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In the past 10 years, there’s been a noticeable shift in how vitiligo is treated and perceived. The skin disorder is still associated with a myriad of psychological and physical comorbidities, and there’s yet to be a treatment approved by the US Food and Drug Administration (FDA).
However, for dermatologists such as Wendy Ripple, MD, of Allegheny Health Network Pediatrics, this is far from the full story.
In an interview with HCPLive, Ripple spoke on the different perspectives of vitiligo among her patients, some of whom have continued to seek treatment for repigmentation while others have looked for ways to recontextualize the disorder in their lives.
“There's a wide reaction to vitiligo; some people live with it, they like their spots, they embrace them, and they don't want to treat them at all, and as long as we make sure there's no underlying or associated disorders, they're happy with that,” Ripple noted. “And then we have other people who want the opposite. They want their skin to be all one color or their normal color, and we'll go to any lengths to try to get it back to back to its normal (skin tone).”
For patients interested in restoring pigmentation in affected areas of the body, off-label strategies such as phototherapy and ruxolitinib cream- which many anticipate being the first therapy approved by the FDA for vitiligo- have been utilized.
However, the deployment of these strategies is often influenced by how the patient wishes to be treated and, crucially, which areas of the body are affected. For instance, the face is made up of very sensitive skin, and as such the use of strong topical steroids is prohibited.
Ripple also reminds patients who are willing to undergo therapy that they must be “very conscientious” and compliant about taking daily medicines and pursuing long-term treatment, and desired responses to these therapeutic strategies are not guaranteed.
However, Ripple added that among patients who are being treated with ruxolitinib cream in her practice, some of the responses have been “tremendous”. She also noted that, so far, insurance companies have been cooperative in covering the therapy for affected patients, though requests will often be denied the first time and require further explanation by Ripple.
“I can remember when I started limiting my practice to dermatology 17 years ago, some of our office visits wouldn't be paid for by insurance if we used the diagnosis alopecia areata or vitiligo, and now we're getting approval for these medicines that are,right now, off-label,” she said. “So that's certainly encouraging that people are seeing (these disorders) as real autoimmune disorders that need to be treated, that have other autoimmune associations that really involve the whole person and not just cosmetic problems with the skin.”
To hear more from Dr. Ripple on representation of vitiligo in media and culture, and what can be done to support those affected by the condition, please watch the full video interview above.