By Dr Davin Lim
|Best Ingredients: Sunscreen, vitamin D creams, corticosteroids, psoralens
|Adjunctive Treatments: Phototherapy, ginkgo supplements, diet
|Worse Ingredients: Herbal remedies
|Tips: Phototherapy & creams gives the best results
What is the basis behind skin care for vitiligo?
Creams help to reduce skin inflammation, & at the same time stimulate pigmentation.
Prescription creams as well as CS ointments reduce inflammation. Vitamin D & prescription creams can stimulate melanocyte migration.
What is the cause of vitiligo?
This condition is genetic, it can run in families. Essentially vitiligo is an autoimmune condition that attacks pigment cells on the skin. This results in white patches.
Can vitiligo be cured?
Vitiligo can be kept in remission, however an absolute cure is not possible. Most cases can be controlled.
Why are anti-inflammatory creams important?
These special creams reduce the inflammation on the skin, helping stop the spread of white patches. Creams are preferable to tablets for small areas of vitiligo.
How do I use creams?
I prescribe creams in a pulsed manner – namely one week on then one week off. Application is only in the evening.
Note: I only prescribe creams in conjunction with phototherapy (UVB light). Phototherapy is bulk billed, meaning there is no out of pocket fee (if you have Medicare). Phototherapy is essential for stimulating pigment cells to produce melanin.
How do psoralen creams work?
Psoralen creams are used in many third world countries such as Pakistan, India, & Africa. These creams are used on the white patches of vitiligo. Psoralens are plant based creams that react with sunlight. This causes a phototoxic reaction that can stimulate repigmentation.
In Australia, I do not use psoralen creams due to their side effects including blistering, patchy pigmentation & hyperpigmentation of the surrounding skin. NUVB or narrowband phototherapy is a safer alternative to psoralen application.
How can I bleach my skin (Michael Jackson style)?
Skin bleaching is a last stage effort in blending areas of normal skin with vitiligo. It is used for extensive vitiligo, an example is the late Michael Jackson. The compound of choice is called MBE or monobenzylether of Hydroquin.
It is the only depigmentation treatment for extensive vitiligo that has been approved by the FDA (Food and Drug Agency, United States of America). MBE it almost always causes irreversible depigmentation, as it results in death of melanocytes (the cells that make skin pigment or melanin). MBEH is available as a 20% cream however some dermatologists will compound up to 50% MBE of HQ.
How do I bleach my skin with MBE?
This treatment is done via the guidance of a public hospital. This treatment requires careful monitoring as side effects are universally seen.
1.Apply MBEH cream once daily for two weeks to a test area, such as the inner upper arm, then increase to twice daily.
- If tolerated, a thin layer of MBEH cream should be rubbed in twice daily to the pigmented areas to be lightened.
- Do not apply the cream to the eyelids or mucosal surfaces.
- Avoid sun exposure at all times to prevent the colour returning in patches.
Depigmentation of normal skin will take up to 12 months; most cases will de-pigment in 4-6. Side effects such as irritant contact dermatitis is universally encountered. The use of pulsed CS ointments can help. Given the marked discomfort during treatment, I refer ALL patients to a public hospital dermatology department.
What are other natural remedies that can help?
You can try supplementing your intake with ginkgo & vitamin D. These are safe natural supplements. There are some papers that suggest vitamin B3, B12, fish oil, vitamin D & folic acid can help.
These are not vitiligo cures, but can supplement your dietary intake.
What foods should I avoid?
Acidic foods such as tomatoes and overdose apple juice- orange juice can cause inflammation. This is not scientifically proven however avoiding acidic foods can help. Eating foods high in fish oil, vitamin D, and folic acid (leafy greens) can help (if not prevent worsening of vitiligo).
Davin’s Viewpoint on Vitiligo Creams
Creams are an essential part of treating vitiligo. They are designed to reduce inflammation & repigment skin. My go to topicals include prescription creams or vitamin D, pulsed with an anti-inflammatory cream.
What we do know is that eating a healthy diet does no harm. In fact there are some studies showing diets rich in vitamin D and ginkgo can help vitiligo. I keep an open mind to treatment- try natural remedies such as vitamin D, Folic Acid, and Ginkgo, but if they don’t work, try the proven method of re-pigmentation – namely with creams and light. Add diet to the regime as it does no harm. In fact most of my patients are on a low acidic diet, vitamins as well as conventional best practice vitiligo repigmentation using light and creams.