Vitiligo Care Personalized for Each Patient: Part 2

To better understand the complexities of treating a diverse range of patients with vitiligo, Dermatology Times gathered insights from 3 dermatologists: Rocco Serrao, MD, FAAD, of Dermatologists of Southwest Ohio in Dayton; Latanya Benjamin, MD, FAAD, dermatologist of Young Skin in Coral Springs, Florida; and Anthony Nuara, MD, PhD, of the Center for Dermatology & Plastic Surgery in Scottsdale, Arizona, who shared their experiences and patient cases in recent roundtable discussions. Their perspectives provide valuable insights into the challenges and advancements in managing vitiligo.

Read part 1 featuring Rocco Serrao, MD, FAAD

Managing Vitiligo in Pediatric and Adult Patients

Insights from Benjamin

Benjamin, a pediatric dermatologist, shared her insights in Parkland, Florida, on managing vitiligo in both pediatric and adult populations. She began by discussing a case of a 35-year-old White woman with a 10-year history of vitiligo and concomitant moderate atopic dermatitis. “This patient’s depigmentation had spread to larger areas of her body, including the face, neck, and arms, and was significantly impacting her self-esteem,” Benjamin said.

Case Study: Managing Concomitant Conditions

Benjamin elaborated on the complexity of managing this patient’s conditions. “This patient not only had extensive vitiligo but also struggled with moderate atopic dermatitis, which compounded her distress,” she said. The presence of atopic dermatitis added another layer of complexity to her treatment plan. “We had to carefully balance treatments to manage both conditions effectively without exacerbating one or the other,” Benjamin noted.

Benjamin discussed how she approached the treatment plan by incorporating therapies that could address both conditions. “We utilized a combination of topical corticosteroids and calcineurin inhibitors to manage her atopic dermatitis while incorporating phototherapy sessions to promote repigmentation of her vitiligo patches,” she explained. The integration of these treatments required close monitoring and regular adjustments to ensure optimal outcomes.

Treatment Adherence and Patient Motivation

One of the key challenges in managing vitiligo, Benjamin highlighted, is treatment adherence. “We [roundtable participants] talked about how to keep our patients compliant and motivated when the treatment plan can work but may take months,” she noted. Ensuring patients stay motivated throughout their treatment journey is critical for achieving positive outcomes.

Benjamin emphasized the importance of continuous treatment, citing the positive outcomes seen with ruxolitinib cream (Opzelura; Incyte) in clinical trials. “Continuous treatment is crucial, especially with therapies like ruxolitinib cream, which have shown significant improvements in clinical trials,” she said.¹ Patient education and regular follow-ups are essential to maintaining treatment adherence.

Access to Treatments

Addressing the practical aspects of managing vitiligo, Benjamin discussed the role of access to treatments. “Access can be key as with our topical therapies. Utilizing specialty pharmacies to help navigate the coverage process can be crucial,” she said. The availability and accessibility of treatments can significantly impact the management of vitiligo, especially for patients with limited resources.

Benjamin also pointed out the advantages of newer therapies that are more tolerable for patients, particularly in sensitive areas like the face. “Newer therapies, like ruxolitinib cream, offer better tolerability, especially for sensitive areas such as the face, making them more suitable for long-term use,” she explained. She and the roundtable participants discussed how advancements in treatment options provide hope for better management of vitiligo.

Reference

1. Rosmarin D, Passeron T, Pandya AG, et al. Two phase 3, randomized, controlled trials of ruxolitinib cream for vitiligo. N Engl J Med. 2022;387(16):1445-1455. doi:10.1056/NEJMoa2118828

Read part 3 featuring Anthony Nuara, MD, PhD