June is Vitiligo Awareness Month. At the 2024 Skin of Color Update, Rebecca Vasquez, MD, FAAD, of UT Southwestern Medical Center, shared a comprehensive overview of vitiligo, highlighting its significant psychological and medical impact.
Affecting 0.5% to 2% of the global population, Dr. Vasquez detailed the role of immune-mediated destruction of melanocytes, which is primarily driven by autoreactive CD8+ T cells. Environmental triggers, like sunburn or phenolic compounds, can trigger or exacerbate the condition, which often appears in areas prone to friction or trauma, such as the elbows and hands.
Clinical Types:
- Nonsegmental Vitiligo (NSV): Most common, progressive, and often associated with autoimmune conditions.
- Segmental Vitiligo (SV): Less common, typically stabilizes after rapid early progression.
Dr. Vasquez emphasized the emotional burden of the disease, especially in patients with skin of color, and the need to address psychological health alongside physical symptoms.
Treatment Options:
- Topical Therapies: Corticosteroids and calcineurin inhibitors.
- Phototherapy: Narrowband UVB (NbUVB) promotes repigmentation, especially when combined with topicals.
- JAK Inhibitors: Topical ruxolitinib has shown strong results in trials; oral versions are in phase 3.
- Surgical Treatments: Autologous skin cell suspension shows high repigmentation success in stable cases.
- Combination Therapies: Approaches like ruxolitinib + NbUVB yield better outcomes.
Emerging Research:
- Oral JAK inhibitors (ritlecitinib, povorcitinib, upadacitinib) show promise.
- Targeting IL-15 as a way to go after tissue-resident memory T cells may offer long-term remission.
Conclusion:
There is no cure, but treatment is advancing. A personalized, multidisciplinary approach is essential to effectively manage both the physical and emotional aspects of vitiligo.
This session summary was written by Dr. Nidhi Shah and published on Next Steps in Derm.
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