Vitiligo Is More Than a Cosmetic Condition

Laurie Vargo, MD, assistant professor of dermatology, University of Nebraska Medical Center, Omaha, as told to Susan Bernstein

Vitiligo is largely a chronic disease with an unpredictable course, so treatment can be difficult for many people. Each person responds differently to different medications. First, I establish their goals and expectations for their treatment.

The mainstay of treatment for vitiligo includes various topical creams, light therapy and oral steroids. But the world of dermatology is always evolving, so new treatments for vitiligo are emerging. If we need to, we can turn to a new treatment toolbox. There is very good research and evidence behind some of our older treatments for vitiligo, and most dermatologists will start with these treatments.

Vitiligo can be autoimmune.

What causes vitiligo is still largely unknown. We think it has an automatic force. Vitiligo is commonly associated with other autoimmune conditions. It is extremely important to review your history of vitiligo. Autoimmune thyroid disease is one of the most common conditions we see in someone who has vitiligo.

There are some new treatments for vitiligo, and I usually use them when we don’t see any improvement with older treatments. We have to weigh all the risks and benefits of any treatment. We have to think about the possible side effects of any treatment, and cost is also a big issue for some patients.

There are many new and exciting drugs in dermatology, but access to them can be a major barrier. Older treatments are better covered by insurance. I don’t want to offer someone a topical cream that they can’t afford when they go to the pharmacy to pick it up.

Start with topicals and light therapy.

For vitiligo, we start with topicals and light therapy. We tailor each treatment plan on an individual basis because vitiligo can be a difficult, frustrating condition to treat. People usually have lifelong disease and must continue their treatment. There is no guarantee that we will be able to recover. [skin] Pigmentation or that your skin will return to normal.

One of the newer drugs for vitiligo is Janus kinase inhibitors, also known as JAK inhibitors. None of these are currently FDA-approved for the treatment of vitiligo, but that will soon change.

With this new class of oral and topical medications, we have to address the potential side effects that come with the treatment.

Interestingly, we have a topical version of one of these drugs called ruxolitinib, which is currently used to treat eczema. There have been some encouraging studies for it in the treatment of vitiligo, including facial vitiligo.

Generally, when we use topicals, we are not as concerned about systemic side effects. However, with these topical JAK inhibitors, including ruxolitinib, we are still uncertain. [how much of the drug you absorb through your skin] And how it might relate to potential side effects. This is still a question.

Protect eyes and skin.

There are other health risks for people who have vitiligo. Our melanocytes are the cells that give us our pigment and protect our skin from the sun. So when you lack pigment-producing cells, you’re more prone to sunburn. I talk to all my vitiligo patients about how important it is to cover up and protect your skin from burns. People with vitiligo have no barrier to protect their skin from the sun’s rays.

I recommend that people with vitiligo or anyone use a sunscreen that is SPF 30 or higher, broad spectrum and water resistant. Applying and reapplying enough sunscreen on your skin is really important. Most people don’t apply enough sunscreen to their skin. You need to apply 1 ounce of sunscreen at a time. This is enough to fill a shot glass. You should reapply it every 2 hours or after sweating or swimming.

Ultraviolet Protection Factor or UPF clothing is another thing I recommend. You can find these clothes in many stores these days. This garment provides additional protection from the sun. It is becoming really popular with kids too. Children wear rash guards when they play outside. Because our eyes also contain pigment-producing cells, it is important for people with vitiligo to use sunglasses to protect their eyes when out in the sun.

Not just a ‘cosmetic’ condition

Our skin is our largest and most visible organ. People with any skin condition are at risk of low self-esteem and reduced quality of life due to their skin condition. People with vitiligo often suffer from it. I feel that it is important for me to educate my vitiligo patients, especially children, so that they can explain what vitiligo is to other people, such as on the playground or at school. I want them to feel comfortable in their own skin. Adults with vitiligo, and all of us, have self-esteem issues when it comes to the appearance of our skin.

I see a lot of people talk about treating vitiligo as a “cosmetic treatment” or vitiligo as a “cosmetic condition.” I think the term “cosmetic” suggests that we are taking something normal and enhancing it. But with vitiligo, we’re treating your skin condition the same way we treat any other health condition.

If you have symptoms of vitiligo, it is important to see your dermatologist for an evaluation. This is because other skin conditions can resemble or look like vitiligo. There are some rare situations that we want to rule out first. There are some allergic skin conditions that can look like vitiligo.

Make-up and self-tanners

One thing I talk to my patients about is a makeup product called Drumblend to cover the skin. You can also use self-tanning products with dihydroxyacetone. Using a self-tanner product is perfectly fine if you have vitiligo. If you want a more even look, you can use it to conceal skin blemishes. If you go outside and get a tan, you will only tan the rest of your skin.

I often recommend light therapy to people with vitiligo. This is one of my favorite remedies for this condition. It is also called phototherapy. This is a treatment that uses ultraviolet rays. Sometimes, when I recommend light therapy, my patients say, “Aren’t you a dermatologist? I thought the sun was bad for your skin! But this type of light therapy is only prescribed by a dermatologist.” should be done.

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