Vitiligo

 

Vitiligo occurs in almost 1% of the population. It is characterized by ivory white patches of skin. Vitiligo may begin in childhood or adulthood and may occur on any skin surface (including the lips, eyelid, and genitalia). About 30% of vitiligo patients have a relative with this condition.Vitiligo is thought to be an autoimmune condition.  It may be associated with autoimmune thyroid disease, diabetes and alopecia areata.02399

For localized cases, topical creams (either topical steroids, vitamin D, or calcinuerin inhibitors) are effective.  In more widespread cases, light therapy (narrowband UVB) may be effective in leading to repigmentation.  For resistant localized cases, excellent results are seen with the eximer laser.

What is vitiligo?

Vitiligo is a dermatologic condition in which the pigment producing cells called melanocytes are lost producing bone white patches of skin. Although this can occur anywhere including the scalp, face, neck, trunk, arms, and legs, there are some special areas of predilection such as around the eyes, mouth, lips, hands and fingers, and genital area. Sometimes patches of hair on the scalp or body may also turn white.  The patches of vitiligo can range from being very focal in one small patch to more generalized over the body.

Dr. Tareen, Kelsey Holmes and Rachel Najda attending Vitiligo Lectureship at University of Minnesota 2015.

Dr. Tareen, Kelsey Holmes and Rachel Najda attending Vitiligo Lectureship at University of Minnesota 2015.

 

Thank you for getting the education to help those of us who suffer. It’s been 21 years since my diagnosis and I finally have met a team that know something about Vitiligo!

 

 

Vitiligo can be an especially distressing and stigmatizing condition in individuals of south asian, asian, latino, and african descent and in other individuals with pigmented skin. It can affect all skin types including fair skinned individuals but in darker skin, the discrepancy between the normal skin and depigmented skin can be quite marked. If you think you may have vitiligo, see a dermatologist who has expertise in this area as they will be sensitive to the overall impact that vitiligo can have in one’s social and professional life.

Are all light patches vitiligo?

There are many causes of hypopigmentation and depigmentation of the skin that produce light or white spots. These conditions range from the innocuous to the more severe and include:

  • variants of dry skin and eczema (pityriasis alba)
  • postinflammatory pigment changes that occur after rashes
  • reactions to harsh chemicals (chemical leukoderma)
  • overgrowth of yeast which is very common and benign (tinea versicolor)
  • certain immune and inflammatory condition of the skin (such as sarcoidosis, lichen sclerosus, or morphea)
  • some infectious diseases such as leprosy
  • certain types of skin lymphomas and cancers
  • changes resulting from unknown causes possibly from chronic sun exposure (idiopathic guttate hypomelanosis)

Your doctor often can make the diagnosis of vitiligo and rule out other causes by a simple physical exam utilizing a special light called a Wood’s light but in some cases a simple skin biopsy may need to be performed.

What causes Vitiligo?

The precise cause of vitiligo is still not known; the disease is probably multi-factorial.  There is likely a genetic susceptibility as there is often a family history of vitiligo or other autoimmune diseases. It is hypothesized that vitiligo is in fact a form of an auto-immune condition. This class of diseases occur when the body’s immune system starts to attack the body’s own tissues, organs, and cells. In the case of vitiligo, the melanocytes would be attacked and destroyed.  Some evidence to support the auto-immune hypothesis is that vitiligo tends to cluster in families and individuals with other auto-immune conditions including certain types of anemia, thyroid disease, diabetes and other endocrine diseases, and alopecia (hair loss). Your doctor may order additional blood tests to rule these other conditions out.

Other hypotheses regarding the causes of vitiligo include self destruction of the melanocytes which may result from unknown causes, nerve defects, or the effect of free radicals on the cells.  Additionally,  physical trauma is known to stimulate patches of vitiligo in prone individuals. This is a process known as the Koebner phenomenon.

What can be done to treat Vitiligo?

The goals of treatment of vitiligo are two-fold:

  1. To prevent progression of the disease and
  2. To try to repigment patches that are already present.

It is always best to try to prevent spread of the condition and treat new, fresh patches as soon as they occur as older, more longstanding patches are more resistant to re-pigmentation.
Treatment options that have been reported to be effective include:

  • topical agents such as steroids and other immune modulating creams
  • oral anti-oxidants such as Vitamin C, E, and alpha-lipoic acid
  • systemic steroids in cases of rapidly spreading disease
  • medical grade light therapy
  • a drug called psoralen used in conjunction with light therapy; sometimes this can be applied topically but is more often administered orally
  • certain types of laser treatments
  • surgical therapy including skin grafting to transfer active melanocytes to the area
  • depigmentation of normal skin (this is only recommended in cases of extensive depigmentation)
  • camouflage with good make-up products

The management of vitiligo can be challenging for both the patient and physician.  Not all treatments work equally well and sometimes need to be used in combination.  Many of the treatment options have limited data to support their use and sometimes have only anecdotal support. Furthermore, medications can have side effects and need to be used carefully.

Nevertheless, successful repigmentation can be achieved especially with early treatment! It is best to find a doctor who will work with you as a team for prompt treatment and maximum control.

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Excimer Laser Treatment for Vitiligo

Convenient: Treatments are painless and take only a few minutes, twice a week, for several weeks.

What Patients Say about Excimer Laser Treatments
“When I started treatments, about a quarter of my face was affected. Now, after 32 treatments, the treated areas are more than 85% repigmented. People who did not see me before cannot detect I ever had vitiligo. If I had vitiligo any other place, I would definitely get excimer laser treatments. It definitely works. There is no point trying anything else.”
-A.D.

Frequently Asked Questions and Answers

How do Excimer Lasers work?
The excimer laser creates a concentrated, but painless, beam of ultraviolet light that is delivered to vitiligo patches through a handpiece. By targeting depigmented patches, the laser stimulates repigmentation and limits exposure to healthy skin.

Who is a candidate for treatment?
Excimer laser therapy is for patients of all ages and ethnic backgrounds. The laser is ideal for localized areas including the face, neck, and torso. Traditionally hard-to-treat areas such as the underarms, hands, and feet are also easily treated, thanks to the laser’s aiming beam and adjustable spot size handpiece. The targeted therapy can treat stubborn patches, even those that have not responded to other treatments.

How does treatment compare with other vitiligo treatments?
Unlike most treatments that have low efficacy or significant side effects, the laser can repigment with a small number of treatments in a relatively short period of time with minimal side effects.

Compared to UVB booths and PUVA that may take 6 months to 1 year of sessions, some excimer laser patients achieve repigmentation in 30 or fewer sessions. Total UV radiation is lower than with UVB booths or PUVA. Treatments are fast and no pharmaceuticals are needed.

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Photo courtesy of Ra Medical Industries

What can I expect during treatment?
Treatment will take place at Tareen Dermatology. First, your Dr. Tareen will determine the best dosage level for you. Then, we will apply the laser therapy. Most treatments take only a few minutes.

Does treatment hurt?
Most patients experience no pain or discomfort. A few patients may feel slight warmth shortly after treatment. This warmth is mild and short-lived. No anesthesia is needed.

How many treatment sessions will I need?
Dr. Tareen will create a customized course of therapy for you based upon the extent, degree of depigmentation, and location of the patches. Patients may enjoy repigmentation after 30 or fewer sessions.

How do I prepare for treatment?
No extensive preparation is required for laser therapy. Just ensure that the skin to be treated is clean, dry, and free of any make-up, lotion, or creams containing SPF protection.

Are there side effects?
The side effects of laser therapy are minimal. Most patients report no side effects. A few patients have reported a mild and short-lived redness at the treatment site. More serious side effects such as blistering and hyper-pigmentation are rare and short-lived.

Are laser treatments covered by insurance?
Some national, state, and local insurance companies cover the laser treatment, but coverage levels will vary by plan. Contact Tareen Dermatology at 651-633-6883 or contact@tarendermatology.com for details about your insurance coverage.

 

CLICK HERE FOR THE EXCIMER LASER FAQ

 

TO SCHEDULE AN APPOINTMENT:

Call our office at 651-633-6883, or click the the Red “Book an Appointment” button below.

 

Click here to read Dr. Tareen’s blog post, “Gingko Bilboa – Restoring Natural Pigments in Vitiligo.

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