Vitiligo At A Glance
- Best Results2-8 Months
- Treatment RecoveryNA
- Procedure Time1-3 min
- Skin SpecialistDavin Lim
- Duration of ResultsMonths to years
- AnaestheticNil Required
- Back to WorkImmediately
Vitiligo is a common condition affecting 2% of people. This condition causes a loss of melanin, the pigment that determines the colour of your skin. Vitiligo is more common in skin of colour & usually affects the skin around the eyes, mouth, elbows, knees, armpits & genital areas. The 20 week vitiligo challenge program uses anti-inflammatory creams & narrowband phototherapy to halt the immune attack on pigment cells and stimulates pigment cells to reproduce- this results in re-pigmenation of white patches.
FactsFacts on vitiligo
- Vitiligo presents as white patches on the skin
- The most frequently affected areas are around the eyes, mouth & face
- Vitiligo affects all ethnic races, but predominantly affects people with darker skin types
- Treatment of vitiligo is with phototherapy, & anti-inflammatory creams
- Our success rate is up to 90% re-colouring
- Vitiligo on the face responds best to treatment
- Vitiligo on the hands & feet respond poorly to treatment
- All phototherapy sessions are bulk billed, so this treatment has no out of pocket expense
What is vitiligo?
Vitiligo is an immune condition where your body attacks the pigment producing cells in your skin. These pigment cells are called melanocytes. Once under attack, these melanocytes hide in your hair follicles.
Vitiligo can be associated with other immune conditions such as vitamin deficiencies, diabetes & thyroid disease.
Vitiligo occurs when the pigment producing cells called melanocytes disappear.
What treatments are available for vitiligo?
The internet is full of promised ‘vitligo cures’, ranging from tablets, thru to creams and hand held light devices. From a Specialist point of view, where vitligo is scientifically managed & skin repigmentation measured, there are only a few proven combinations that actually work-
Anti-inflammatory creams: These include Vitamin D creams, Calcineurin inhibitors and anti-inflammatory corticosteroid creams. They all work by stopping the attack of your immune cells on pigment producing cells called melanocytes. A combination of creams works best.
Narrowband phototherapy: This is medically prescribed phototherapy using light at 311 nm. Phototherapy has to be conducted at least twice a week to stimulate melanin in vitiligo patches. (Ideally 3-4 times per week gives optimal results). This treatment if fully covered under Medicare.
Vitamin D supplementation: A recent article published in 2014 suggests the use of Vitamin D tablets for supplementation in patients with vitiligo.
Prostagladin Inhibitors: Emerging research has shown that this group of anti-inflammatory creams can help re-pigment patches of vitligo. Creams should be combined with narrowband phototherapy.
Ginkgo biloba extract: One non- controlled study in India conducted in the early 2000s showed ginkgo supplements can help with skin repigmentation.
How do dermatologists treat vitiligo & what is the success rate?
Vitiligo is treated with a combination of creams, & narrowband phototherapy– this gives the highest success rate of re-colouring your skin.
Creams are used on a nightly basis, and phototherapy should be performed 2-4 times per week.
The success rate of re-colouring patches of vitiligo is mostly dependent on the areas involved, as a guide-
- Facial vitiligo – 90% chance of re-pigmentation
- Vitiligo on chest and body- 50-75% chance of re-pigmentation
- Acral vitiligo (hands and feet)- 10-20% chance of re-pigmentation
Another important clue as to whether your vitiligo will respond to phototherapy and creams is the presence of hair follicles that are pigmented. The more pigment in your hair follicles, the higher the success rate.
This represents my average success rate for treating vitiligo.
Why is it essential to have BOTH phototherapy & anti-inflammatory creams when treating vitiligo?
Both treatments are essential for optimal success because the aim of the program is to stop your immune cells from attacking your pigment cells, and to stimulate any remaining pigment cells to re-colour the white patches of vitligo.
Anti-inflammatory creams such as Tacrolimus, Vitamin D & pulsed corticosteroids halt the immune attack.
Narrowband phototherapy stimulates the pigment cells hiding in your hair follicle to re-populate vitiligo affected skin, leading to re-pigmentation. If you have creams without phototherapy, the success rate of treating vitligo is low.
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How much does vitiligo treatment cost?
The initial vitiligo consultation cost $ 248 and is partially covered by Medicare, providing you have a valid referral from your GP.
All phototherapy sessions are bulk billed with no out of pocket expenses. Cream cost approximately 50 cents per day, and can be purchased via myskinpharmacy.com.au (compounded creams).
Where can I get narrowband phototherapy for vitiligo?
Phototherapy is offered at Cutis Medical in Taringa, Brisbane.
Make sure you have a valid referral and ask for a VITILIGO SLOT under Dr Davin
How many sessions of narrowband phototherapy will I need?
As part of the 20 weeks Vitiligo skin repigmentation challenge, you will need at least 50 sessions of phototherapy to see if your vitiligo will respond to this treatment method.
Is narrowband UVB treatment safe & how many lifetime sessions can I have?
Yes, medically prescribed narrowband phototherapy is very safe with no risk of skin cancer. The current European studies on phototherapy has shown that up to 500 lifetime treatments are safe. This means if your vitiligo returns, repeat sessions are possible.
How does medically prescribed phototherapy differ from sunlight?
Sunlight contains a spectrum of wavelengths delivered over a long period of exposure. Some wavelengths promote skin cancer whilst others accelerate skin ageing. Narrowband phototherapy, delivered medically takes only a few seconds to minutes to perform and uses only one wavelength 311nm of UVB. This wavelength can halt the immune system from attacking pigment cells, but most importantly promotes re-pigmentation in vitiligo affected patches.
Are there any side effects to narrowband UVB therapy for vitiligo?
Side effects are very rare following narrowband treatment. The most common side effect is skin darkening, as the rest of your skin is treated, along with patches of vitiligo.
You can reduce skin darkening by applying sunscreen to areas not affected by vitiligo.
Can lasers treat vitiligo?
Yes however the success rate is low. I have performed clinical trial over the years using several types of lasers to repigment skin affected by vitiligo. These include Fractional laser resurfacing as well as Eximer 308 laser.
For fractional laser resurfacing, only 2-5% of patients respond to this treatment, and this has to be used in conjunction with phototherapy. Pigmentation, if it returns is never complete, and always patchy.
308 Eximer laser is a much more effective treatment, and works on the same principle as phototherapy- namely to stimulate pigment cells to produce melanin. The advantage with Eximer laser over phototherapy is that individual spots can be treated within seconds, saving time and exposure of skin unaffected with vitiligo. The down side of Excimer laser is the cost- each treatment cost over $200 with no Medicare rebate. Most patients require 20-30 session, not a sensible option.
Are any tests required to diagnose vitiligo?
No. In 95% of cases this condition can be easily diagnosed.
As previously discussed, I always work in with your GP to obtain annual blood test to look for conditions such as diabetes & thyroid disease that can be associated with Vitiligo.
What diet and natural remedies can I follow to help re-colour my skin?
Diet, vitamins and supplements can play a role in re-colouring white patches of vitiligo. There are now several scientific papers on the use of vitamins & natural remedies that can help. Vitamin D, folic acid, low acidic foods & ginko can all help
How do I book in to see a Vitiligo specialist?
A referral from your GP is needed to see a Specialist as this will enable you to claim back a percentage of the initial consultation and all of the phototherapy sessions. Call Clinic Cutis to book an appointment with myself.
Is Vitiligo treatment covered under Medicare?
Yes! In fact if you hold a Medicare card, all phototherapy sessions are bulk billed, so no out of pocket expenses are incurred.
Anti-inflammatory creams are not expensive, and cost less than 50 cents a day!
Does overseas Health Insurance cover vitiligo treatments?
In most cases they do, however you individual circumstances may vary. Ask your Health Insurance if they cover NARROWBAND PHOTOTHERAPY by a Dermatologist before making an appointment.
Davin’s viewpoint on vitiligo
Vitligo is a very common condition, and I have at least 150 patients under my care every year. The chances of re-pigmenting white patches depends on 3 important factors, the area of vitiligo– patches on the face, chest and upper back respond best, whilst vitiligo on the hands and feet/ fingers and toes have a poor response rate. Secondly, the presence of pigment within the hair follicles of vitiligo patches- repigmentation occurs from both the surrounding skin and within the hair follicle. Lastly – the commitment from the patient to undertake both phototherapy and use creams on a nightly basis. This combination treatment is the basis of the 20 week- vitiligo challenge program.
Re-colouring can be seen in over 90% of cases, especially for facial vitiligo.
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