Repigmentation on Hypopigmented Patches or Lighening the Entire Skin Tone

[shanakape]

I am 28+ years & around skin type V. Nearly 7 years back I lost my pigmentation on some areas of my legs making them far visible due to the high contrast of these patches with the sorrounding skin. The actual cause was not really known, but this happened only once and spreading lasted during a brief period of 2-3 weeks. Then the spreading stopped, yet the damage it caused was quite horrible & stayed permanently. Few dermatologists suspected it to be Vitiligo, though they were not 100% sure. I want to know whether there's a way to bring my normal pigmentation back on these few yet somewhat large Hypopigmented patches.
I know there're Nanoband UVB phototheraphy techniques for bringing the pigmentation back, but that kind of treatments are very hard to be found in the Asian region (I'm from Asia), also it involves a risk of skin cancer. Anyway can you just suggest me (other) possible processes to get my pigmentation back even if they're not currently being done in these regions so that at least I can hope I would get these done later ? Or any place which performs phototherapy for repigmentation ? Or if such repigmentation techniques are still immature & risky, is it possible to make the entire skin tone ligher from within ( I mean from dermal layer to the epidermal layer), so that the patches would go much less noticeable ?. I know this involves a combination of treatments, not just one process, and involves a fair bit of risk too, but If you have any suggestion, it's greatly appreciated. Is there something called L-Gluetathione injections which can make your skin ligher from within so that entire body would become somewhat ligher in complexion ? Please advise, this has become quiet a horrible frustrating experience for me as I didn't have any such issue when I was in my early 20s & all of the sudden this mess came. Thanks, any help/suggestion is greatly appreciated.

[shanakape]

Thanks for the information. In fact, these patches are not really spreading now for 6+ years, these were only spreading during the initial 2-3 weeks more than 6 years back when this initially came to my attention. So the dermatologist I have consulted now said I wouldn't need any steroids as this is not spreading. Is it possible this to start spreading again in future even after all these seemingly inactive years ?
However under the mentioned 2-3 weeks, I meant 6 years ago when this was invasively spreading, the initial suspicision was that this was due to a certain fungal activity, so I was under the medication for fungus during that time. Then it stopped. But is it possible to have this permanent depigmentation/hypopigmentation due to fungus even when it's dead and inactive ( It has to be inactive as the patches are not spreading, Am I right ?). I mean are there such fungal activities which can destroy the entire melanocytes layer in the affected area, so that these white patches (in fact it's the visible result, may not be the acatual cause) would become permanet.
The thing is I'm now more worried about these patches, I mean their horrible look compared to the surrounding skin (I'm around photo type V), so I consulted few other dermatologists after few years. They suspected this to be Vitiligo, not confirmed though yet as I haven't even undergone any blood or biopsy tests yet. My concern is if this is not spreading in future, Can I get these white patches removed by targetting only on the patches, not the entire body. I had heard about the nanoband UV / Intense Pulse Light systems which can target the affected areas, but unfortunately that kind of equipment for repigmentation purposes seemed to be not available here, at least that's what I came to know after consulting few dermatologists here. Their recommendation is to apply a solution which can increase the sensitivity on the affected patches & stay in the sun. I'm a bit reluctant for this procedure as it can also discolorate the entire body, especially since I have the hyperpigmenation issues on other part of the body whenever I stayed outside in the sun for few hours. So that's the concern & the reason why I wanted have a more targetted action. Anyway I'll check the options again when I re-visit the dermatologist next time. Not sure whether they would be doing any autologous melanocytes transfer here, may be not. Your post was really useful anyway, at least it confirmed that I can keep some failth at least in future. I had heard about most of these treatment techniques even in the past, but it's quite difficult to find a place which performs such better advanced techniques (Nanoband UV phototheraphy, Autologous Melanocyte transfer etc.) for these whiter patches. Other more pervasive treatments (oral medications, staying in the sun etc.) cannot have the targetted action I think (of course i can apply a high SPF foundation on rest of the body when I stay in the sun, in order to minimize the damage there, not sure how far they would help me under the very harsh sunlight here in Asia), so can endup making me even more discolourated I think.

[Bhupinder Kaur, MD]

Hello,
Vitiligo is a pigmentation disorder in which melanocytes (the cells that make pigment) in the skin are destroyed. As a result, white patches appear on the skin in different parts of the body. Diagnosis can be confirmed by external examination, blood tests to check skin cell count  for melanocytes and biopsy of the skin patches.

Treatment options include steroids, psoralen photochemotherapy(PUVA),depigmentation and surgical therapy like skin grafting, micropigmentation or tattooing and autologous melanocyte transplants. However the choice of therapy depends on the number of white patches; their location, sizes, and how widespread they are and the option that is convenient to you. I would suggest  you to discuss these options with a dermatologist.

I hope it helps. Take care and please do keep me posted in case you have any additional doubts. Kind regards.