Reviewing Key Clinician Insights and Innovations in Vitiligo Care This Year

Maggi Ahmed, MD, PhD: Combining Surgical Precision With Immunological Innovation in Vitiligo Treatment

Maggi Ahmed, MD, PhD, highlighted the psychological toll of vitiligo during her presentation at the 20th Annual Skin of Color Society Scientific Symposium. Her research, funded by SOCS, demonstrated improved pigmentation outcomes when combining melanocyte transplantation with topical JAK inhibitors or tacrolimus. Despite challenges during COVID-19, her study revealed that immunomodulation significantly enhances surgical success.

Iltefat Hamzavi, MD: Upadacitinib for Vitiligo Achieves Skin Repigmentation Through Week 52

New late-breaking data on upadacitinib for non-segmental vitiligo was presented at the 2024 American Academy of Dermatology Annual Meeting. A phase 2 trial involving 185 adults showed significant re-pigmentation at 52 weeks using Facial and Total VASI measures. The 11 mg dose demonstrated the best efficacy, with 63% achieving F-VASI75. Patient-reported improvements were also notable, with up to 90% describing their condition as "much better" or "a little better." Study author Iltefat Hamzavi, MD, emphasized the potential for upadacitinib to address this disfiguring condition while highlighting its safety profile and the need for patient counseling on treatment timelines.

Read more insights from Hamzavi related to Merck's MK-6194, an emerging therapeutic for non-segmental vitiligo.

Iain Stuart, PhD: Promising Data Showcases Potential of BET Inhibition

VYNE Therapeutics presented promising pre-clinical and phase 1b data on VYN201 for nonsegmental vitiligo at the Society for Investigative Dermatology Annual Meeting. Iain Stuart, PhD, VYNE's CSO, discussed the potential of BET inhibitors, like VYN201, in treating vitiligo and other dermatologic and immunologic diseases. The pre-clinical data showed VYN201's superiority over JAK inhibitors, reducing inflammation and promoting melanocyte recovery. The phase 1b trial demonstrated safety and efficacy, with 39% improvement in facial vitiligo at the highest dose.

Nanette Silverberg, MD: Considerations for Topical Therapeutics and Clinical Excellence in Vitiligo

At the 2024 Revolutionizing Alopecia Areata, Vitiligo, and Eczema conference, Nanette Silverberg, MD, presented 2 sessions on vitiligo treatment. In the first session, she reviewed topical therapeutics, discussing the social determinants of vitiligo and barriers to care such as delays in diagnosis and access issues. She highlighted off-label treatments like topical tacrolimus, pimecrolimus, corticosteroids, and calcipotriene. Silverberg also stressed the importance of managing patient expectations, as meaningful repigmentation can take up to 6 months.

In her second session, Silverberg focused on achieving clinical excellence in vitiligo care. She emphasized the need for a holistic, individualized treatment approach, incorporating both on- and off-label therapies, including combination treatments with devices, to provide the best patient care.

Read more insights from Silverberg related to aggressive approaches to pediatric vitiligo care.

Karan Lal, DO, MS, FAAD: What’s New in Devices for Vitiligo?

At the 2024 Revolutionizing Alopecia Areata, Vitiligo, and Eczema conference, Karan Lal, DO, discussed recent advances in devices for vitiligo treatment. He emphasized the importance of combining topical and procedural approaches for better outcomes in vitiligo management.

Lal highlighted that excimer lamp therapy, which is more affordable, portable, and easier to use than excimer lasers, can treat larger areas more efficiently. Lal noted that platelet-rich plasma (PRP), known for promoting hair growth, also aids repigmentation in vitiligo by improving interactions between melanocytes and other skin cells. Studies showed the best results when PRP was combined with excimer therapy. He also discussed the potential of melanocyte keratinocyte transplants, particularly for segmental or stable vitiligo, and mentioned the Recell device by Avita as a promising option.

David Rosmarin, MD: Looking Ahead to Advancements in Vitiligo

At the 2024 Revolutionizing Alopecia Areata, Vitiligo, and Eczema Conference, David Rosmarin, MD, shared insights on advancements in vitiligo and atopic dermatitis treatments. Regarding vitiligo, Rosmarin discussed phase 3 data for ruxolitinib cream, highlighting that factors like age, disease duration, or prior treatments did not significantly impact treatment outcomes, although the anatomic location did. Early and aggressive treatment was emphasized for optimal results.

Read more insights from Rosmarin related to phase 3 ruxolitinib data and adolescent repigmentation.

Walter Liszewski, MD: Exploring the Intersection of Permanent Makeup and Dermatology

Walter Liszewski, MD, explored the intersection of permanent makeup and dermatology, distinguishing between permanent makeup and decorative tattoos, discussing the regulatory differences, training for artists, and the potential benefits for patients with skin conditions like alopecia areata and vitiligo. Liszewski emphasized the importance of dermatologists collaborating with tattoo artists to ensure safe practices for patients seeking cosmetic solutions. He also addressed concerns about tattoo ink and allergic reactions, noting that allergies often arise as pigments degrade over time due to UV damage.

Naiem Issa, MD, PhD, FAAD: Insights From the 16th 5CC World Congress

The 16th 5CC World Congress featured Naiem Issa, MD, PhD, FAAD, who spoke at sessions on several dermatological topics, including microneedling for vitiligo. Issa highlighted the benefits of microneedling as a treatment for vitiligo, explaining how it could stimulate melanocytes and promote repigmentation in challenging cases. Issa also pointed out the global exchange of ideas, with attendees discussing how to adapt treatments based on the resources available in their respective regions. Audience engagement focused on 2 main topics, including the potential role of antioxidants in treating vitiligo.

Rocco Serrao, MD, FAAD: The Psychological Impact of Vitiligo

In a roundtable discussion in Ohio, Rocco Serrao, MD, FAAD, emphasized the significant impact of vitiligo on patients, affecting 0.5% to 2% of the population. He highlighted the psychological and social challenges, which vary depending on skin tone and personal circumstances. Serrao shared a case of a 20-year-old collegiate athlete with segmental vitiligo who struggled with self-confidence due to the appearance of white patches on his face. He noted that many patients, like this one, are unaware of available treatments, contributing to feelings of hopelessness. Serrao stressed the importance of personalized treatment plans for both segmental and non-segmental vitiligo. He recommended narrowband UV-B phototherapy as a gold standard for treating extensive disease but emphasized the need for patients to commit to long-term treatment.

Latanya Benjamin, MD, FAAD: Managing Vitiligo in Pediatric and Adult Patients

Latanya Benjamin, MD, FAAD, a pediatric dermatologist, shared her approach to managing vitiligo in both pediatric and adult patients in a roundtable discussion in Florida. She discussed a case of a 35-year-old woman with extensive vitiligo and moderate atopic dermatitis, highlighting the complexity of treating both conditions simultaneously. Benjamin described a treatment plan combining topical corticosteroids, calcineurin inhibitors, and phototherapy to manage the patient's conditions. She stressed the importance of patient motivation and adherence to long-term treatments, especially with therapies like ruxolitinib cream, which has shown positive results in clinical trials. Benjamin also emphasized the need for better access to treatments and the advantages of newer, more tolerable therapies, particularly for sensitive areas like the face.

Anthony Nuara, MD, PhD: Integrating New Therapies in Clinical Practice

Anthony Nuara, MD, PhD, moderating a roundtable in Arizona, shared his experience managing vitiligo in adult patients, highlighting a case of a 32-year-old professional makeup artist. The patient, concerned about how her depigmented patches affected her career, had minimal improvement with initial treatments. Nuara conducted thorough assessments to rule out comorbidities and developed a personalized treatment plan that included topical corticosteroids, calcineurin inhibitors, and phototherapy. He also introduced ruxolitinib cream for its effectiveness and tolerability in sensitive areas. The patient showed significant improvements over 6 months, and Nuara emphasized the importance of continuous care, monitoring, and patient education, as well as connecting patients to psychological support groups.

Andrew Alexis, MD, MPH, FAAD: Key Insights on Ruxolitinib and Personalized Care

Andrew Alexis, MD, MPH, FAAD, shared vital insights into vitiligo management, highlighting the effectiveness of ruxolitinib in achieving repigmentation. Through 3 patient cases, he emphasized the importance of personalized treatment plans, addressing adherence challenges, and managing expectations. A 60-year-old man achieved near-complete facial repigmentation with ruxolitinib, while other patients benefited from a combination of oral and topical therapies. The cases reinforced the significance of tailored care and consistency in treating vitiligo.

Chesahna Kindred, MD, MBA, FAAD: New Approaches for Treating Challenging Vitiligo Cases

In a discussion led by Chesahna Kindred, MD, MBA, FAAD, she shared insights on vitiligo treatment, particularly focusing on the challenges of treating depigmented lesions on difficult areas like the hands and face. Topical ruxolitinib, combined with NB-UVB phototherapy, emerged as an effective approach for many patients, offering a more flexible alternative to traditional treatments. Cultural competency also played a crucial role, as clinicians addressed societal perceptions and emotional impacts on patients. This conversation highlighted the importance of personalized, culturally sensitive care in vitiligo management.

Ted Lain, MD, MBA, FAAD: Overcoming Treatment Challenges and Enhancing Patient Confidence

Experts gathered in Texas for a roundtable to explore complex vitiligo management. Clinicians discussed treatment approaches for rapid repigmentation, including topical JAK inhibitors and systemic steroids, emphasizing the emotional and psychological impact on patients. Two key cases—a young South Asian man seeking quick results before his wedding, and a 50-year-old Black woman struggling with facial vitiligo—highlighted personalized care strategies and the effectiveness of ruxolitinib in achieving significant repigmentation.

Pearl E. Grimes, MD, FAAD: Overcoming Relapse and Improving Disease Management

In a roundtable discussion, Pearl E. Grimes, MD, FAAD, explored 2 distinct vitiligo cases to highlight effective treatment strategies. The first case involved a 45-year-old woman with comorbid vitiligo and atopic dermatitis. Grimes emphasized the importance of addressing both conditions simultaneously, recommending ruxolitinib combined with narrowband UVB phototherapy as an ideal treatment approach. This combination minimizes steroid-related side effects while promoting repigmentation.

The second case focused on a 35-year-old man with long-standing vitiligo, who sought permanent repigmentation beyond temporary camouflage. After experiencing relapse with prior treatments, the patient showed significant improvement with topical ruxolitinib, demonstrating its effectiveness in sustaining repigmentation.

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