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.  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.

Vitiligo is often diagnosed on clinical grounds, however 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 the condition may spread over time.  In some cases the white patches can spontaneously repigment, particularly in children, although it is rare for the disease to resolve completely without treatment.

For more information on vitiligo click here.

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.

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. For more information on this product and to find stockist click here.

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 edge of the lesion. 



Topical treatment includes topical corticosteroid creams, 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 the disease before trying other treatments or if vitiligo involves smaller areas.

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. The usual procedure is to stop after 4 – 8 weeks and then resume treatment after a period of rest. Your dermatologist may combine Vitamin D creams with new calcineurin inhibitors if steroids are not effective.

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Over the past 5 years the use of narrowband UVB phototherapy has gained popularity as the treatment of choice for more extensive 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.

More on what is involved in Narrowband Phototherapy.

On average at least 40 -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 7.

In general 40-60% 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.

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Laser technology has enabled dermatologist to treat skin in a way never thought possible. Westside Dermatology is currently undergoing trials of Fractional laser treatments for vitiligo patients.

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Fractional re-pigmentation is a new method pioneered by dermatologist at a Harvard University Laser Forum. Westside Dermatologist Dr Davin Lim and Dr Shobhan Manoharan are currently heading trials in Brisbane to add further research into vitiligo treatments.  Overall success rates of over 50% can be seen after 3-5 treatments.

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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 repigmentation. Treatments are spaced 2-4 weeks apart. The heal time after each treatment is approximately 2- 5 days.

More on Fractional laser treatments

To date, approximately 50% of patients respond to Fractional Re-pigmentation.

Good factors for repigmentation include- vitiligo on the face, neck, chest. Vitiligo that has responded to narrowband phototherapy. Vitiligo that is new. (less than 3 years old.)

Poorer success (20% chance of repigmentation) is seen on areas of the hands and feet, long standing vitiligo, and in areas where the hairs are void of pigmentation.

Fractional Re-pigmentation is a new treatment, currently undergoing World Wide trials. Medicare does NOT cover this form of treatment for vitiligo, and the treatment is subsidized by Westside Dermatology.

As a guide, Fractional laser re-pigmentation cost $280-$ 410 per treatment, depending on the areas treated.

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.  

Other Laser used to treat vitiligo

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308 nm eximer lasers have gained experimental interest in the treatment of vitiligo. We do not use this treatment at Westside Dermatology due to the fact that side effects are commonly seen (burning of skin). Narrowband phototherapy is more cost effective, more effective for the patient, with a much safer safety profile than laser treatment in the management of vitiligo.

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.

Vitiligo treatments do take time and effort, and patients must be well motivated. Repigmentation is NOT usually seen for 2-3 months after the start of treatments.

If narrowband phototherapy is to be considered patients must be motivated to undergo treatments at least twice a week (preferably 3 times a week). In general, motivated patients will have at least 50% chance of repigmentaion.

For more in depth information on Vitiligo treatments click here

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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

As dermatologist are Specialist, a referral from a GP will enable you to claim a percentage of the consultation and in many cases 100% rebate for phototherapy sessions. Dr Davin S. Lim and Dr Shobhan Manoharan manage the Vitiligo Clinic at Westside Dermatology. Call us directly on (07) 3871 3437 to make an appointment or to discuss issues regarding the referral process.

Enquire about vitiligo treatment

Dr Davin S. Lim

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 40-60%. Fractional Re-pigmentation seems to be promising, however further trials are needed to see the true efficacy of this new treatment.

• 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