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What can be done to treat vitiligo in the lower lip?

What can be done to treat vitiligo in the lower lip?

The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

Dr. Hemalatha

Published At August 4, 2017
Reviewed AtMay 14, 2024

Patient's Query

Hi doctor,

My daughter has vitiligo on her lower lip. It came to our notice this year, and we consulted a doctor immediately. The doctor gave Dicaris 150 mg to be taken on the weekends of every week for four months. She finished 32 Dicaris tablets so far. She also used Melbild lotion at night and sun exposure on the next morning for three months. Now it seems that the white patch is not stopped spreading. It has increased very little. I have uploaded images before taking Dicaris and present. Now we want to go for vitiligo surgery. But we have come to know that before the surgery, the patch should stop spreading. What should we do? Please help.

Answered by Dr. Shaunak Patel

Hello,

Welcome to icliniq.com.

I appreciate you going at length in explaining me the exact medicine regimen. You are well in time and not late, so do not worry. I normally give tablet Azathioprine taking into consideration the weight factor. After the stabilization has been achieved in about a couple of months, I advise PUVA (photochemotherapy) or Excimer light for a minor patch. Considering surgery in mouth area would not be a good option, as it is the dynamic part of the expression and not stable and thus chances for graft failure or improper results. As a home care regimen, I have had good results with Tacrolimus ointment. It needs to be used for a long time though a little after the total treatment is over for a better suppression of skin immunity. As a word of advice, avoid too hot or too cold drinks to be sipped. She must apply sunscreen on lips and also use a lip balm with good sun protection factor after that. Kindly let me know how can I help you further.

Patient's Query

Hi doctor,

Thanks for your advice. I would request you earnestly to answer my following queries. How long should tablet Azathioprine and Tacrolimus ointment be continued to get stabilization? What is meant by weight factor? Please give a detailed name of the tablet and ointment with the brand name. What precautions are to be taken for these medicines? My daughter is a little bit weak physically. She took Dicaris tablet 150 mg for four months. Are these two safe for her? Where PUVA or excimer light therapy are available? Are these two safe? How long these have to be continued? Where should I go for these treatments? Your way of writing has given me much hope. Please forgive me if I have shown any audacity in asking the above questions. Waiting eagerly for your reply. Regards.

Answered by Dr. Shaunak Patel

Hello,

Welcome to icliniq.com.

Azathioprine and Tacrolimus need to be given till stabilization, which means till vitiligo has stopped spreading. This depends on person to person and since you said that your daughter is weak and the dose is calculated as per the weight. Also, take precautions as advised. PUVA and excimer are safe, but some redness and skin irritation persists after exposure, but it is manageable and usually, subsides in 3 to 4 days. It has to be continued till your doctor advice, or you see satisfactory result whichever is earlier. Certain medicines like Methoxsalen need to be popped before the sessions for best results. The dosage shall be calculated by the attending dermatologist. Keep me posted. I have not mentioned exact doses, as I leave it to the discretion of the doctor after the final examination. This is the best outline of treatment that I suggest you.

Patient's Query

Hi doctor,

I am back again with concern. I have gone through many articles online, from there I have got some more queries. I am here for your kind answer. For Tacrolimus, it is written that it should not be used in children younger than 16 years. But my daughter is 14 years 10 months old. One doctor mentioned Azoran (Azathioprine) is an immunosuppressant and has been tried in some conditions such as pemphigus vulgaris but its role in vitiligo is unlikely to be beneficial. Unfortunately, there is no effective therapy known as date. This line is quite frustrating for me.

Answered by Dr. Shaunak Patel

Hello,

Welcome back to icliniq.com.

I give Tacrolimus with caution and I feel that a sharp delineation of age is not the final criteria. Body weight and profile also should be taken into account. Azathioprine is widely used. Maybe it is the doctor's opinion but treatment plan and choices can change from doctor to doctor. So, do not worry. All aim at stopping the disease process in one way or the other.

Patient's Query

Hi doctor,

Please answer my following additional queries. I found in a photograph of my daughter that the white patch was developing. It means the vitiligo started before that time and taken this size within 5 years. We could not notice this at all. Will it affect the treatment process? If the patch seems to be static we will stop the use of medicine. Does it happen that the patch starts spreading again when the medicine is stopped? When we consult a doctor, there is a chance that different types of medicines are prescribed. What should we do if steroids are prescribed? I have come to know that between PUVA and Excimer therapy, excimer is a newer one. Which one is better compared to other? How much time will it take for re-pigmentation on my daughter's lip? It is written in almost every article that whole treatment involves much risk and danger such as developing skin cancer, causing harm to other organs, etc. Please tell us how we should proceed. It is written in many places that vitiligo is not curable. Is it that true? If so, then what do these treatments mean?

Answered by Dr. Shaunak Patel

Hello,

Welcome back to icliniq.com.

Thanks for your reply. Medically, there is a minimum of six months (practically speaking three months) stability criteria before we go for any skin treatment related to vitiligo. However this period can vary amongst doctors. We wait and watch for the time period stated above. Then we proceed. Personally I give steroids to curtail any active form of vitiligo and then switch over to other medicines. So, yes, it is of no problem if your health care provider has a plan to taper it and stop. Excimer was developed in response to the ill effects of PUVA in the long run (short period of course does not have any ill effect). However PUVA has been around from quite a while now and still is the choice of treatment. Alternatively NB-UVB has been developed which is much more safer. Excimer is placed at a higher price because of its specific nature and ability to give response effectively. There are two things to bear in mind - Excimer laser and Excimer lamp. Former is a quite costly system to afford so doctors sometimes prefer the lamp. However the lamp is not so powerful like laser but gets the job done nicely too. Excimer is the best treatment for targeted body areas. Before you agree to start the treatment ask your doctor which one he has excimer laser or lamp. For sure vitiligo has a cure. Better to start early. Your doctor will be able to explain you for sure how much success rate after a test patch is performed so that you can have an idea about the success rate, time and cost involved.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Shaunak Patel
Dr. Shaunak Patel

Dermatology

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