Management Strategies and New Directions in the Treatment of Vitiligo - Episode 7
Drs. Rosmarin and King discuss the importance of shared-decision making and understanding of patient goals in managing vitiligo.
Brett King, MD, PhD:Great. And now, tying everything together, David, we've heard about the patient encounter, we've heard about discussing treatment expectations of treatment helping patients understand their vitiligo, the quality-of-life impact disease. Now, what about patient preference reference quality-of-life impact and the approach to treatment? How do these things ultimately shape the way you approach treatment goals with individual patients?
David Rosmarin, MD: The first thing that’s important is not to make assumptions and to have a shared decision-making approach. There's some patients who come in who are very much affected by their vitiligo, and there may be others who just want to know what their disease is and what's happened and maybe some more information about it. And it's important not to make assumptions that all patients want to be treated and there are multiple different factors that affect the quality of life. Culture is a big part of them as Amit spoke about earlier. Age matters too. We know that our teenagers are much more affected than our preteens. Also, having it in exposed areas, such as the face enhance. But what seems to also have a big effect is patients who have progressive disease as well, that anxiety of not knowing when they're going to get new lesions or not, or the fact that it's spreading. That can affect patients more than even having it in those exposed areas. All of those can contribute to how we think about treatment or not. And I often divide treatment into different steps. The first thing is I recommend support groups, such as vit-friends to almost all the patients if they're interested in that. But one of the key things is if they have progressive disease, are they interested in stabilizing that disease or not? And that may be all that a patient is interested in. And a second goal might be repigmentation itself. And then a third goal is once you've achieved that repigmentation, what about maintaining it? And there are different regimens to help patients so that they don't start to lose that pigment again. Because there's nothing worse than spending a lot of time to repigment and then they start losing it again and going through that process, which can be quite traumatic. Those are all important aspects to how I think about treatment, but it's important to listen to the patient and ask them, what are you interested in? Not to assume that all patients want to be repigmented. Some may just want stabilization of their disease, some may want repigmentation, and some may be on that maintenance goal.
Brett King, MD, PhD:It's important what you said, because – and this gets around to what Amit was talking about also, right? It helps for patients to understand what's happening and what is possible because that ultimately is going to help shape their expectations of treatment. And ultimately, if we don't walk down this path and touch on these different points, we're not going to be able to create reasonable expectations of treatment, which is just going to lead to heartache and disappointment down the road. And, what we're hearing over and over again from all of you is we need to have a conversation. This is not a 6-minute visit. This is not a 10-minute visit. We must talk to patients. We must understand the effect on them. We have to create reasonable expectations, help them deal with their vitiligo while we are trying to achieve repigmentation if that's what they want. And for listeners, it's just important. There's a lot of talking, a lot of talking, a lot of understanding from patients, what they need to help set up a successful relationship for the future.
David Rosmarin, MD: Yes. That's true that these visits do take a lot longer. It's important that we remember our empathy and our compassion, the reasons why we went into medicine in the first place and sometimes helping patients through this process though, can be quite rewarding as well. I can't emphasize enough what you said earlier. It is a medical disease. It is not a cosmetic disease.
Transcript Edited for Clarity