Vitiligo treatments

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Vitiligo is an auto immune mediated condition that affects the pigment producing cells of the skin known as melanocytes. In vitiligo these cells are destroyed by the body’s immune system, and hence no pigment is produced in the areas affected.

Vitiligo presents are progressive white patches on the skin. The common sites affected are the face, in particular around the eyes/ eyelids and the mouth. Acral sites (such as the fingers/ hands and feet) are commonly involved. If vitiligo occurs in the scalp a condition known as poliosis (white hairs) may occur.

• More on Vitiligo before and after pictures

In the majority of cases the diagnosis of vitiligo is straight forward, and no tests are required. If the pattern is unusual, your dermatologist may elect to undertake a tiny biopsy to confirm the findings. As this disorder is related to other autoimmune conditions, we may elect to order blood tests if they have not been performed prior to referral. 

The course of vitiligo is highly variable. The condition may remain static or stable, or the condition may spread over time.  In some cases white patches can spontaneously recolour, particularly in children, although it is rare for the disease to resolve completely without treatment.

Our Vitiligo Skin Re-colouring Program has a success rate of 80% for the treatment of vitiligo.

This 20-week program is designed to kick start skin pigmentation in white patches of vitiligo. There are two essential components to this program-

1. Anti-inflammatory prescription creams. Our Dermatologists will tailor a combination of anti-inflammatory creams, as well as Vitamin D creams to apply on your white patches. In most cases we will cycle application of various creams to area of vitiligo. Most creams cost between $20- $60 and can be purchased in major pharmacies.
2. Phototherapy sessions. 2-3 sessions are needed per week. Sessions are covered under Medicare. Phototherapy uses a metered and precise dose of ultraviolet B light to help wake up the dormant pigment cells in your skin.

The majority of vitiligo patients will get an improvement on this skin re-colouring program.

• More on Westside’s Vitiligo Clinic skin re-colouring program

A specialist dermatologist is the best person to assess and manage vitiligo. It is important to establish a diagnosis, search for any associated autoimmune conditions and discuss prognosis and treatments, including the success rate of various treatments in relation to the patient’s pattern of vitiligo.

The use of phototherapy combined with creams will give the highest success rate for the treatment of vitiligo.

As an guide the following options are available-

No treatment

This is an option if the patient has very fair skin. Strict sun protection is important, with SPF30+ sunscreens, protective clothing and sun avoidance.


Camouflage

This is achieved with make-up and topical dyes including self tanning lotions. We recommend Dermablend as the make up of choice for vitiligo patients

Active Re-pigmentation

In order to re-pigment the skin, new pigment cells must be produced from existing ones.  These pigment cells come from the base of hair follicles, or from the edges of the white patches.  



Creams treatment for vitiligo includes topical corticosteroids, Vitamin D creams and Calcinurin inhibitiors. Although not completely understood, steroids may be helpful in repigmenting the skin particularly if started early in the condition and where only a few patches or spots need to be treated. They are often used to halt the spread of vitiligo.

Patients must apply the cream or ointment to the white patches on their skin for at least 3 months before seeing any results. It is the simplest and safest treatment but not as effective as some others. This treatment must be carefully monitored by a specialist dermatologist as steroids can thin and damage the skin if not carefully watched. The doctor will closely monitor the patient for side effects such as skin thinning and skin striae (stretch marks). Because of side effects steroid creams and ointments should not be used for extended periods of time. Your dermatologist may combine Vitamin D creams with new calcineurin inhibitors as part of your skin re-colouring program.

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Over the past 5 years the use of narrowband UVB phototherapy has gained popularity as the treatment of choice for vitiligo. Narrowband phototherapy or nUVB uses a specific UVB wavelength which stimulates the cells in the skin to produce pigment. Initial exposure times to the light are short however the exposure time increases as the treatment progresses. The amount of UV exposure is delivered by a precise phototherapy unit. Treatment takes on average 30 to 50 seconds to perform.

Photothearpy forms an essential part of our Vitiligo Re-pigmentation program. All phototherapy sessions are bulk billed, and covered thru Medicare.

• More on Narrowband Phototherapy for Vitiligo

On average at least 30 -50 treatments are needed before improvement is seen. Two to three treatments are recommended every week. The areas of vitiligo are photographed prior to treatment and the patient’s progress is frequently monitored throughout the treatment process. Phototherapy can NOT be used in patient’s with a personal or family history of melanoma, and is NOT recommended for children under the age of 8.

• More on vitiligo before and after pictures

In general 60-80% of patients respond well to phototherapy. Patches on the trunk, upper limbs and face respond best, whilst areas on the hands and feet are more resistant to treatment. Long standing vitiligo may also be more resistant to treatment.

If you can see coloured hairs within your white skin patches of vitiligo, chances are you will get your skin colour back!

• More on Westside’s Vitiligo Re-pigmentation Program

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Specialists have used lasers to treat vitiligo for the past decade, however results are not as predictable as phototherapy. There are two types of lasers primarily used to re-colour white patches of skin seen in vitiligo- Fractional lasers and 308nm Eximer Lasers.

Fractional laser treatment of vitiligo is a re-pigmentation program pioneered by dermatologists in Harvard University. Westside Dermatologists Dr Davin Lim and Dr Shobhan Manoharan have conducted several trials on the use of fractional laser resurfacing over the past 4 years, and the following conclusions can be reached-

• Fractional lasers abate or destroy a fraction of the skin, each laser beam vaporizes a section of skin the width of a hair shaft, penetrating only one fifth of a millimeter deep. Fractionation is only conducted in the areas of vitiligo. It is thought that destruction of abnormal cells (vitiligo prone cell are not prone to normal stimuli that results in pigment formation), allows normal cells to regenerate from the base of the hair follicle, or from adjacent areas.  Essentially abnormal vitiligo prone cells are destroyed, only to be replaced by normal cells surrounding vitiligo areas, or from the hair follicle within vitiligo areas.
• Often 3-5 treatments are needed for repigmentatoin. Treatments are spaced 2-4 weeks apart. The heal time after each treatment is approximately 2- 5 days.
• Fractional laser treatments can work in 10%-20% of vitiligo cases. Phototherapy using Westside’s Vitiligo Skin Re-colouring Program is more effective, safer, and more cost effective. We never recommend laser treatment before vitiligo phototherapy.
• Fractional lasers for vitiligo is a last resort treatment. Test patches will need to be conducted prior to resurfacing. (Cost of test patch- $250, not covered under Medicare)
• Fractional lasers cost for treating vitiligo ranges between $650-$990 per treatment, and is not covered under Medicare. Phototherapy sessions are Bulk Billed and covered by Medicare.

308 nm eximer lasers have gained experimental interest in the treatment of vitiligo. Westside Dermatology’s Vitiligo Clinic will be trialing the 308 Eximer laser in late 2013. To date, this laser has a similar efficacy as narrowband phototherapy.

De-pigmentation
Treatment

In patients with extensive vitiligo involving more than 80% of the body, monobenzyl ether of hydroquinone maybe considered to depigment normal skin. This process may take six months to two years to achieve.  Strict sun protection is required after de-pigmentation.  This process is NOT carried out at Westside Dermatology, however specialist supervision can be carried out in public hospitals. 

Natural remedies, nutrition and vitiligo

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Scientific publications regarding diet and natural remedies in the treatment of vitiligo are limited. A paper published in 2003 showed promising results in slowly progressive vitiligo treated with ginkgo biloba.  For an abstract of this paper click here.

For more information on diet and vitiligo click here.

The initial step of treatment is a firm diagnosis of this condition. The next step is to exclude any associated auto-immune conditions that maybe associated with this condition, including a thyroid test, diabetes test and to check levels of Vitamin B12.  Most General Practitioners can perform these simple, but reassuring tests.

Our vitiligo specialists have a success rate of 60-80% using our Vitiligo Re-pigmentation program, however patients must be motivated to undertake this 20 –week program. If narrowband phototherapy is considered patients must be committed to undergo treatments at least twice at our clinic. This 20 week program is subsidised under Medicare.

• More on Westside’s Skin Re-colouring Program 

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A Medicare rebate applies to a percentage of the consultation cost- consult your GP for a referral to a Dermatologist.

Narrow Band Phototherapy is fully covered by Medicare with no additional costs to the patient.

Fractional re-pigmentation is NOT covered under Medicare

Call us directly on 07 38713437 to make an appointment for Vitiligo treatments.  Consultation slots are readily available during the week, and on Saturday mornings. Phototherapy can be commenced on the day of the consultation.

A referral from a GP will enable you to claim a percentage of the consultation. Dr Davin S. Lim and Dr Shobhan Manoharan manage the Vitiligo Clinic at Westside Dermatology.

• More on vitiligo before and after pictures

Dr Davin S. Lim
Laser Dermatologist
Westside Vitiligo Clinic

Vitiligo can be highly variable in extent and variable in response to treatments. In the past decade several new treatment have emerged for the treatment of this once untreatable condition.  With a combination of narrowband phototherapy, and topical treatments, success rates are in the order of 60%- 80% can be seen.

Our vitiligo skin re-pigmentation program is designed as a 20-week trial of two of the most powerful methods to fight vitiligo and kick start the re-colouring process. I usually start patients on a combination of anti-inflammatory creams and Vitamin D, as well as narrowband phototherapy. The majority of patients will notice repigmentation within a few weeks of therapy. Areas such as the face and neck seem to respond much better compared to extremities.

Contrary to popular belief, vitiligo can often respond nicely to a tailored treatment program.

• Vitiligo support group
• National vitiligo foundation

"Vitiligo treatments that finally work. I didn’t think treatment was possible until I saw my dermatologist" G Kumar,  Sumner Park

"A combination of creams and light treatment and I nearly have my colour back. Extremely happy with the vitiligo management team at Westside." H Sidu, Westlake