What’s New in Devices for Vitiligo?

“Vitiligo is a chronic autoimmune disease, and we're learning now that vitiligo really has to be treated with both a topical approach as well as, typically, with a procedural approach. And what that means is we know that when we do things in combination, just like in anything else, they do better,” said Karan Lal, DO, in an interview at the 2024 Revolutionizing Alopecia Areata, Vitiligo, and Eczema conference in Chicago, Illinois.

Lal, the only dual fellowship-trained cosmetic and pediatric dermatologist in the US who practices at Affiliated Dermatology in Scottsdale, Arizona, and Dermatology Times’ newest Editorial Advisory Board member, presented “Recent Advances in Devices for Vitiligo.” Lal’s top takeaways from his session include defining the difference between an excimer laser and excimer lamp therapy, platelet-rich plasma for vitiligo, reconsidering photodynamic therapy, and melanocyte keratinocyte transplants.

Pearl #1: Excimer Lasers and Lamp Therapy

“I really wanted to highlight the fact that excimer lamp therapy is non-coherent radiation, which has a variable wavelength, but with a peak at 308 nanometers. And the reason why that's important is because excimer lasers are very expensive and not often practical in many office settings. In the market right now, there's a very monopolizing effect of the excimer laser, so it's really hard for people to get them, and there's a lot of maintenance required for them. Excimer lamps are much easier to use; they're much smaller. It's kind of like a hair dryer. That's important for me, because I travel from clinic to clinic, so I can bring it with me from where I travel. It also doesn't make that much noise, which is important for my kids who are on the spectrum. But it has a larger spot size, so I can treat a bigger surface area, which is often less time-consuming than using an excimer laser, and it's a fraction of the cost,” said Lal.

Pearl #2: Platelet Rich Plasma

“PRP also known as platelet-rich plasma, typically is very well known for its effects on improving hair growth, but it's also anti-inflammatory. There are some studies that prove that what PRP does is its growth factors really improve the interaction between keratinocytes and fibroblasts on melanocytes and help repigmentation. I highlighted a study where they looked at PRP versus excimer laser therapy versus just excimer therapy and they found that patients that received the PRP along with excimer had the best response,” said Lal.

Pearl #3: Reconsidering Photodynamic Therapy

“Photodynamic therapy is very well known for the treatment of actinic keratosis, and one of the studies I highlighted uses used red light therapy along with ALA [5-aminolevulinic acid,] and really did not show any improvement in vitiligo compared to topical administration with topical steroids. So, photodynamic therapy is probably not something that's helpful in treating vitiligo,” said Lal.

Pearl #4: Melanocyte Keratinocyte Transplants (MKTP)

“There's a company right now called Avita, which is working on a device called Recell. I was one of the clinical investigators for their most recent study, and that is essentially a cure for the treatment of segmental vitiligo and stable, generalized, or focal vitiligo. I talked about the nuances in performing MKTP and knowing that if you're someone who treats vitiligo but doesn't have the means to do it, find the people in your community that do it," said Lal.

Reference

Lal K. Recent advances in devices for vitiligo. Presented at: Revolutionizing Alopecia Areata, Vitiligo, and Eczema Conference; June 8-10, 2024; Chicago, IL.