Restoring Skin Pigmentation in Vitiligo With Advanced Treatments - Episode 12
Expert dermatologists discuss the impact of vitiligo and vitiligo treatment on quality of life.
Seemal Desai, MD: This has been a phenomenal discussion. We’ve talked about pathophysiology, we talked about treatment, data, and safety. So, let’s round over to home base and talk a little bit about just promoting compliance and adherence, and that patient experience and patient journey. Brittany, I’m going to start with you, and Ted, I want you to chime in here as well. We talked about conventional treatments for vitiligo. They obviously can put a burden on patient’s lifestyle, time, and commitment; lots of office visits are needed. How do you think the new advent of the ruxolitinib cream and, potentially, these new other therapies will help impact the burden for patients?
Brittany Craiglow, MD: For sure, going to phototherapy or going for excimer [laser therapy] 2 or 3 days a week is not feasible for most patients and certainly not something that’s sustainable long-term. Again, the data we have is ruxolitinib monotherapy, so that’s something you can do without anybody else at your house. I think getting people to do it is the next step, to get adherence there. But again, as you mentioned, patients with vitiligo are very motivated, and I think we just need to make sure and tell them at the outset, this is something you need to do routinely, and you need to keep going because you’re not going to see anything for a while. Also, in the beginning or when you start to repigment, it’s also important for patients to know that they might not really love what they see because they get this “salt and pepper” look that is almost more obvious than complete depigmentation. This is something where you may not love the road, but we think that we’re going to be able to get there in the end. So, we have to commit to it. Do you think that you can do this twice daily most days out of the week? If you need to set an alarm for it, great. I always tell people, put it with your toothbrush. Don’t brush your teeth with it, but do it when you brush your teeth. They have data; it takes 28 days to make a habit. You do it for 28 days, it’s part of your life. Talking about home phototherapy, if we’re able to get that for patients, that can make things a lot easier. Then again, when we have the conversation with them, asking, what’s reasonable for you? And making it OK for them to say, “Wow, that’s a lot.” I’ll say to people, this is hard. I’m not sure I could do it; do you think you could? Are you that motivated?
Seemal Desai, MD: I like that.
Brittany Craiglow, MD: And then figuring out, kind of like you were saying, acknowledging the impact on quality of life. We have to give them permission to say, because they want to be the good patient, they want to say, “Yes, Doctor, I’ll do whatever you say.” But in the back of their mind, they’re like, “Oh my gosh.” When they get home and they realize what that actually means, and they’ve got kids, and they’ve got to run out the door, it’s a whole different scenario. So, I’ll say, “This is a lot of work. Do you think that you can do it and are you motivated enough?”, And I will say, “Or do you think we should just choose one area to start with? Or if after a while you fatigue, then OK, maybe then we focus on one.” But again, it’s really about being their cheerleader but also acknowledging that it’s not easy, even though it sounds easy. Just put a cream on twice a day. When you have a busy life, it’s one more thing.
Seemal Desai, MD: It’s one more thing to do. Ted, anything to add?
Ted Lain, MD: I think Brit had some really good points there. I think it’s important to understand that on the label, there’s no limitation of use in terms of time. We have 52-week data. As Nada Elbuluk said, we’re going to get more data in terms of safety and longer use. So, this can be used in all areas of the body, and I would encourage people to really ask patients about those special sites, the genital area in particular. It can be devastating for patients, much like other inflammatory diseases are devastating in that area. So don’t forget to ask, examine, and talk about how this one treatment is available to be used in all body areas for an unlimited amount of time. We do have a BSA [body surface area] limitation, but not a time limitation.
Transcript edited for clarity