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
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.
Do you have any experience with using Innova V1 or Vitiligo cover cream? Can you use a cover cream that works like a sunless tanner in addition to topical steroids? Topical steroids are causing facial redness. Treatment started last week. How long will redness last? Have only been using once a day instead of twice a day due to redness. Thank you!
Cover creams work well for vitiligo spots and are offered by various manufacturers. They are blended to match the natural color of your skin. Sunless tanners are difficult to use in vitiligo. They should really be applied in a large area because they do not typically match our skin. While they would make the vitiligo spots darker, the surrounding skin will become even darker.
Innova V1 is an anti-oxidant supplement with claims to promote melanin production. It has not been studied in vitiligo and I do not have experience with it.
Facial redness is not common with steroid use for one day. Please contact your dermatologist about this side effect.
Hi Doctor,
i have an appointment with your clinic in coming few days. i suspect i may develop or have developed vitiligo as i see verrryyy small whit dots. Can this be diagonised by biopsy at this stage? And can we prevent it from spreading at this early stage? i have a family history of father, grand father and grand mother having vitiligo.
Thanks
A strong family history might place you at slightly higher risk of developing vitiligo, yet small white spots could be from sun damage or other conditions, and if in doubt clinically, a biopsy can absolutely help with diagnosis. Halting progression of vitiligo is not always possible but early treatment is.
Are you familiar with Microart in beverly hills california? I have has three MKTP procedures and they were all incomplete. I am trying to find the best micropigmentation facility in the united states to closely match the rest of the areas that remain unpigmented
I am not familiar with the above referenced tattoo parlor. Our office removes or revises micropigmentation, and we are located in Philadelphia, Pennsylvania.
Percentages wise, what is simply the best treatment for vitiligo? Or the progression of treatments. I’m seeing white spots on my neck that are increasing. I have brown skin and my age is 36. I’m currently applying tacromilus cream but not seeing any results.
Vitiligo has different ways of presenting and what might be the treatment with the highest success in the localized form is not necessarily the best for another variant. Vitiligo on the neck is not one of the common presentations. If the diagnosis was proven by biopsy and if your vitiligo is limited to your neck, narrowband UVB treatment (excimer laser) has the highest probability to repigment you. There are very few individuals that respond within just a few treatments. For most off those undergoing narrowband UVB therapy (excimer laser), treatment is many months long (3-36 months). I would still continue tacrolimus at night.
I have vitiligo, am African American and would like to know what is the best sun screen to use.
In general, I recommend physical sun block with an SPF of 30 or higher for vitiligo. Elta MD makes some very good quality physical sunscreens that are clear and so does MD Solar Sciences.
I have been using tacromilus cream to treat white spots on my chin and other lighter colored skin areas. My dermatologist said I have a mild case of vitiligo. I can’t say I agree I thinks its slowly getting worse. Anyway is tacromilus cream safe to keep using for a long period of time. Does it stop the progression. Also I have light areas of skin and some of the spots are also missing hair. Does tacromilus have any affect on potentially growing hair back in the beard area. Also every time I go to the dermatologist he just looks at me and says you look OK which is not true is there any other treatment he should be trying. I had about 7 or 8 treatments of the excimer laser at another dermatologist but it had no effect on whites spots and they said it was not working. Is there anything else to do treatment wise.
Tacrolimus is safe for use for long periods of time when the body surface area is small and intact. This is usually the case in vitiligo. Tacrolimus does not stop progression – it treats the inflammation in the areas where is is applied but cannot prevent that other areas become affected. Hair loss is not associated with vitiligo, but tacrolimus does not cause hair loss nor will it exacerbate it. Excimer laser treatment are very effective yet their success cannot be judged after 7-8 treatments. One of my mentors used to tell his patients with vitiligo, that they would enter a 3-year relationship with his office when they started phototherapy. While it does not always take three years to achieve stable and persistent repigmentation, it often takes many treatments. Only in very few lucky individuals, repigmentation occurs already after a handful of sessions. Excimer laser treatments are brief but time consuming because you will need to be treated 3 times a week. They can also be costly if not covered by insurance.
Hello, I have vitiligo and would like to explore my options for treatment. Is this something that is covered under insurance?
Topical medications and narrow band UVB treatments are usually covered by insurance. Sometimes precertification might be needed before treatment can begin.
Hello,
I am being treated for vitiligo with narrowband light treatment in Irvine CA. I will be traveling for the holidays and don’t want to set my treatment back. Can I have my treatment parameters sent to your office and schedule a treatment on the 29th of December?
It is certainly possible to continue your narrowband UVB treatments. For safety reasons, we use an excimer laser to deliver the narrowband UVB treatment as long as the affected area is less than 10% of the total skin surface. If your affected skin is wider spread, treatment in a light box is the only treatment option and you need to reach out to the local universities. If you are currently treated by excimer laser, please schedule an appointment on 1/29 through online booking with one of our dermatologists in the Haverford office. Please have your dermatologist send the treatment records for the last 2 weeks. You might remember that pre-certification is needed for submission of treatment to your insurance. This pre-certification is dermatologist specific not patient specific. In other words, our office has to obtain pre-certification, which is usually performed after we can evaluate your skin. The same evaluation will also determine the laser settings in conjunction with your treatment records. If we submit pre-certification on the date of first treatment, we will have to obtain a deposit to cover the treatment until your insurance reimburses us. You have the option to use your insurance for the brief consultation but not for the treatment. Fee for narrowband UVB treatment is no higher then $150 per session but could be lower for a small area. Please let us know by contacting rad@ringpfeildermatology.com how you would like to proceed.
I have been to your office in the past and seen one of your doctors to ask the doctor if she thought I had was developing or had vitiligo. The doctor at that time said no the light color you are seeing is from hair missing in your beard so it looks white. At that time about a year ago it may have appeared to look that way, but I was very skeptical because I had what appeared to me to be white spots on my face. So I went on and now I am noticing more white spots on my face so went to another dermatologist and he said I think you have Pityriasis Alba but that is basically a childhood disease I thought, he said anyone can get it. I have serious doubts about what he said and your doctor said. I now have more whites on my face so I am coming back to your practice again. I think I have Vitiligo what should the doctor do to confirm what I have when I see her this time other than a biopsy I got that done at another office and it turned the spot on my face white.
A biopsy should have confirmed the diagnosis. Wood’s light examination can give clues but is not absolutely specific. Please bring the pathology report form the previous biopsy to your appointment as o that all pieces of the puzzle can come together.
hi doctor,
in your experience have you found tacromilus creams to stop localized spreading of vitiligo? please advise. my lesions are not in a noticeable area but they are spreading in size. I would be pleased to just stop the local spread.
I am making an appointment to be seen in your office, are you agreeable to your patients seeing a natropath for nutritional recommendations while they are under your care? please advise.
thank you for your service, many dermatologist in my area do not treat vitiligo. Thank you.
Many autoimmune or autotoxic conditions benefit from a complex management including adjustment of diet as well from local intervention and we encourage this approach.
Tacrolimus can help to stop the spread in an existing lesion and it also helps to repigment that area once the inflammation has subsided.