White Patches on the Skin

WHY IT’S IMPORTANT TO DIAGNOSE AND TREAT EARLY

If you or a loved one has developed white patches on the skin, it’s important to seek the advice of a dermatologist as soon as possible.  Some conditions such as pityriasis alba, a common form of eczema, may be self-limited and curable.  Other conditions, such as vitiligo, may be more challenging to diagnose and treatment can be lifelong especially when delayed.  And no matter the age, gender or skin color, as vitiligo affects all equally, its psychosocial impact can NOT be underestimated.  As a patient once said to me, ”vitiligo is not a disease of the skin, it is a disease of the soul.”

If you have vitiligo, it’s critical for you to know that it CAN be treated and that your doctor, even your dermatologist, may not even be aware of the great strides made in vitiligo treatment over the last few years.  

Dr. Amit Pandya, a specialist in pigmentary disorders, including vitiligo, states “Vitiligo is an autoimmune disease which is treatable if diagnosed and treated early. It is important that we get this message out to the public so that patients can get the treatment they need, especially children, adolescents and young adults, who are the most vulnerable to the psychological effects of this condition.”

Vitiligo is Treatable
Here’s a recommended article for anyone with vitiligo (or treating vitiligo) to read:

Solving the Vitiligo Puzzle

And here are recommended articles to share with your doctor:

Current and Emerging Treatments in Vitiligo

Vitiligo Working Group Consensus on Narrowband UVB

Phototherapy is Essential to Vitiligo Treatment
These recent landmark publications highlight the importance of phototherapy, and in particular narrowband UVB phototherapy, as the standard of care in vitiligo treatment.  So often, one is given topical medications to suppress the inflammation in the skin that is causing the loss of color.  However, how do we get the skin color back?  Light therapy is critical in stimulating the skin color cells, called melanocytes.  And did you know that once one is able to repigment, phototherapy alone can be used to both suppress inflammation AND stimulate the development of skin color?  Yes, there is hope for saying goodbye to messy topical steroids.

Treatment is Your Decision, Not Your Doctor’s
If you have vitiligo, the decision to treat is deeply personal, and only YOU can decide if treatment is right for you.  Given many dermatologists may not yet be made aware of the recent advances in treatment, please be aware your doctor may not show as much interest or concern about treatment as you.  Many don’t want to be educated by a patient because it hurts their pride.  So, I encourage you to share your knowledge and maybe even email or print this blog to discuss during your appointment.

Vitiligo Treatment Facts
I’ll help you by presenting the facts so you can make the best decision for you.  Ultimately, if you want to pursue treatment and you think Clarify Home Light Therapy is a good option, we’re here to help.

Let’s start by being transparent about the most realistic expectations related to both your potential to regain skin color and the time commitment that will be required—both on a daily basis and the life-long surveillance and potential treatment journey ahead.

Your Healing Journey
The exact cause of vitiligo is unknown. It’s most likely an immune disorder that destroys the body’s melanocytes, the cells that produce pigment because it thinks they’re a foreign body your immune system needs to defend against. Genetics may play a factor in this, and many people affected by vitiligo have reported a single emotional or physically stressful event or trigger as the point when their vitiligo surfaced.

Your Doctor Exam
Vitiligo may also be associated with other autoimmune conditions such as thyroid disorder, diabetes and anemia.  A thorough exam by your healthcare provider is recommended because of the relationship between these disorders. Your exam may include:

  • Thyroid panel, including TSH and thyroid autoantibodies, to rule out thyroid disease
  • Fasting blood sugar, to rule out diabetes
  • Complete blood count, to rule out anemia

The complex nature of vitiligo is treated by a combination of therapies, including but not limited to:

Diet and vitamins
There are no specific recommendations for people with vitiligo. Eating a diet rich in fruits and vegetables is a good way to support your immune system, and some specific vitamins have been identified as helpful to patients with vitiligo:

  • Vitamin C: at least 100 mg daily
  • Vitamin E: at least 100 IU daily
  • Alpha lipoic acid: 40 mg daily

Camouflage
Certain types of makeup (such as Dermablend) and skin stains (such as Microskin, Zanderm) containing dihydroxyacetone can help to make vitiligo less noticeable.

Phototherapy or Light Therapy
There are several types of light therapy that are effective in treating vitiligo, and typically, they’re performed in a doctor’s office two or three times a week for several months, although home therapy options are also available.

With early diagnosis and treatment, skin color typically reappears at the following rates:

  • 25% at 36 treatments
  • 50% at 72 treatments
  • 75% at 108 treatments

If your physician has not previously mentioned clinic-based or home phototherapy, it may be due to inconvenience, cost, or lack of resources for oversight and management. Our own product, Clarify Home Light Therapy, is designed to address these concerns and removes many of the barriers and inconveniences associated with other phototherapy tools and treatments.

Topical Creams
Topical corticosteroids and tacrolimus are most often used as first-line treatments of vitiligo in combination with phototherapy.

Depigmentation
When vitiligo is particularly extensive, a medication called monobenzone can be used to remove all the skin color, creating a more uniform skin appearance.

Surgical Procedures
This is an area of treatment that is changing and growing rapidly and is performed by select experts in only a few locations in the U.S. Patients who have achieved maximum repigmentation with combination therapy, may opt for these surgical procedures. Skin grafts or cell suspensions from the unaffected colored skin are transferred to the skin without color.

Realistic Outcomes
The amount of repigmentation varies greatly from person to person. Ultimately, the outcome depends on a combination of several factors, with consistency and adherence to combination therapy being one of the most important ones. The extent and location of body involvement, duration of condition and presence of pigmented hair and visible hair follicles all play a part in the process.

Predictors of Success
There are some general predictors of successful response to phototherapy that have been identified. Patients under the age of 30, with darker skin, who have shown signs of vitiligo for fewer than two years  and/or who have it primarily on areas covered in hair follicles or most parts of the face tend to see the best results. Older patients, with lighter skin or white hair or who have shown signs of vitiligo longer than a few years, don’t usually see the same response to treatment.  That doesn’t mean they don’t respond—they can and do, it is just not as fast or predictable.

Diagnose and Treat Early
In general, it is best to seek treatment as soon as possible, especially within two years of diagnosis. Patients who are treated early on with light therapy and topical creams see an average of 50-70% repigmentation within 6-12 months.  A dermatologist is best equipped to diagnose.  If you have difficulty finding a dermatologist in your area, I recommend visiting the American Academy of Dermatology website to locate a dermatologist near you.

DermatologistOnCall
Sometimes, even with a dermatologist located in your hometown, the waiting time may be extraordinary. In this case, you may consider seeing a dermatologist online.  Teledermatology practices, such as DermatologistOnCall, can help expedite seeing a skin specialist.  This method of care can also be very cost-effective by avoiding lost time for missed work and travel. 

Realistic Treatment Times
Treatment session times and healing course will vary greatly from person to person based on the affected area and the method of treatment.

For example, the Clarify Handheld treatment surface is a 2 x 2 inch square, the size of a medium-sized sticky note.  Treatments begin at 25 seconds but increase progressively each treatment session.  Most people are happy when the total treatment time per session is as long as one TV show, maybe two at most.  Thus, 10-20 treatment squares is ideal after 12 months of treatments. However, some people are very happy treating only areas that are most visible.

The size of the Clarify Handheld will work well for just about anywhere but is especially nice for the face, neck, hands and other body areas.  It is uniquely good for areas that are shaded from the bulbs in standard phototherapy booths or panels.   The Clarify Handheld is also especially nice for wrinkly skin such as around the mouth or finger joints, as skin can be stretched and a nice even treatment field applied directly onto the skin.

The Clarify Handheld is great for anyone who wants the best vitiligo treatment possible combined with convenience and an affordable price point.  But you need to be able to reach the area you’ll be treating or have someone who can help you with it—and of course, you need a recent smartphone.

(If you think a larger panel might be needed for your own treatment, be sure to sign up for our updateswe’re working on that, too!)

Are you the Right Fit?
Consistent and adherent use of a combination of treatments is the greatest predictor of vitiligo treatment success. You must have a high level of motivation to treat and you must be someone who is good at following directions.  We teach you to treat yourself safely—your success (and possibly failure) is in your own hands.

But don’t worry if you don’t know much about phototherapy!  Clarify’s CarePartner Program will teach you everything you need to know about home light therapy.  So if you’re willing to spend a couple minutes each day for the first week or so to learn how to perform Clarify Home Light Therapy properly, you’ll be able to treat yourself safely, effectively and confidently whenever and wherever it’s convenient for you.

Want to give Clarify a try? We want to meet you!  Contact us to learn more or order to get started.  We’re here if you need us.

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