Updates in the Treatment of Vitiligo - Episode 3
Dr Rosmarin gives a brief overview of treatment pathways.
David Rosmarin, MD: When I treat vitiligo, I’m trying to find out the patient’s goal. I usually break it down into 4 different answers. One is a patient just wants to know what they have, and they’re perfectly comfortable with their disease. They aren’t looking for anything else. They just want to know what’s happening and their prognosis, perhaps how it affects having children or the chance that their children or siblings may have vitiligo. The second is that patients who are actively progressing may want to halt the progression. They aren’t interested in repigmenting. They want their disease to stop spreading. That could be a goal of a patient. The third is repigmentation, which is the majority of our patients’ goals. They want to get their pigment back. They want to be how they were [when they were] born and reverse the autoimmune attack of the pigment cells. The fourth is maintaining that pigmentation [after patients repigment], so patients don’t go into reverse. Those are the 4 goals we have for treatment: knowledge of what their disease is and their prognosis, halting the progression, repigmentation, and maintenance.
If a patient has progressive disease that they want to stop, there are different signs that it may be progressing. The most common types include trichrome, or 3-colored, vitiligo: the normal skin color, the white patches, and a color in between, which is the spreading front. If patients have confetti lesions that are small white dots, that’s also a sign of activity. The less common types are if patients have evidence of vitiligo in response to trauma, such as having vitiligo at a scratch mark or developing vitiligo in a tattoo. Lastly, is if it’s inflammatory, with a red ring around the vitiligo, which is very uncommon. Those are all signs of activity.
To help stop it, the most common treatment we use is oral steroids, particularly dexamethasone, which may be done 2 times a week for about 12 weeks. There can be some adverse effects associated with steroids, such as weight gain and trouble sleeping, but that tends to be very well tolerated overall and can often halt the progression. Another common treatment that we’ll use, sometimes in combination with the oral corticosteroids, is phototherapy. Phototherapy can be done twice a week, but ideally [is done] 3 times a week, and can help calm down the immune system, which can initiate the repigmentation process. There are other treatments that are a lot less standard that can be used for halting the progression, but the 2 that are most common by far are phototherapy and oral corticosteroids.
Transcript edited for clarity.