Vitiligo & white hairs

  • Best Results1- 6 months
  • Treatment Recovery6-9 days
  • Procedure Time60-180 minutes
  • Skin SpecialistDr Davin Lim
  • Duration of ResultsLong-term
  • AnaestheticLocal
  • Back to Work6 days
  • Cost$-$$$

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-

  • Topical creams + narrowband phototherapy
  • Adjunctive vitamins
  • Vitiligo diet
  • Surgical techniques incl. FUE, micrografting

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.

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-

  1. 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.
  2. 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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