Discovering Dermatology Times: August 2024 Personalized Vitiligo Care Supplement

The August Case-Based Peer Perspective supplement of Dermatology Times includes a collection of thought-provoking discussions and strategies surrounding how to personalize treatments for patients with vitiligo from Rocco Serrao, MD, FAAD; Latanya Benjamin, MD, FAAD; and Anthony Nuara, MD, PhD. Be sure to read the highlights from the supplement below. Also, don’t miss a moment of Dermatology Times by signing up for our eNewsletters and subscribing to receive the free print issue and supplement each month.

Part 1

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.

Serrao’s Perspective

Serrao initiated his discussion in Cleveland, Ohio, by emphasizing the importance of understanding the impact vitiligo has on patients. “With 0.5% to up to 2% of the population having vitiligo, it’s absolutely essential for clinicians to understand that we’re going to see individuals with this condition,” he said.1 Serrao highlighted the varying degrees of psychological and social impacts vitiligo can have on patients, depending on their skin tone and personal circumstances.

Case Study: A Collegiate Athlete’s Struggle

Serrao shared a case of a 20-year-old man who is a collegiate athlete with segmental vitiligo. “He recently noticed these white patches on the right side of his face, and his brow was also turning white. He was very embarrassed by the appearance, affecting his self-confidence and interpersonal relationships,” Serrao recounted. This patient had not tried any treatments yet, highlighting a common issue—lack of awareness and access to effective therapies.

“Up to 60% of people with vitiligo believe there are no treatments available, which leads to a loss of hope. This is often due to health care providers not being aware of the therapies that are available,” Serrao said. This lack of awareness among both patients and providers can hinder effective management of the condition.

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Part 2

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.

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Part 3

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.

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Part 4

Managing Vitiligo in Diverse Patient Populations

Understanding the unique needs of different patient populations is crucial in managing vitiligo effectively. Dermatology clinicians must consider factors such as age, skin type, comorbidities, and psychological impact when developing treatment plans.

Pediatric Patients

Managing vitiligo in pediatric patients presents unique challenges. Benjamin emphasized the importance of involving both the child and their parents in the treatment process. “For children, it’s crucial to ensure that both the child and their parents understand the treatment plan and its importance. Encouraging adherence through educational materials and regular follow-ups can help maintain treatment efficacy,” she advised.

Benjamin shared a case of a 10-year-old girl with vitiligo who was struggling with low self-esteem due to her condition. “This young patient was very self-conscious about her appearance, especially in social settings. We involved her parents in the treatment plan and provided resources for them to help support their daughter emotionally,” Benjamin recounted. This holistic approach helped improve the child’s self-esteem and adherence to treatment.

Adult Patients With Comorbidities

Nuara highlighted the importance of addressing comorbidities in adult patients with vitiligo. “Comorbid conditions, such as thyroid disease or autoimmune disorders, are common in vitiligo patients and can affect treatment outcomes. Comprehensive baseline assessments and regular monitoring are essential,” he explained.

He shared a case of a 45-year-old man with vitiligo and hypothyroidism. “Managing this patient required a multidisciplinary approach. We collaborated with his endocrinologist to ensure his thyroid condition was well controlled, which in turn helped improve the efficacy of his vitiligo treatment,” Nuara noted.

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