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Dr. Sarah Asch details therapeutic strategies for treating pediatric patients with vitiligo.
An estimated 2 million patients in the United States have vitiligo, which is a dermatologic condition defined by depigmentation of the skin.
Though there is currently no cure, recent medical advancements have helped patients and providers alike gain a broader perspective on the skin condition. Likewise, prominent cultural figures with vitiligo have also contributed addressing the stigma surrounding the disease.
Despite this, vitiligo is still considered by many to be solely a cosmetic condition, though it is very much a medical condition as well.
Sarah Asch, MD, FAAP, FAAD, Society of Pediatric Dermatology Teledermatology Committee Chair, spoke of how the public perception of vitiligo has evolved in recent years, as well as how vitiligo affects adults and pediatric patients differently and the myriad of promising new therapies that are currently being explored.
“We know that vitiligo really does have a really big impact on people's quality of life, both in children and adults, and we know the impact is not the same for every person,” Asch said. “So, it was very important for us to provide resources for people who are affected by vitiligo in terms of advocating and making sure they have access to support groups and other resources that could be helpful to them.”
Asch noted that a stronger focus on treating pediatric patients – who represent approximately 25-30% of those affected by vitiligo- has been adopted in recent years.
“Children tend to have a better response to therapies than adults, and so we do actually treat them more aggressively, and this is really a new way of thinking about vitiligo,” Asch said. “Ten years ago, there was much less of a push to treat early and aggressively because we did not understand the difference that we could make in terms of the bringing the color back to the skin.”
Topical steroids such as hydrocortisone and topical calcineurin inhibitors have been used to signal color-making cells in the body and promote re-pigmentation. Meanwhile, larger body surface areas will often be treated with phototherapy.
Perhaps the greatest challenge in implementing phototherapy, however, is that it requires some patients to visit dermatology offices multiple times a week. Additionally, at-home phototherapy units are often not covered by insurance, making it increasingly difficult for some patients to receive treatment.
“That can be very cost prohibitive, and it’s another avenue in which we're really working for advocacy for our patients with vitiligo,” Asch said. “To have this recognized as more than just a cosmetic issue, that it is a true autoimmune disease that needs treatment.”
Meanwhile, promising new data on topical ruxolitinib cream indicated that a Food and Drug Administration (FDA)-approved therapy might soon be available for children and adult patients.
“The data was very impressive; one of the things (the data) showed was a 75% improvement of the facial vitiligo,” Asch said. “That is incredible. We just don't have other treatments that have that kind of response on that kind of timeline. It was tested on children ages 12 and up, and so probably the first approvals will come out for 12 and up, hopefully even this year.”
To hear more from Dr. Asch, listen to the podcast above.