Restoring Skin Pigmentation in Vitiligo With Advanced Treatments - Episode 15
Expert dermatologists share final thoughts on treatment of vitiligo and topical ruxolitinib.
Seemal Desai, MD: So, this has been a tour de force of an amazing discussion. In the last few minutes let's get some sort of final parting thoughts and, really, I would love to have your thoughts about where we are in our disease state understanding, anything we talked about clinically, and kind of your hopes and dreams for the future of this disease and, really, for skin disease. We know that there are so many skin diseases out there that we treat that don't have FDA-approved therapies. Ted, I'm going to start with you. I'd love to have some final few minutes of your thoughts.
Ted Lain, MD: Thank you. What a wonderful panel, and Dr Desai, thank you so much for leading us. It was really a very thought-provoking discussion. I learned a lot personally, so thank you to everybody here. I do want to say as a principal investigator, as someone who runs quite a few of these vitiligo trials, recruitment can be difficult. For those people who are watching this, if you don't mind helping the local sites out with recruitment because we all want to get these drugs in the hands of our patients as quickly as possible. Some of the latest medications that are available are in clinical trials right now. Using the investigational sites in your area can be helpful, and for those of us who are really trying to get the latest, we rely on you. So that's one thing I would say, thank you for letting me do that. Otherwise, I think the topical ruxolitinib is a wonderful first step in treatment for an autoimmune disease that has sorely needed something particularly for itself. I'm so happy that we – as I said, that ruxolitinib, has opened the door and now there are so many others that are in development. I think that what we'll see is similar to what we've seen in psoriasis. We're now kind of experiencing an atopic dermatitis, where there's just going to be a rush of highly efficacious treatments that will both systemically and topically allow us to treat the entire patient and really elevate their quality of life, which is what is most important.
Seemal Desai, MD: I love that. Heather?
Heather Woolery-Lloyd, MD: I would say my biggest take home – first of all, this has been such a wonderful panel. Like you, I learned from everyone and thank you for moderating this. I think it’s a very exciting time to be treating patients with vitiligo. I’ve been treating vitiligo for 20 years and I will say, as I mentioned, it was hard when patients – 10, 15 years later, there really was nothing new. There really was nothing new for so long and so this is a very exciting time. I'm very hopeful, optimistic, excited to see the results from the newer trials that come out, and, like you said, we're going to get not just 1 new FDA-approved treatment, but I'm sure in the future, many. That will be such a change for a disease that I feel like was neglected for many decades.
Seemal Desai, MD: Heather, let me just ask you, since you are really engaged with social media and getting the right messages out there, have you really found that social media has been a wonderful way to talk about vitiligo? Hasn't that been your experience because you've done some great work on that?
Heather Woolery-Lloyd, MD: Yes, so I do think social media is great for rare diseases because, although vitiligo really isn't rare – it's actually not that rare – but for diseases that people don't talk about much, I think patients can feel very isolated. If you're a vitiligo patient and you feel isolated, you might have 1 family member, a distant family member, who has it, but you might not have anyone else to talk about it with. One of the biggest impacts I think social media has is that it allows people to connect and to share things that even us as physicians wouldn't be able to share: the best textured make-up, the best – what lasts longer? What doesn't rinse off in the pool? Those types of things are the things that you can learn on social media. From a physician standpoint, I really do try to make an effort to do a lot of education so that they're getting the correct information and not the old wives’ tales and remedies that have no data and no proof. From our perspective as physicians we can give, create content that's accurate and valid and also introduce new concepts because this new topical has just been introduced in the last year, so for people who haven't seen their dermatologist, they got burnt out and haven't been in in 2 years then say, “Oh there is a new treatment now, let me go and make an appointment with my dermatologist.” I think social media plays 2 roles from our perspective and a role in education. From a patient's perspective, it's a way to connect with other people and really get further insights beyond what we can offer our patients.
Seemal Desai, MD: I just have to say kudos to you, and Brittany, and Nada, and Ted, all of you guys who do that to put out the right messages about board-certified dermatologists and sending the right messages because there are influencers out there who aren't medical professionals who are giving the wrong information to our patients. Many of our organizations that we're all a part of have really championed this. The AAD [American Academy of Dermatology] has an incredible “Your Dermatologist Knows” social media campaign that started in the past few months. It's been incredible because we have to really band together to get the right info out there so then patients know what the right question is to ask, when to seek treatment, and when to have hope. Brittany, would love some of your final thoughts.
Brittany Craiglow, MD: I feel like so many – I agree with everything really that's been said already. I do really feel optimistic that in, right now lots of patients come and maybe they come to see me for something else, and they have vitiligo and I'll say, “Oh have you treated that,” and the patient says, “Oh no, I've been told there's nothing to do for it over and over.” They've sought treatment and somebody said, “It's no big deal, that's cosmetic,” patients have felt dismissed. I really do think that that tide is changing. With an approved therapy there's all this awareness now that this is an autoimmune disease. It's just like anything else we see, and it really warrants treatment. With the advances in the scientific understanding, we now have a pathogenesis-directed treatment. I really think in 5 or 10 years that patient experience is going to be very different. We're going to have multiple fairly reliable and effective therapies. We also are going to have patients who are coming in earlier, and probably going to do better, because they're getting treated at the beginning of their disease, rather than 20 years down the road where it's going to be a lot harder to repigment them. This longstanding vitiligo may be something that slowly kind of goes away over time, which is kind of exciting.
Seemal Desai, MD: Super exciting. I am optimistic that we will have a cure for vitiligo in our lifetime. I'm really optimistic of that so we're going to hopefully keep going for that. Nada, what would you say? You're so passionate, like me, about this.
Nada Elbuluk, MD: Absolutely. This has been an amazing panel. I echo what everybody said. I think the exciting thing is that as we're understanding the pathogenesis more we are going to have more of these targeted therapies. Similar to what Ted was saying, the way we see that the treatments are blossoming for psoriasis and atopic dermatitis, I think vitiligo is next in line. Ruxolitinib is the beginning of that, and it's not just topical and oral medications, but procedural therapies. The transplantation process for vitiligo used to be quite involved and there's a treatment that's in studies right now that once that gets approved will allow people to do procedural therapies in their office much easier than before. I think the other really exciting thing is seeing the voice of individuals with vitiligo really getting amplified, and seeing public representation of vitiligo increase. We're really seeing that help decrease the stigma that comes with the disease. Winnie Harlow was one of the first people to kind of really come out and model without her makeup. That was a huge statement for people with vitiligo that, “I can do this, and I can feel good about myself, and I know that I look great and not feel that I have to have hide- behind makeup or anything else.” Mattel came out with the Barbie. There are dolls with vitiligo, CoverGirl hired their first model with vitiligo, “Call of Duty” now has a character with vitiligo. So, just across all these sectors of society, this public representation is huge, and I think it's so important for us to be able to advocate and support our patients in every regard for getting treatments, but also for not getting stigmatized for their disease and making the public know what is and be educated about it. I think there's a movement happening all in the right direction and it's very exciting to see.
Seemal Desai, MD: I couldn't agree with all of you more. I think now is just such an incredible time. This has been a fantastic panel. I am so hopeful about vitiligo treatments for our patients. I hope we'll be able to have the opportunity to do more of these discussions in the very near future. I'm sure we're going to be having lots more scientific data that's going to be rich and fulfilling for us to be able to share for our patients. So, Dr Lain, Dr Woolery-Lloyd, Dr Craiglow, Dr Elbuluk, thank you for joining me. It's really been a pleasure to be with you all today for this exciting discussion and thank you all for watching this HCPLiveâPeer Exchange. If you enjoyed the content, please subscribe for our e-newsletters and to view upcoming peer exchanges and other great content right to your inbox, make sure you visit HCPLive.com. I'm Dr Seemal Desai. It's been my pleasure to be your chair and moderator for today's discussion. Thank you for joining us.
Transcript edited for clarity