Combining Surgical Precision With Immunological Innovation in Vitiligo Treatment

“We have all seen our patients [with vitiligo] crying in the clinic, and we’ve probably cried with some of them,” said Maggi Ahmed, MD, PhD, second year resident at the University of Massachusetts Memorial Medical Center in Boston, during her session at the 20th Annual Skin of Color Society Scientific Symposium (SOCS) happening in conjunction with the 2024 American Academy of Dermatology Meeting (AAD). “As dermatologists we need to be mindful of the burden of the disease on our patients' psychology.”

Ahmed leads research to ensure a greater understanding of surgical management of vitiligo and the immunological underpinnings for successful long-term surgical outcomes. Utilizing grant funding from SOCS in 2020, she demonstrated superior pigmentation outcomes and reduced CD8+ T cell numbers with the combination therapy, supporting the conclusion that the combination approach significantly improves surgical outcomes in stable vitiligo lesions.¹ 

Dermatology Times had the opportunity to catch up with Ahmed after her session “Melanocyte Transplantation Plus Topical JAK Inhibitor or Tacrolimus for Treatment of Vitiligo: A Randomized Comparative Study” to discuss key pearls to consider putting into practice.

Dermatology Times: What motivated you to explore the combination of melanocyte transplantation with either a topical JAK inhibitor or tacrolimus for the treatment of vitiligo?

Ahmed: It's actually years of studying [vitiligo]. We've been following those patients up and we've been noticing variable repigmentation among patient, despite perfect selection of surgical candidates. So our preliminary data revealed that there might be immunological biomarkers that are influencing this variability in the surgical outcomes. And our early phases of the research revealed significant elevation of some of the immunological markers. And accordingly, we decided to investigate whether disruption of these immunological cells within will improve the surgical outcomes. And here we landed into using either a JAK inhibitor or calcineurin inhibitors ruxolitinib or tacrolimus.

Dermatology Times: What were some key outcomes or trends that you noted in your research?

Ahmed: The main key point from that study are that using the immunosuppressive regimen, the combination of phototherapy, and either ruxolitinib, which is JAK 1 and 2 inhibitor, or tacrolimus, which is a calcineurin inhibitor would improve the surgical outcomes more than if we use just the surgery alone with no immunosuppressive.

Dermatology Times: What challenges did you encounter in gathering data for this study?

Ahmed: The study was started during the COVID time, and that was really a challenge. It kind of affected the end of the study points and that's why I mentioned that some of our patients ended at 7 months, and some of them ended at 12 months, and some of them even extended after. Otherwise, it was smoothrunning, and the patients were happy about participating. I would have loved to enroll more patients, but funding and the COVID situation at that point [were affecting research]. We ended up with 12 patients, but we compensated that by enrolling 43 lesions within these patients. So that made up for the number. So we are working on new things to come up. Research ideas are never done. At this point, there nothing really complete to announce, but we will keep working on that and announce when the time is right.

Dermatology Times: This is a milestone year for the SOCS. How has SOCS membership empowered you in your career?

Ahmed: SOCS has a lot of good experiences in my mind because my first [research] grant that I got awarded was from SOCS. It's was the Pfizer grant and I was the first one to get this grant, which was an amazing experience. They funded that project and they funded me for 2 years, which was really helpful so I'll never forget this throughout my career.

Dermatology Times: What are you looking forward to at the 2024 AAD Meeting?

Ahmed: I'm looking to learn more and to attend specific topics that I would like to investigate more and dig deeper in. AAD is a good chance to update your knowledge, to get answers to some questions, and to get ideas as well to move forward. I'm overall interested in surgery, pigmentary skin disorders, and lasers so my talks will be divided between the 3 of these topics.

Reference

1. Ahmed A. Melanocyte transplantation plus topical JAK inhibitor or tacrolimus for treatment of vitiligo: a randomized comparative study. Presented at: 20th Annual Skin of Color Society Scientific Symposium; March 7, 2024; San Diego, CA.