Vitiligo Care Personalized for Each Patient: Part 3

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 2 featuring Latanya Benjamin, MD, FAAD

Integrating New Therapies in Clinical Practice

Nuara’s Experience

Nuara, who moderated a roundtable discussion in Scottsdale, Arizona, brought a unique perspective with his experience in treating adult patients with vitiligo. He shared the case of a 32-year-old professional makeup artist who was deeply concerned about her depigmented patches affecting her livelihood. “She came to us seeking treatment because she felt that her condition reflected on her professional skills,” Nuara explained.

Case Study: A Professional Makeup Artist’s Journey

Nuara discussed the initial steps in managing this patient’s condition, emphasizing the importance of understanding her unique concerns and goals. “As a professional makeup artist, her appearance was integral to her career. She felt that the depigmented patches on her hands and face could undermine her credibility with clients,” he said. This case highlights the profound impact vitiligo can have on patients’ professional and personal lives.

Prior to visiting Nuara, the patient had been treated with the topical calcineurin inhibitor tacrolimus and a class I steroid for 6 months. However, she experienced minimal improvement and started noticing skin thinning in periocular areas. “The patient was not satisfied with her results and was concerned about the visible skin thinning,” Nuara noted.

“One of the first steps we took was to conduct baseline labs to assess for comorbidities, such as thyroid disease and anemia,” said Nuara. “Her thyroid function tests, including thyroid-stimulating hormone, thyroxine, thyroid peroxidase, and complete blood count, were all normal.” To address her concerns, Nuara performed a comprehensive assessment, including baseline laboratory tests to check for comorbidities such as thyroid disease. “We conducted a thorough assessment to rule out any underlying conditions that could be contributing to her vitiligo. It’s important to consider the whole patient, not just the skin manifestations,” he emphasized.

Nuara developed a personalized treatment plan tailored to the patient’s needs and lifestyle. “Given her profession, we focused on treatments that would be effective yet minimally disruptive to her daily routine,” he explained. The treatment plan included a combination of topical corticosteroids and calcineurin inhibitors to manage inflammation and promote repigmentation.

In the roundtable discussion, the group considered the next steps for a patient who had failed initial topical treatments. “We discussed the use of phototherapy, specifically the excimer laser, as a viable next option,” said Nuara. The patient underwent excimer laser treatments twice a week for 3 to 4 months.

“We also incorporated narrowband UV-B phototherapy sessions, which have been shown to be effective for vitiligo. This required careful scheduling to accommodate her work commitments,” Nuara noted. The phototherapy sessions were initially set at 3 times a week, with frequency adjusted based on response.

Monitoring Progress and Making Adjustments

Regular follow-ups were essential to monitor the patient’s progress and adjust the treatment plan as needed. “We scheduled follow-ups every 3 months to assess her response to treatment and make any necessary adjustments,” Nuara said. This flexible approach ensured that the treatment remained effective and aligned with the patient’s evolving needs.

The patient also received ruxolitinib cream. “Ruxolitinib cream was introduced as part of her treatment plan due to its efficacy and tolerability, especially for sensitive areas like the face and hands,” Nuara explained. The cream was applied twice daily, and the patient was educated on its proper use to maximize benefits.

Connecting Patients to Support Groups

Nuara emphasized the importance of addressing the psychological and social aspects of vitiligo. “We provided resources for psychological support, including counseling services and support groups, to help her cope with the emotional impact of her condition,” he said. This holistic approach aimed to improve the patient’s overall well-being and quality of life.

He shared that the patient initially struggled with feelings of anxiety and self-consciousness. “She expressed concerns about how her clients and peers perceived her. We encouraged her to join a support group where she could connect with others facing similar challenges,” Nuara recounted. This support network played a crucial role in boosting her confidence and resilience.

Ongoing Management With Positive Outcomes

Over the course of her treatment, the patient experienced significant improvements in her vitiligo. “After 6 months of consistent treatment, we observed notable repigmentation in the affected areas, and her atopic dermatitis was well controlled,” Nuara reported. The patient was pleased with the results and felt more confident in her professional and personal life.

Nuara highlighted the importance of ongoing management and patient education. “We continued to monitor her progress and made adjustments to the treatment plan as needed. It’s important to educate patients about the chronic nature of vitiligo and the need for continuous care,” he advised.

Read part 4 featuring insights from the full panel