Skin Pigmentation

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 vitiligo patches in prone individuals. This is a process known as the Koebner phenomenon.

The goals of the treatment of vitiligo are two-fold:

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

It is always best to try to prevent the 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 makeup products

Managing vitiligo can be challenging for both the patient and the physician. Not all treatments work equally well and sometimes need to be used in combination. Many 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 re-pigmentation 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.

The excimer laser creates a concentrate but painless, beam of ultraviolet light that is delivered to vitiligo patches through a handpiece. By targeting de-pigmented patches, the laser stimulates re-pigmentation and limits exposure to healthy skin.

Unlike most treatments that have low efficacy or significant side effects, the laser can re-pigment 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 re-pigmentation in 30 or fewer sessions. Total UV radiation is lower than with UVB booths or PUVA. Treatments are fast and no pharmaceuticals are needed.

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.

Treatment will take place at Tareen Dermatology on the latest state-of-the-art medical equipment. Your provider and our team of knowledgeable, experienced laser technicians will collaborate to determine the appropriate dosing for your skin type and then our trained laser technician will perform the treatment. Most treatments only take 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.

Tareen Dermatology providers will create a customized course of therapy for you based on the extent and degree of depigmentation and location of the patches. Patients may enjoy re-pigmentation after 30 or fewer sessions.

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 severe side effects, such as blistering and hyper-pigmentation, are rare and short-lived.

Some national, state and local insurance companies cover laser treatment, but coverage levels vary by plan. Contact our office at 651-633-6883 or contact@tareendermatology.com for details about your insurance coverage.