Restoring Skin Pigmentation in Vitiligo With Advanced Treatments - Episode 8
Expert dermatologists comment on the impact of UV light exposure on areas of the skin with vitiligo and their recommendations for sunscreen use.
Seemal Desai, MD: Brittany, you mentioned response rates. We talked about the difficulty in other sites. What are your thoughts on why the body pigmentation lagged behind the facial repigmentation? Do you agree with Ted’s comments?
Brittany Craiglow, MD: Yes. It has a lot to do with follicle density, but I also think ambient UV [ultraviolet] light. We’re all walking around. What’s getting light every day? Even in Connecticut, where I’m wearing a jacket, I’m getting light on my face. Even a little sun exposure might be enough to tickle those melanocytes to say, “The bad guys are gone. You can come back.” Light is very important, and in warmer climates we may see people repigment faster on their body.
Seemal Desai, MD: I’ve got to ask this. It’s a little off-the-cuff, but I want everyone’s opinion. For patients with vitiligo, because we want a little light, do we still tell them to wear sunscreen on their face? Let’s go. Let’s each tackle that. Nada, do you want to tackle it first?
Nada Elbuluk, MD: I do. I give them the same recommendation that I give any other individual who comes through my office. I recommend sunscreen. Because a lot of them think they’re at increased risk for skin cancer, I do tell them that the good news is we know that individuals with vitiligo are not. They’re at decreased risk of melanoma, which is reassuring. It doesn’t mean you don’t need sunscreen. You can still get sunburned. I want you to wear it just like anyone else. For most of my patients, if I want them to get light, we’re doing it through phototherapy. I don’t want them getting tons of natural exposure with no sunscreen. That’s my approach.
Seemal Desai, MD: Ted, what about you?
Ted Lain, MD: I do the opposite, and that’s because we have such poor coverage of phototherapy where I live, so I rely on natural light to help these patients. For the most part, I tell them enjoy the sun at least in the areas affected by vitiligo. If they push back a little, I’ll say, “Use it on the other areas, but allow your vitiligo to enjoy the sun.”
Seemal Desai, MD: Our Miami tropical expert, what do you do?
Heather Woolery-Lloyd, MD: I’m in between. I tell patients to wear sunscreen, but I tell them to get around 10 minutes of sunlight a day. In Miami we have a very high UV index, so almost anyone can burn 10 minutes outside.
Seemal Desai, MD: Absolutely.
Heather Woolery-Lloyd, MD: I tell patients to wear sunscreen because I’m in that climate, but I also tell them to get around 10 minutes of sunlight a day.
Seemal Desai, MD: If they’re doing narrow-band or excimer [laser treatment] in your office, do you still tell them that?
Heather Woolery-Lloyd, MD: No. Then it’s not as important, but it’s very helpful. I live in a place where I get a lot of help to get my patients with vitiligo better, and that sunlight really helps.
Seemal Desai, MD: Brittany?
Brittany Craiglow, MD: I’m more in your camp, although I try to do phototherapy because in the wintertime in Connecticut, forget it. Sometimes we’ll have them take a break on their phototherapy. In the summer, I’ll say “You can run around in the backyard”—I treat a lot of children—with your undies on for 10 minutes, and then you put the sunscreen on.
Seemal Desai, MD: One thing that’s happened to me is I’ve had patients come in who are so used to wearing sunscreen in their daily regimen every morning that they’ll come into phototherapy. They’ll have their sunscreen on. Then I look at their treatment log, and they’re 15 treatments in. We have to keep pushing their dose. It’s because they’re wearing their sunscreen before coming in for phototherapy. It’s very important to tell them, “When you wear photoprotection, don’t wear it right before coming in for your light treatment. Otherwise, you’re impeding your UV therapy.” I had to have that discussion because I love the think tank that we all have here.
Transcript edited for clarity