vitiligo - Patients ask Dr. Ringpfeil answers
Please feel free to use the blog below to share information about vitiligo or to ask Dr. Franziska Ringpfeil a question that might be of interest to others.
Philadelphia and Mainline Center of Dermatology and Cosmetic Surgery
610.525.5250
rad@ringpfeildermatology.com
Vitiligo
Vitiligo is a disease manifested by loss of pigment in the skin. It is an acquired disorder that often runs in families. It is characterized by depigmentation or total lack of melanin pigment. It can occur in small localized areas or be widespread. Fifty percent of individuals develop the disease before the age of 20 and 25% develop the disease before the age of 10. The cause is unknown but is believed to autoimmune in nature. It is more commonly seen in individuals with endocrine disorders such as thyroid disease.
DIAGNOSIS
The diagnosis can be made clinically in the presence of well demarcated areas of depigmentation found symmetrically over boney prominences such as the knees or around body orifices such as the mouth, eyes and perianal or periurethral area. When the diagnosis is unclear, a skin biopsy may need to be done.
MANAGEMENT
Patients with vitiligo must be advised to follow strict sun protection. The areas of skin affected by vitiligo cannot tan and will burn with sun exposure. Sunburns raise the risk of skin cancer. Also, when normal surrounding skin is tan the loss of pigment is more noticeable. Also, since vitiligo can be associated with endocrine disorders such as thyroid disease, blood tests to rule out an underlying disorder may need to be performed.
TREATMENT AND MEDICATION
Treatment options are influenced by the amount of skin involved and the location. Often a trial of treatment with a topical corticosteroid is the initial treatment choice. Topical immunomodulators such as Protopic Ointment or Elidel Cream have also been shown to be effective and are more appropriate for extended use on delicate areas. A series of narrowband ultraviolet light treatments (NB-UVB) have also been found to be very effective. The excimer laser delivers NB-UVB directly to specific skin areas without affecting normal surrounding skin. Ringpfeil Advanced Dermatology has an excimer laser and is proud to be able to offer excimer laser treatment to our patients. Excimer has come to be preferred over older light treatment modalities such as PUVA (psoralens plus ultraviolet A). The advantage of excimer over PUVA is shorter treatment times, decreased risk of phototoxic reactions, and the ability to use excimer in children, pregnant women and in individuals with kidney or liver disease since no oral medication is utilized. In cases where depigmentation due to vitiligo is very extensive, permanently removing all remaining pigment can be offered for cosmetic reasons.
COPING
For individuals who are self-conscious about vitiligo involving visible areas such as the face and hands, cosmetic products under the brand names of Covermark or Dermablend are available for camouflage. The National Vitiligo Foundation is an organization that can be a resource for educational materials and support groups.
Uncensored Patient Reviews
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Last updated: 11/25/2014 10:53 AM,
Last updated: 11/25/2014 10:53 AM,
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(answers:674)
#1
I was very impressed by the patience and information the staff provided--I did not feel rushed at all and was able to ask many questions. 2014-03-31
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The speed and throughness of the visit. 2015-01-15
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Doctor was very friendly & knowledgable. I especially appreciated that she seemed unrushed and focused on me. I am hopeful that the procedure she recommended will improve my condition (facial scar). 2014-03-22
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The office atmosphere: paintings, light fixtures. 2014-11-28
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any information on services provided for enhancing skin apperance 2014-10-25
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everything was wonderful2010-08-25 12:47:35
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Service was fantastic. No suggestions. 2011-11-29 13:58:45
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this is my first time so will let you know as time progresses2010-11-02 11:02:24
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keep doing what you did.2011-03-11 14:14:27
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Better parking? 2015-01-13
I had vitiligo for 8 years now and I had tried different treatments (PUVA, topical steroid, meladinine cream/solution with exposure to sunlight/PUVA, oral meladinine, oil of bergamot). The vitiligo covered my neck, and one-fourth of my face. I looked for another dermatologist because i lost hope with my past dermatologists. Then somebody recommended me a good natural treatment and it worked very well. Now i’m 90% cured. With only 1 1/2 month of treatment. I found it at natural vitiligo treatment dot com.
Thank you for sharing your success.
Can the Excimer laser be used to treat hypopigmentation caused by glycolic peels?
Hypopigmentation is rarely a side effect of a glycolic acid peel. If it were to happen it should be so short lived that it does not require treatment. If a scab formed during a glycolic acid peel and the scab was accidentally picked off, a scar could form in this spot. Hypopigmented scars can be difficult to treat but the CO2 laser has a chance to correct them. Excimer lasers remove inflammation and by removing the inflammation that causes vitiligo, they allow proper pigment production by our pigment forming cells. Their effect in hypopigmentation without inflammation is not easily predictable.
I’m currently treating with NB-UVB and am trying to determine whether to combine the NB-UVB with Protopic, since I’ve heard you can receive faster repigmentation that way. I asked my dermatologist about this and she unfortunately doesn’t know. (I think I’m her only vitiligo patient.) Do you have any advice? Thanks for your time, I really appreciate it.
Combination makes a lot of sense and in many people gets to results faster. It can be applied before or after NB-UVB treatments.
Hello I have been worried because some spots of vitiligo appeared on my mouth and some others on my hands, ears. I just want to get the best treatment and sees results. I am feeling a lot of shame even to shows my face, or when I walk in the streets, I feels like the funny monkey that everybody laugh. I will be waiting for your recommendation.
And thanks you for this web page..
Many people with vitiligo feel the way you do. A number of treatments are available and sometimes it helps to start treatments sooner than later. Our office offers the gold standard, narrowband UVB treatments in form of excimer laser, as well as prescription treatment and so do a number of dermatology offices. Please make an appointment with a dermatologist if you have not yet done so.
Hi I’m Michael,
Just want to ask what is the best treatment in my vitiligo? It is in my face (Left Part of my Cheeks), and also big part left side of my ears and neck. It’s not that big, but it’s spreading around my face. What should I do? Some of the spots are not that really white (only on my neck) and the spreading is not that fast. I have vitiligo for 4 years and its great that it is not spreading really fast. Also, I’m using Copper Magnetic Bracelet for 4 months and been using Gingko Biligo for 2 weeks and I didn’t really see any changes. So, I’m here to get help and keep my high hopes to get rid of my vitiligo. Hoping for your positive response. Thank you.
)
Regards,
)
Mike
Localized narrowband UVB treatments via excimer laser and tacrolimus topical ointment are worth considering in your case. Please make an appointment with your dermatologist to discuss these prescription treatments.
Do copper bracelets work to repigment vitiligo spots and/or ginko biloba?
I am unable to verify the efficacy for neither copper bracelets nor ginko biloba in the treatment of vitiligo.
Hi, my baby is 2 years old and has vitiligo in his chest and few spot in his back just in his left side I am using fluocinonide cream . I was reading about vitiligo and I want to know if I should give him a special diet to help to repigment his skin like gluten free food, more vitamin b12 or food is not the reason of his skin problem. Thank you
Vitiligo is an autoimmune or autotoxic condition. The triggers for vitiligo may be variable and improvement may be noted in some who follow dietary restrictions. This does not necessarily mean that dietary factors have triggered the lightening of the skin. A gluten free diet can safely been given to a 2 year old, however, increasing vitamin B12 without knowledge of depletion is not advisable at this age.
I have vitiligo for last 5 yrs. I just have three spots on my face. I was able to control vitiligo using nbuvb hand held at home & Protopic. I got 10% pigmentation back using NBUVB. But progress suddently stopped. For that reason, I started using xtrac treatments for last 4 months and have done 30+ treatments so far. I have not gotten any pigmentation from it yet. I was wondering how long should I continue this treatment?
Generally, it can take many treatments to see repigmentation in vitiligo with NBUVB. In our practice, we like to see something by treatment number 20, however it can take longer. Granted you are having treatments 2-3 times per week and you have at least mild pinkishnes in the treated areas, I may give up by 40 treatments that show no increase in pigment.
Ia m 35 years old. I have RA and Vitiligo and the latter is causing me much more suffering (be it emotional) than the former crippling disease.
I have been prescribed elidel and protopic. Originally i was prescribed protopic only but the greasiness and shininess of my face following application makes it impossible for me to apply it in the morning and go to work with such a glossy face. I did my research and found elidel. The fact that it’s a cream is much better for me.
I do have a couple of questions:
1- I have read that Elidel is like Protopic’s weaker cousin and not likely to lead to repigmentation. Is this true? Should I just suck it up and apply protopic in the morning?
2- How many times a day can protopic be applied. I read somewhere that protopic can be applied many times during the day.
3 – I have also read that protopic works best when also used with a topical corticosteroid creram. Is this true?
Thanks
Elidel is a slightly weaker cousin of Elidel and may take longer to induce pigmentation. In some, Elidel will not cause repigmentation and is therefore not the first choice for facial vitiligo treatment. However, results can vary from person to person. There is no strong data that suggests that combining Protopic with a topical corticosteroid is more effective in treating vitiligo. Perhaps, you could consider application of Elidel in the morning and application of Protopic at night. Both calcineurin inhibitors Protopic and Elidel are FDA approved for twice daily use. You should discuss any increase in the treatment frequency with your dermatologist. I am restricted from addressing this in a blog.
I was diagnosed with vitiligo at 12-years-old. My de-pigmentation has been fairly stable until recently. I am now 24 and I have several lesions on my face (around my eyes, on my cheeks). Previously I was given topical steroids as the first line of defense and had some success, although it took a couple years. I am anxious to get re-pigmentation on my face quickly. Will the topical steroids still be the first line of defense?
Furthermore, I have recently read a couple studies regarding the use of ginkgo biloba, folic acid, and vitamin B12 in preventing the spread of vitiligo and, in some cases, aiding in re-pigmentation. Is there any validity to that?
The first line of defense for treatment of vitiligo around the eyes and on the face is now Protopic ointment. Dietary modifications help some people to repigment. These also include a gluten free diet. However, at this time, there is no scientific evidence that supports the relationship between these dietary modifications and alteration of vitiligo spread. The results are merely based on case reports.