicular unit below.
Over the past few years there has been more research into FUE, autologous melanocyte transfer as well as cultured cell transfers.
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