Insights Into Advancing Vitiligo Care

During the second day of the APP Institute Dermatology 2024, David Rosmarin, MD, and Andrea Nguyen, DMSc, MPAS, PA-C, presented updates on advancing vitiligo care, focusing on targeted therapies and strategies to improve patient outcomes in their session, “Advancing Vitiligo Care: Updates in Targeted Therapy and Strategies to Improve Patient Quality of Life.”

Dr Rosmarin, the Kampen-Norins scholar and chair of the department of dermatology at Indiana University, kicked off the session by emphasizing that vitiligo is more than a cosmetic issue; it is an autoimmune condition causing skin depigmentation that often begins by age 30. He highlighted the importance of using tools like the Wood’s lamp to assess the extent of depigmentation, especially in fair-skinned patients.

“Vitiligo is categorized into 2 main types: segmental and non-segmental,” stated Dr Rosmarin. “Non-segmental vitiligo, the more common type, typically affects areas like the face and hands.” Segmental vitiligo has a rapid onset and stabilizes after 2 years, often affecting children. He discussed the challenges of treating mucosal lesions, noting that permanent pigmentation is rare.

He also shared key indicators of active vitiligo, such as confetti depigmentation, trichrome vitiligo, and the Koebner phenomenon. Additionally, he highlighted the strong link between vitiligo and autoimmune thyroid disease, recommending routine thyroid stimulating hormone screening.

Dr Rosmarin emphasized the need for patient-centered care and staying informed about emerging research in vitiligo, including newer treatments like Janus kinase (JAK) inhibitors and the ongoing exploration of subclinical hearing loss in affected patients.

Next, Dr Nguyen, a physician assistant at First OC Dermatology in Irvine, CA, shared valuable insights on advancing vitiligo care, focusing on quality-of-life strategies.

Dr Nguyen presented a case study of a 32-year-old man with vitiligo, highlighting the significant emotional and social impact of the disease. “Research shows vitiligo patients have higher rates of depression and anxiety compared to controls, with up to 35.8% experiencing anxiety.”

Dr Rosmarin then discussed vitiligo as a Th1-driven autoimmune disease, explaining how JAK inhibitors like ruxolitinib cream effectively target this pathway. “Clinical trials have shown that approximately 50% of patients achieve significant facial repigmentation after a year of treatment.”

Dr Nguyen reviewed additional treatment options, including topical corticosteroids, calcineurin inhibitors, and phototherapy. She emphasized the importance of setting patient expectations for repigmentation, noting that “it can be a slow process requiring consistent treatment.” Surgical options and depigmentation therapies were also briefly covered.

The session concluded with practical tips for navigating insurance challenges and securing treatment access. Drs Nguyen and Rosmarin stressed the importance of patient-centered care, advocating for open discussions about treatment goals, quality of life, and the need for combination therapies to achieve optimal outcomes in vitiligo care.

For more meeting coverage, visit the APP Institute Dermatology 2024 newsroom.

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Reference
Rosmarin D, Nguyen A. Advancing vitiligo care: updates in targeted therapy and strategies to improve patient quality of life. Presented at: APP Institute Dermatology; Aug 16–17, 2024; Virtual.