Restoring Skin Pigmentation in Vitiligo With Advanced Treatments - Episode 1

Prevalence of Vitiligo

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Drs Brittany Craiglow and Nada Elbuluk review the precipitating factors that trigger vitiligo, as well as segmental vs nonsegmental vitiligo.

Seemal Desai MD: Hello and welcome to this HCPLive® Peer Exchange titled, “Restoring Skin Pigmentation in Vitiligo With Advanced Treatments.” It’s a pleasure to be here today with my esteemed colleagues. I’m Seemal Desai, I‘m a board-certified dermatologist in private and academic practice in Dallas, Texas, and on the faculty at UT [University of Texas] Southwestern Medical Center. Joining me are 4 other expert colleagues and friends to have an exciting discussion about repigmentation options in vitiligo. Let me begin with introducing our esteemed group today. I have Dr Heather Woolery-Lloyd, director of the skin of color and division of dermatology at the University of Miami Department of Dermatology; Dr Brittany Craiglow, associate professor and adjunct dermatology faculty at the Yale School of Medicine in New Haven; Dr Nada Elbuluk, associate professor in the Department of Dermatology at the Keck School of Medicine at the University of Southern California, and director of the skin of color and pigmentation program; and finally, my friend and colleague Dr Ted Lain, chief medical officer of Sanova Dermatology in Austin, Texas. Welcome, everyone. It‘s great to have you all here today.

Our discussion today will focus on the pathophysiology of vitiligo, standards of care, and new and emerging therapies for this often-devastating disease. We‘re going to explore evidence-based approaches. We‘re going to have some fun dialogue, we‘re going to make this really conversational, and talk about a patient-centered approach to managing vitiligo and improving patient outcomes. Let me say that now more than ever I think this is an extremely exciting time for this disease, for our patients who have been suffering from this disease. At no other time in my career have there been so many new things that we now have in our therapeutic armamentarium, and more things on the horizon, so I‘m sure my colleagues will agree, we‘re in for a robust discussion today. Let‘s get started. Brittany, I‘m going to start with you, and let‘s tee it up a bit, if you would, give me your sense of, what’s the prevalence of vitiligo? Recap for me a bit the demographics, what are you seeing in your practice? And how do we approach understanding this disease?

Brittany Craiglow, MD: Sure. Vitiligo is a pretty common autoimmune disease. We see it affecting all ages, often it has an onset in young people. It can be localized, it can be generalized, it can affect just a segment of the body, and that historically has been thought to be harder to treat. Oftentimes patients will report a preceding sort of trigger, they had a sunburn, there was maybe friction, things like that. But a lot of times we don’t have a good reason for why it happened when it did, and that’s largely because there is a genetic predisposition and it happens probably because of multifactorial things.

Seemal Desai, MD: I’m glad you mentioned the multifactorial aspect of this, because we know that this is a disease, one, from a treatment perspective that we never treat with monotherapy, but also one from a pathophysiologic perspective that has lots of other things that can trigger it. Do you want to talk also a bit about some of the precipitating factors or what in your experience triggers vitiligo in many patients?

Brittany Craiglow, MD: Yes, I think a lot of times it’s hard to say. There may be a history of a viral illness, of a psychological stressor, some environmental change. Sunburn is something we hear often. But again, I think just as many people who have this story or something to blame it on, for other people, you look back and can’t sort it out.

Seemal Desai, MD: Yes, I think you uncovered a lot there in just a couple of minutes, because we know there’s so much more that we don’t know about this disease that still needs to be studied. And we’re going to get to some of that data in just a minute. Nada, let me turn to you because you’ve done a lot of work in skin of color and in pigmentary disorders, and it’s always great to see the exciting amount of research coming out of your fellowship program. Let’s talk a bit about the types of vitiligo. So, morphologies, talk to me a little about physical findings, some of the different patterns we talk about. I think our audience could benefit from understanding that there are different types and subtypes.

Nada Elbuluk, MD: Sure, absolutely. The 2 big categories are segmental and nonsegmental, and Dr Craiglow was alluding a bit to segmental, where it’s one side of the body, localized, doesn’t spread or change. And that can be harder to treat, and we think there may be some differences in the pathophysiology of it. For generalized vitiligo vulgaris, you can have localized disease, and then there is widespread generalized disease, and that can often be in a symmetric pattern. There are also some types of vitiligo that when they present, we know their disease is very active. Some of those examples are trichrome vitiligo, where you’re not just seeing depigmentation but also hypopigmentation and then the normal skin; Koebnerization and confetti vitiligo are also signs of active inflammatory vitiligo; as well as a subtype called inflammatory vitiligo, which is not very common, where there’s sort of a rim of erythema around the vitiliginous areas.

Those are important markers to pick up on your exam because that person’s probably going to spread more quickly, and if they want to have treatment, you’d want to engage them in that more quickly.

Transcript edited for clarity