vitiligo Blog
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.
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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.
I am a 40 year old male with vitiligo on my legs and genital area. I am being treated with narrowband uvb on my legs with limited success thusfar after about 15 treatments. I’ve just begun using elidel n my genital area but have not seen any results in the past few weeks. What else can I use to treat this sensitive s area? My Dr also gave me a cream called Vitises which is supposed to help with Melanin production. I’m wondering if this product is effective at all in treating vitiligo?
It appears that your current treatment is very appropriate. Both Elidel and narrow band UVB are state or the art. It will take many narrow band UVB treatments even when using the excimer laser to achieve re-pigmentation and I would like to appeal to your patience. I am aware of Vitises but have no personal experience with its efficacy.
Does Copper Magnetic Bracelet can also treat vitiligo
Vitiligo is an autoimmune or auto-toxic condition. Copper magnetic bracelets are thought to help fight auto-immune diseases. The mechanism is poorly understood and they do not work in everybody.
I am suffering from vitiligo from the ten years .When i was ten years old and this was only on my right leg and now after the ten years no progress is on my upper body part. What is the mean of this sign for no progress on the whole body
Vitiligo is unfortunately unpredictable. The fact that you have developed another vitiligo area on your upper body does not mean it will progress but it could.
This disease has not been spreading from ten years on the upper part of the body. Can we say that ,this disease will not spread on the whole body for the life time
It is unfortunately not predictable.
Hello my son is 5 and he has vitiligo it is pretty much all over his knees private area little spots on his arm but what’s really bothering me is tht it is now appearing on his face. I have the protopic cream and the UVB light but I’m unsure how often to apply the light and the cream. Is is safe to use this light on his face literally it is above his eye lids please help us. He always asks mommy is God going to give me my skin color back I responded yes just believe. Thank you for your time..
These very treatment specific questions must be answered by your son’s dermatologist. Unfortunately, I can not recommend treatment without seeing your son.
Dear Doctor,
Pls advise. Thank you!
When my 10 yo son (now 11) returned from sleepaway camp last year, I saw patches of white on both elbows and knees. Admittingly, his bunk was treated for bed bugs with Pyrethrins which, I was told by Mount Sinai Hosp, could be stressor that set off this problem. All autoimmune bloodwork was neg.The dx of vitiligo was quickly made and protopic .03% was rx twice a day. I am on my second $150 tube and I can honestly say, with the exception of one knee that has a tad left, it is gone! My worry is that when he returns to camp, will the spots that are so light become more pronounced that I will have to do this all over again OR should I send him with ointment and ask the nurse to apply it? Either way, he probably won’t put sunblock on him like I do. If I send him with no ointment, can I resume in Aug when he returns or will that make it worse. I guess I was lucky to this point b/c I heard the farther from the face, the harder to cure…but it looks like it has
It is difficult to provide recommendations without seeing your son. These specific questions pertaining to your son’s care are best answered by his dermatologist.
my daughter is 6 years old and she is suffering from vitiligo since a year .she has vitiligo around her mouth ,a patch in her nose and in her neck …is protopic safr to use for her n if i used it ,is it true that while using protopic she should not be exposed to the sun
Protopic is safe for use in children as long as it is limited to small body areas. The areas that you describe fall well within this scope. Sun protection is recommended for everybody, especially children and especially with vitiligo. No additional protection is needed with Protopic.
Dear Dr. I have been suffering from Vitiligo since 12 years on my legs (extensively) and hands which have just started showing on my fingers. I have been under medication for a very long time. My skin doctor has changed my medicine from oral tablet Dicaris to to Tab. Melanocyl taken twice on alternate days and exposure to sun for 10 min. With local application of Tacros and Elecon cream. Please advice what should I do, am totally depressed as it become difficult in my working place and each one stares at my fingers. the white patches have appeared all of a sudden on all my fingers.
please advice me on what to do and what diet should I follow and what is a gullten free diet
It appears that you are treated in a country outside of the United States.
The treatment regimen thus far was very reasonable and it appears that you are in very able hands. Please understand that I do not comfortable giving specific treatment recommendations without examining you and I strongly encourage that you discuss treatment modifications with your dermatologist.
There is no scientific data that a gluten free diet can help, just case reports. Gluten is found in many wheat products.
Further information about gluten in our daily diet is available online and changing one’s diet requires taking into account that your diet stays balanced. It may be worth a trial to stay gluten free for about 3 months.
Hello I have Vitiligo on my hands and it is almost totally depigmented. I would like the small areas removed for an even complexion. How long will this take and what treatments do you suggest??
This not an easy task. Topical agents to bleach skin permanently, such as monobenzone, are usually considered when significant percentage of the entire body is affected by vitiligo. Standard fading creams containing hydroquinone in concentrations up to 8% (compounded only) are only marginally effective. These potent topical agents have associated health risks. Pigment reduction by laser should only be considered if the remaining pigmented areas are tiny. Results with laser treatment may be incomplete and may be uneven.
i ve alwayz had this dry and flaky lips all round the year like some pple have during harmmatan[am a nigerian]which i constantly peel off….naw d affected dry part now depigmented….my dermatologist says its vitiligo….and am so worried..i wanna knw wat is the best option for treatment of lip vitiligo is pls
Confirmation of the diagnosis through skin biopsy is appropriate. In my experience, Protopic works best for repigmentation of the lips. It must be used with care near moist mucous membranes (the moist portion of your lip)
About a year ago my wife, 50 rears old, developed vitiligo spots on forehead just below hairline. For last five months she is having full body uv narrow band treatment, in the beginning twice a week and for past two months once a week. Every time she asks the doctor about the length of treatment he say its a trade off. This leaves a question of safety level.
We are thinking of reducing the treatment to once a month with longer exposure.
Can someone please advise what should be our next course?
Vitiligo is not easy to treat and narrowband UVB is the correct and most reliable treatment. Narrow band UVB can be delivered focally to only the affected area via a laser called excimer laser. Please find a dermatologists in you vicinity who offers this treatment.
Can excimer lazer be given on Lips (Vitiligo) ?
Excimer laser treatments can be performed on the lip with proper dose adjustment.
Hello,
I am 27 and have vitiligo around my mouth, and have melasma above my upper lip as well…. I use topicals for both: Protopic and Hydroquinone in the respective spots.
My question is: does Protopic worsen my melasma when messing up with the dark spot? (I know hydroquinone could worsen vitiligo, of course, but I want to know if something bad happens the other way too)…
Thank you very much in advance!
Protopic is not known to worsen melasma.
Hi, I have had vitiligo since I was 11 years old. I’m 52 now, on gluten free diet for 3 years. I started repigmenting a year ago. I repigmented quickly on my arms, which were the areas I lost pigmentation recently, but for my total surprise my legs, which have been depigmented since I was a kid, are starting to repigment.
I have done lots of treatments with no results, including UVB lamps, to see this results when I was nor expecting anything is like a miracle to me. I must say that gluten makes me feel awful, so I’m 100% gluten free, except accidental cross contamination in restaurants, my house is 100% gluten free, my whole family feels better.
I look and feel younger, no more migraines, depression, fibromyalgia, fatigue, restless legs, and vitiligo repigmenting, I owe my life to the doctor who told me “I think you are gluten intolerant” and tested me for those antibodies. I keep pictures of the process.
This is really a great success story. Thank you for sharing it!
I am 38 and have just been diagnosed with vitiligo and melasma. I have had the vitiligo around my eyes for the last nine years (I asked several dermatologists during that time if I had Vitiligo and I was told I did not but no one used a Wood’s lamp to check) and around my nose and spreading out to my cheek a bit for the last year. I have had the melasma for the last two and a half years. I have now gone off the bcp. Everything is limited to my face (as far as I know, there are a few speckles on my leg and chest but the doctor did not look at them).
I was prescribed Desonide for a week and then Protopic for three weeks and then the Desonide for a week and the Protopic for three. I was told I cannot do light therapy as it will exacerbate the melasma and my skin darkens very quickly (I am half Indian). Is this the right course of treatment? I am getting married this year and very anxious to re-pigment and clear up the melasma. I have read about vitamins and Bimatoprost and homeopathy and gluten free diet and the dangers of phenols in hair coloring online. Do these things affect Vitiligo? My doctor did not mention any of them. Thank you for your help!
Treatment of vitiligo is difficult and thus far we do not yet know of any that assures 100% repigmentation. Should you not respond to Protopic, your vitiligo on the eyelids may be treatable with excimer laser, which delivers narrowband UVB light and can be precisely delivered to the vitiligo spots.
UVB is not typically the ray that is implicated in firing up melasma, however, caution should be exercised to avoid the melasma spots. Bimatoprost also helps in vitiligo.
Your melasma is very difficult to treat due to the fact that you have vitiligo. Any trauma of the skin could trigger vitiligo in somebody who has vitiligo. Therefore, I would stay away from Melanage peel (otherwise the best treatment for melasma). The key is very slow treatment of your melasma with various topicals, such as hydroquinone or plant based non-hydroquinone fading creams, glycolic acid, vitamin C over many months. Microdermabrasion may be used to speed up the process.
The role of vitamins, gluten, phenol and other chemicals in vitiligo is still debated.
I am a 38 year old mother and have had vitiligo since i was young. i have tried many creams and stuff to regain my pigment loss and nothing has worked. i spoke to many Dr.s and have been told there is nothing to help this disorder. I have several auto immune disorders as per graves desease, R.A and vitiligo. Is this a possible way to go for me PUVA and is this covered by health insurance. I would like to speka to someone in this feild is there some way for someone to call me
PUVA or narrow band UVB treatments are not contra-indicated when you have Graves disease or rheumatoid arthritis. However, if you take certain medications for rheumatoid arthritis, oral psoralen (P in PUVA) may not be tolerated. Typically, health insurance covers these treatments but there could be a copayment or coinsurance even after you meet your deductible for procedures. Precertification is needed for both procedures and your insurance will inform you of your responsibilities with these procedures. It can take many treatments (20 or more) to see the effect. Unfortunately, we do not provide over the phone consultations at this time but I encourage you to speak to your dermatologist about these treatments If he/she does not offer it, your could be referred to a center that does.
I’ve had Vitiligo for many years now, but it’s only recently started spreading. I’ve been to my dermatologist and he recently suggested UVB treatment as well as the cream Fluocinonide. I go to UVB treatment when I can afford it, but it can get expensive after a while.
My two questions are: 1. Can the Fluocinonide cream make my Vitiligo worse? I’m not sure if its just my Vitiligo spreading fast, but it seems like its gotten gradually worse in a fairly short amount of time (right around when I started the cream). And 2. If the UVB treatment doesn’t work, are there any other options? I’ve heard about the Excimer laser, but that’s even more expensive than the UVB box.
Any insight to my questions would be greatly appreciated!
Fluocinonide is a topical steroid and is not known to worsen vitiligo. As you had suspected, it is the rapidly spreading vitiligo that may not yet have responded to treatment and causes additional depigmented areas. Next to topical steroid and calcineurin inhibitors (Protopic or Elidel) narrrowband UVB treatments are the current standard of care in vitiligo. This can be administered in a UVB light box with narrowband UVB lamps or through an excimer laser. Normal skin can be spared with excimer laser treatments, allowing higher levels of energy to be administered to vitiligo spots. This can in some people make the treatment much more efficient. Excimer laser treatments are useful for localized vitiligo.
Thank you for the quick reply Dr. Ringpfeil. Would you suggest I ask my dermatologist if I should be put on either Protopic or Elidel in addition to Fluocinonide? Currently, the Vitiligo is only only my hands (started with the fingertips, quickly spreading) and elbows. I’d like to do everything I can to stop it, especially before it starts crawling up my arms and onto my face.
Excimer laser treatments are very expensive, which is why I’m only doing the UVB light box. My dermatologist said that the UV light treatment is fairly effective for patients, but didn’t elaborate when I asked him what ‘fairly effective’ means. If my body does NOT respond to UVB light treatment, do I have any other options?
Thank you again for your input, it is greatly appreciated.
I agree that narrowband UVB light from a light box is effective, and excimer laser treatments may not be necessary. Your medical management depends on a number of different factors and I believe, the details of the management (steroids by mouth to try to abort the flare, Protopic or Elidel or topical
steroid) are best discussed with your dermatologist.
Here is another question that I have on Vitiligo:
If white patches are evident on a vitiligo patients skin but the hair that grows in that same region are still dark and obviously still has pigment in the follicle core, then how can you get the pigment from those hair follicles to reproduce new pigment in that skin region? It seems odd that if the melanin is destroyed in the skin, then why wouldn’t the melanin in the follicles also be destroyed?
It is possible that in the early stages of vitiligo, the immense density of melanin in the hair follicle is incompletely destroyed by the immune response of our body. In fact, the residual and much more dense melanin in hair follicles is believed to be the source for repigmentation as repigmentation occurs first around the opening of hair follicles. When vitiligo is longer standing, even the pigment in the hair follicles gets destroyed, which is most noticeable in scalp, beard or other terminal hair.
Is it possible for hair that has turned white fom vitiligo to turn back to black?
Also, I am currently undergoing eximer laser treatments, and the skin looks pink but isn’t freckling. Does this mean the treatment isn’t working?
Hair that has turned white from vitiligo can repigment when vitiligo resolves. Excimer treatments first cause pinkishness in treated areas before repigmentation occurs. If nothing is visible after 20 treatments, it may mean that this treatment does not work for you.
If the home treatment that I am trying doesn’t get the fingers, hands or toes pink with 5 minute sessions, but the other areas are turning pink with less time, does that mean to increase the exposure time or just that the area will not respond?
Also, what is your opinion on Scenesse and have you kept abreast of those studies? It looks promising and exciting for us vitiligo patients.
It is unclear if you are exposing your vitiligo spots to UV rays or to a sensitizing medication. Regardless, you can play with exposure times by covering the areas that react adequately after 5 minutes and increasing exposure by very little at a time to the areas that are not yet pink.
Scenesse, the implantable melanocortin receptor agonist, has great theoretic potential and time will tell how it can be used.
I have diabetes and hypothyroidism, I am 46 and developed vitiligo back in 2003 in my genital area which didnt bother me but within the last 4 years, it showed up on my hands and has got worse. This year, it showed up on my face which in approximately 1/4 inch in diameter and 1 1/2 long. I tried Protopic and fluocinonide but neither worked. Even though my hands look bad, they aren’t as big of a deal as my face is but my funds are limited. I attempted to change diet, increase b vitamins and nothing has changed it with the fear of it getting worse. With being fairly young still, I would like to find the best possible way.
I know that every patient is different and being half Italian, my olive complexion gets darker in the summer making it much more noticeable, What are some of the best ways that you would try to correct this issue? Is the potential restoration of pigment at a higher level by newly seen spots as opposed to spots over a longer time frame? Which method have you’ve seen with the best results in restoring pigment?
Indeed, everyone is different and there are different ways vitiligo can present. The younger pigment deprived patches sometimes repigment easier.
Calcineurin inhibitors such as Protopic and narrowband UVB (including excimer laser) are the most successful treatments and are available here in the US. Surgical options may be considered but results are not always even and there is a chance of side effects such as unwanted hyperpigmentation or scarring. You may want to consider narrow band UVB treatments as your next step.
Do you use UVB therapy for vitiligo as well as the XTRAC laser? what other forms of treatment do you use?
Some forms of vitiligo respond to light treatment. Currently, narrowband UVB treatment appears to be the light treatment that is most efficacious and has the best safety profile. IF many areas of the skin are involved narrowband UVB is delivered in a UVB treatment box. If the area is small or the scalp is affected, an excimer laser is used instead to deliver the narrowband UVB ray. Other treatments include devices in the visible light range as well as topical medications. The type of treatment depends on the type of vitiligo, the body area affected as well as the extent of the body area affected.
We do excimer laser treatments.