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Hi All,

Vitiligo patches on top of the hand are probably the hardest to treat.  There are apparently some obvious reasons for that,  but the real reasons are usually unknown by most of people.

This post assume that you have read Non-Segmental Vitiligo Protocol post, so that you are taking care of the primary and secondary causes of vitiligo. http://www.vitiligofriends.org/forum/topics/non-segmental-vitiligo-basic-protocol-suggestion

Back to hand vitiligo patches, the obvious reasons (minors)  are:

1- Thicker skin: It causes less absorption of any cream, like Elidel, Protopic, etc.

2- Close to non-hairy skin: Top of the hands are near the non-hairy skin of the palms, so that there are less available melanocytes to migrate.  

Brief explanation: Melanocytes come from three possible sources: from the hair follicle unit which is the main provider of pigment cells, from the border of vitiligo lesions, and from unaffected melanocytes within depigmented areas; pigment cells at these locations originate a perifollicular, border spreading and a diffuse repigmentation pattern.

The real reasons (majors) are:

1- Hand bones are very close to he skin (almost no flesh in between).

2- The excess of physical traumas that happens in a daily basis activities (hits, friction, cuts, scratches, injuries, shocks, knocks, punches, hand-shakes, HI5s, push-ups, basketball playing, etc.). 

So, how to treat hand vitiligo patches?

The only things that can be done to improve whatever cream treatment are:

- Dermastamp the patches (once a week) before applying the cream.  Use 0.5mm model to avoid bleeding.

http://shop.owndoc.com/product-info.php?dermastamp05-pid245.html

- Wear soft gloves as much as possible (or just at home) to reduce hand impacts, hurts, friction, etc.

The gloves have to be very comfortable and not tight.

- Avoid physical traumas (hits, friction, cuts, scratches, injuries, shocks, knocks, punches, hand-shakes, HI5s, push-ups, basketball playing, etc.).

Well, I hope it works for you.

PS: 

Excessive impact and friction may aggravate vitiligo:

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