Monday, December 20, 2010

Treatment of Vitiligo, Hypopigmentation and Hypopigmented Scars.

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Lighter colored (hypopigmented) areas of skin can be due to skin damage with scarring or for unknown reasons. When the cause is unknown the process is called vitiligo and is presumed to be due to an autoimmune phenomenon or a viral infection. Vitiligo affects 1 to 2% of the people in the world, 2 to 5 million in the US alone. Have of these affected people developed it before the age of 20. Regardless of the cause the common factor between all of them is white patches of skin where the skin pigment cells called melanocytes have been killed. If the line width of the area is in the order of a few millimeters application of a tattoo needle without tattoo pigment or application of an excimer laser has corrected the problem. Tattoos have also been employed but this is impractical when the hypopigmented patches are large. Tattooing a skin color into the white patch has not been reliable as the approximation of any given individuals native skin color is very difficult. Of course cover make up has been around for centuries and can provide adequate camouflage but has to be repeatedly applied.

With modern scientific knowledge and technical know how these larger hypopigmented areas can be effectively treated. The process involves harvesting skin from one area as with a very thin skin graft. Pulverizing that skin into a thin paste and then spraying it onto the hypopigmented area after the area has been dermabraded to create a raw surface. The process is much easier to perform using the Recell device depicted in this video.


Before and 16 weeks after dermabrasion and cell spray application to inner left ankle vitiligo

white hypopigmented scar

Before and 7 months after laser abrasion and cell spray application to the forehead for depigmentation from chemical peel and previous laser dermabrasion

In these cases the depigmented areas were repopulated with pigment cells.

hyperpigmented scar

Before and 6 months after dermabrasion and cell spray to decrease the pigmentation of a skin graft placed for a scald burn

vitiligo lip

Vitiligo of the Lower Lip

This cell spray methodology can clearly increase or decrease skin pigmentation in the appropriate patient but the evenness and intensity of the resulting re-pigmentation is not predictable. For larger areas more than one treatment session may be required. The treatment may also be limited in Afro-Americans or others who are prone to keloid or bad scar formation. In such cases it would be prudent to first test patch a small patch of skin with dermabrasion or laser abrasion to make sure the patient does not form bad scars after the procedure.

The CelluTome device is FDA approved for epidermal (surface skin cell) harvesting. The device uses heat and suction to create an array of 128 superficial pigment containing epidermal blisters, each around 2 mm wide, over 30 minutes. It then cuts the blisters in a painless fashion without bleeding because the blisters are so superficial. The device simultaneously places all of the blister grafts on a standard surgical dressing. The donor area which is usually the thigh heals within 3 or 4 days and the same site can be used 2 or 3 times.

In treating vitiligo the depigmented area is abraded or lasered to create a raw surface that the dressing containing blister grafts is placed on. The dressing is clear so you can see graft take and repigmentation taking place. This method has been used effectively to treat vitiligo, diabetic foot wounds, burns, pyoderma gangrenosum and traumatic wounds. Most wounds heal from the edges inward but seeding the wounds in this manner speeds up the healing process as healing occurs from the edges of the wound and the edge of each blister graft.

The main problems with this approach for vitiligo is some areas such as the lips, eyelids and fingers are not amenable to placement of the clear dressing. Use on the neck or wrists would require the use of a cervical collar or splint in order to keep the dressing in place.

July 5, 2011 addendum:
A just released report describes the use of topical bimatoprost 0.03% ophthalmic solution (a prostaglandin F2-alpha analogue) in the treatment of vitiligo. 1 drop is applied per 2 cm2 of affected skin twice daily for 4 months. Repigmentation begins after 2 months of application and more than half of patients get the majority of the area repigmented. Vitiligo less than 6 mohnths old responds better than older patches of vitiligo. Facial areas respond more quickly (generally within 4 to 6 weeks) with less risk of recurrence after the 4 month treatment period than other areas of the body. This may end up being a cheaper alternative to surgery.

Aaron Stone MD - twitter
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  1. I do realize that this post is older, but I assume you still follow up with your blog. I have several and severe hypo-pigmented spots on my face, neck, and chest. The spots are from unusual acne that I develop, which heals slowly, and finally leaves white patches. The white patches almost always appear. I've had some of the hypo-pigmented scars on my chest since I was a young girl. I have very fair, Irish skin. I do have an autoimmune disease, so I am wondering if that plays a role in the skin's lack of correctly healing itself.
    Is this procedure available mainstream? I live in Cincinnati, OH.

  2. Bimatoprost is for vitiligo but what you are describing is not vitiligo. What you are describing sounds like discoid lupus. You should be seen by a Dermatologist for medical management. Once the underlying cause is controlled Recell skin cell spray is your best option to repigment these areas. Unfortunately Recell is still not FDA approved for use in the US though it has been available to patients in Canada and the EU for a number of years.

  3. Hi recently the skin on my lips has been changing colors to more like a pale white color i have a black skin i never seen anyone with this problem . At first i got fever blisters on my lips then it went away and left a scar that is white on my top/bottom left side of the lip im 16 yrs so i really need help here like is there anything i can do to regain its normal skin color?

  4. It sounds like ReCell would be your best bet but it is still not available in the US.

  5. Any idea when Recell might be available in the US?

  6. I have no idea and cannot understand why it is taking so long. My name is on the company email list so I should receive notification as soon as it is FDA approved.

    1. Hypo-pigmentation after corns. How can this be helped?

  7. The best way to treat this is ReCell but it is still not FDA approved in the US and I have no idea when/if it will be. It has been available for years in Canada, Europe etc. and I cannot figure out what is holding up its approval in the US.

  8. Hi my wife has a laser peel and unfortuantely it resulted in Hypo pigmentation on her face. She is really upset about it and how effective would the recell work on her? Does it give an even skin tone or could it be even worse? Thanks

  9. There is no guarantee what the evenness of the color tone will be but it does improve the appearance. The area is dermabraded and then the pigment cells are sprayed on. Just as in spray painting the more you spray the more pigment you get.

    Never having seen your wife I cannot make any specific recommendations but in some cases you only need to treat the edges of the previously treated areas in order to make the hypopigmentation less visible by making the transition between hypopigmented and normally pigmented areas more gradual.

  10. Can a white scar be formed after a large pimple doc??

  11. when my cold sores heal and the scab falls off, it leaves a pink spot on my lips which is lighter than my natural lip color. the area is flat and kind of shiny.i have 2/3 spots all over my lips. is that hypopigmentation? how can i treat it? is there any topical over the counter ointment/cream?

    1. This comment has been removed by the author.

    2. If it is pink it is by definition not hypopigmented. What you need to do is start treatment as soon as you get a cold sore not wait until you have it and it is already resolving or resolved. That will require a prescription from your doctor. There is no over the counter for this. My blog comment section is not a substitute for your doctor.


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