How does the visit work?
You answer questions and send at least 2 photos. The doctor reads your answers and looks at your photos. Then the doctor sends a plan. The plan starts with sun care and skin care. Use sunscreen, SPF 30 or higher. Cover your skin in the sun. Do not use tanning beds or sun lamps. Try not to hurt or rub your skin. Makeup can cover the patches. The doctor may also send one cream. You use one cream at a time: a steroid cream, for your arms, legs, chest, belly, back, hands, or feet; tacrolimus ointment or pimecrolimus cream, which you can use on your face and neck too; or Opzelura (ruxolitinib) cream. Some of your answers can rule out a cream. If you use light treatment, a tanning bed, or a sun lamp, we rule out tacrolimus, pimecrolimus, and Opzelura. If every cream is ruled out, you get no medicine. We tell you to see your own doctor.
Do you diagnose vitiligo?
No. A doctor, nurse practitioner, or physician assistant must already have told you that you have vitiligo. We diagnose nothing here, and we do not order tests. Your photos only help the doctor see that your patches look like what was diagnosed. If your photos show a warning sign from the lists on this page, you get no medicine. We tell you what that list says. If your photos do not look like vitiligo, you also get no medicine. We tell you to see your own doctor. If we find any of this out after you pay, the visit price is usually not refunded.
Which creams do you use, and which are approved?
Opzelura is the only medicine the FDA approved to bring back lost skin color in vitiligo. Doctors also use the steroid, tacrolimus, and pimecrolimus for vitiligo. That use is called off-label, because their FDA labels do not name vitiligo. Unlike the other creams, the steroid cream has no FDA boxed warning. But it can thin the skin. Tacrolimus and pimecrolimus have an FDA boxed warning. It says their long-term safety is not known. Do not use them nonstop for a long time. A few people who used them had skin cancer or lymphoma. A link was not proven. Opzelura has an FDA boxed warning. It lists serious infections, death, cancer, heart attack, stroke, and blood clots. Cancers, blood clots, and serious lung infections were also reported in people who used Opzelura cream. Death, heart attack, and stroke were seen with pills of the same kind. We only send Opzelura if your answers show it is safe for you.
Do you order blood tests?
No. Ask your own doctor about a thyroid check. Ask your own doctor about a yearly skin check too, while you use tacrolimus, pimecrolimus, or Opzelura.
Why not on my eyelids, lips, or private parts?
These creams must stay out of your eyes. Do not use them on your eyelids, your lips, or inside your nose or mouth. Patches on your eyelids, lips, genitals, groin, anus, or inside your mouth or nose need your own doctor, so this visit cannot help with them. Do not send photos of your private parts.
Can my child use this?
No. This visit is for adults 18 or older. Please see a skin doctor for your child.
Is it safe in pregnancy or while breastfeeding?
Please see your own doctor. This visit is not for anyone who is pregnant, might be pregnant, plans to get pregnant in the next 3 months, or is breastfeeding. We ask again at every check-in. With Opzelura, do not breastfeed while you use it, or for about 4 weeks after your last dose.
How long until I see color?
Color comes back slowly. Give a cream 12 weeks. Opzelura can take 24 weeks or more. Take a photo of each area every 4 weeks, in the same light. Color can fade again after you stop. If you do not see color after the full time, send new photos at a check-in.
How do check-ins work?
Your first check-in is free. It is at about 2 weeks. A later check-in has a price that is shown before you pay. Check-ins are for photos, side effects, and safety questions. We send each cream as a 4-week fill, with 2 refills. We send medicine for up to 12 months. Then you see your own doctor for a skin check. At every check-in we ask the warning-sign questions again. We ask again how much skin your patches cover, what other medicines you take, and how your health is. We also ask again about these: pregnancy, planning a pregnancy, breastfeeding, patches on one side only, many new patches or fast growth, new patches on your eyelids, lips, or private parts, a pill for vitiligo, light treatment from a skin doctor, a bleaching cream, melanoma, and cancer immunotherapy. If any of these is yes, or your patches now cover more than 10 of your hands, stop using the cream you have. We send no more medicine. We cancel your refills. See your own doctor instead. If a warning sign from the lists on this page starts, do not wait for a check-in or our reply. Get care as shown there, and follow the first list that fits.
Can I use a tanning bed or sun lamp?
No. Use sunscreen, SPF 30 or higher, and cover your skin in the sun. If you use light treatment, a tanning bed, or a sun lamp, we rule out tacrolimus, pimecrolimus, and Opzelura. If a skin doctor gives you light treatment now, see your own doctor.
When do I need care right away?
Read from the top. If more than one fits, follow the first one. Call 911 or go to the ER now if you have trouble breathing, or wheezing; chest pain or tightness, or sudden pain in your upper back; swelling of your lips, tongue, face, or throat, or trouble swallowing; trouble speaking, weakness or numbness on one side of your body, or a drooping face; sudden loss of vision; or a new rash with blisters or peeling skin over large parts of your body, especially after a new medicine. If any of these start after you begin a cream, stop the cream. If you have thoughts of ending your life, or of hurting yourself, call or text 988 now. Call 911 if you are in danger. Go to the ER or urgent care today if you have pain, swelling, or tenderness in one leg, or eye pain with redness, sensitivity to light, or blurry vision. If any of these start after you begin a cream, stop the cream. See a doctor in person today if you have a fever of 100.4 F (38 C) or higher, or shaking chills; skin that is red, warm, swollen, or painful, or that has pus; a rash of blisters, or burning pain, on one side of your body; hives, or an itchy rash all over your body, after you start a cream; or easy bruising or bleeding, or great tiredness with pale skin, while you use Opzelura. If any of these start after you begin a cream, stop the cream. See a doctor in person within 14 days if you have a spot or mole that is dark, new, growing, changing, bleeding, or crusted; skin in or near your white patches that is scaly, raised, sore, blistered, open, or crusted; skin in your white patches that is hard, tight, thickened, shiny, or wrinkled; or swollen lumps in your neck, armpit, or groin. If you use tacrolimus or pimecrolimus and get swollen lumps, stop it until you see a doctor.
What does it cost?
The visit price is shown before you pay. The first check-in is free. Later check-ins have a price that is shown before you pay. You pay the pharmacy for the medicine. Ask the pharmacy what a medicine will cost before you buy it.