What is vitiligo, and why should I care?

  • Vitiligo
  • Vitiligo
  • Vitiligo

An effective new FDA-approved treatment is here

Vitiligo is a condition where white/light-colored patches occur on the skin. It can also affect hair-bearing areas, causing the hair in those areas to turn gray. Vitiligo can be particularly troubling when patients have tan, brown, or dark brown skin, as the spots are much more apparent. Socially and psychologically, Vitiligo can be devastating and have profound adverse quality-of-life effects.

 Vitiligo can be one of the most psychologically devastating of all diseases. Patients report self-isolation, embarrassment, identity shame, and low self-esteem. Many children (and adults) experience bullying, stigmatization, and emotional distress. The disease can also significantly affect intimacy depending on the location of Vitiligo. 

 Fortunately, many mainstream social media platforms and manufacturers are embracing Vitiligo and trying to promote its mainstream acceptance. 

 The new treatment

For the first time, patients suffering from Vitiligo have a new (FDA-approved topical treatment for the disease.

In July, the FDA approved a cream containing ruxolitinib (Opzelura) for treating (non-segmental) Vitiligo. Ruxolitinib is a medication known as a Janus kinase (JAK) inhibitor. Ruxolitinib cream was first FDA-approved in September 2021 for treating atopic dermatitis.

The JAK-inhibitor class of medications is rapidly becoming the superstar of new dermatologic treatments. The FDA, this past spring, approved another landmark dermatologic medication, Baricitinib, an oral JAK inhibitor. 

Baricitinib was the first treatment for patients with alopecia areata. JAK inhibitors were introduced in 2012 as treatments for certain types of arthritis. Since then, many more uses have been discovered, especially in inflammation-related diseases. 

JAK inhibitors reduce inflammation. As noted, ruxolitinib (Opzelura) is FDA-approved to treat both Vitiligo and Atopic Dermatitis. This is excellent news for the over 2.5 million Americans suffering from Vitiligo.

One crucial question is, are these new medications safe? The class does come with a black box warning that indicates the drug has an increased risk of heart attack, stroke, cancer, infections, blood clots and death. 

These warnings pertained to the whole JAK-inhibitor class of medications. They were based on patients with rheumatoid arthritis being treated with oral medications. The new topical medications appear not to carry the same risks. Still, the patient and physician should address and evaluate the risk-benefit concerns on a case-by-case basis. 

Additionally, about 6% of patients can develop acne or irritation at the application site. Ruxolitinib (Opzelura) is currently approved to treat Vitiligo in patients 12 years and older. 

What causes Vitiligo? 

Vitiligo is a condition where the patient’s immune system inappropriately destroys the cells in the skin that produce color (melanocytes). The destruction of melanocytes is due to a long-term, inappropriate, autoimmune inflammatory response. Vitiligo can be induced or exacerbated by sunburns, skin trauma, environmental toxins, chemicals and stress.  

How common is Vitiligo?

About 1% of people will develop Vitiligo in their lifetime. Up to 50% of people with Vitiligo can identify a family member with Vitiligo. About 5-10% of children will have a sibling with Vitiligo. There appears to be a genetic link.

  • 25% of patients will develop Vitiligo before the age of 10.
  • 50% of patients will develop Vitiligo before the age of 20.
  • 75% of patients will develop Vitiligo before the age of 30.

Unfortunately, when you are a person of color, Vitiligo is much more noticeable. Vitiligo has been associated with other immune-mediated conditions, including atopic dermatitis, thyroid disorders, alopecia areata, rheumatoid arthritis, adult-onset diabetes, anemia, lupus, Addison’s disease, and psoriasis.

How is Vitiligo diagnosed?

A board-certified dermatologist can most easily diagnose Vitiligo. The diagnosis can also be aided by a special light examination called a “wood’s lamp,” a skin-microscope observation (dermatoscopy), or a skin biopsy.

Can Vitiligo be prevented?

  Vitiligo cannot be prevented. However, once it occurs, appropriate and aggressive treatment can keep it from spreading.

How is Vitiligo treated?

Unfortunately, because there were so few effective treatments in the past, many patients with Vitiligo may have given up on treating it. We need to spread the word that there are new, effective treatments for Vitiligo. 

Vitiligo is now treated by topical prescription medications such as the new class of JAK inhibitors such as Ruxolitinib (Opzelura), other topical anti-inflammatory medicines, Vitamin D, meticulous sun protection, and special narrow-band UVB phototherapy light treatments. Often, a combination of these is employed. 

In extreme cases, when only a small patch of dark skin remains, the area can be lightened (depigmented). Sometimes small skin grafts from normal areas can be transplanted into areas of Vitiligo. Also, camouflaging skin (with make-up) can work well.

We are still gathering long-term safety information with the new class of JAK-inhibitor medicines to treat Vitiligo. We are also determining how long patients will need to continue using the medications for the best effect. 

Topical ruxolitinib can take 2-3 months or longer to take effect, so patients need to be patient. It will be interesting to see if other large-scale studies evaluating combination treatments like JAK inhibitors plus phototherapy can decrease the time to depigment. This is certainly something we have seen in our clinic. 

At our clinic, we have used compounded JAK-inhibitors, and now Opzelura, in combination with topical steroids, topical macrolactams, topical vitamin D preparations, and narrow-band UVB phototherapy with amazing results over the years. We are excited to add Opzelura (and any other JAK inhibitors that may be coming) to our therapeutic armamentarium. 

One of the things that I have noticed is that, fortunately, the head and neck seem to respond best. The trunk, arms and legs are second best. The hands and feet are most difficult to respond.” 

Action steps for anyone with unwanted Vitiligo

Be sure to get under the care of a board-certified dermatologist. Learn about Vitiligo and the current treatments. Also, join the National Vitiligo Foundation and participate in local Vitiligo support groups.

It is essential to realize that Vitiligo is a common condition and that you are not alone. The great news is that there are fantastic, effective new FDA-approved treatments for Vitiligo.

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