Ask The Expert: Vitiligo (Part 2)

When should you start treatment for vitiligo?
Ideally, treatment for vitiligo should be started within the first 12-24 months. Getting the right treatment or the right combination of treatment for that person’s type of vitiligo as early as possible is the key to success.

How is vitiligo treated?

There is no cookie cutter approach for vitiligo. It really depends on the presentation of the patient – their age, location of the spots of vitiligo, size of spots and many other factors.

The success of the treatment depends largely on the duration the vitiligo has been present and the location of vitiligo. Areas involving fingers, toes, ankles etc generally don’t respond as well as other areas.

Vitiligo treatments available in Melbourne currently include: topical steroid creams or calcineurin inhibitor creams.

For widespread cases of vitiligo, we can use light therapy (which is also known as narrow-band ultraviolet light B or phototherapy) which can stimulate the pigment cells and encourage them to re-pigment affected areas. Fortunately, for patients in Australia, phototherapy is subsidised by Medicare if a dermatologist recommends this treatment.

There are also localised laser treatments available called excimer lasers and this can be used for very early small lesions but is not good when more than one small spot exists.

What happens when treatment is stopped?

If treatment is a ceased abruptly, there is about a 40% chance that the white spots will come back quickly, so, it is important to think about maintenance therapy for most patients. Maintenance might be in the form of creams or light therapy – but the details of the type and duration of maintenance treatment will depend on the individual being treated. Your vitiligo expert will be able to recommend what is best for you.

Are there any new treatments on the horizon for vitiligo?

Yes! Newer treatment are emerging for vitiligo which is very exciting for all of us who are involved in vitiligo research and supporting the vitiligo community. One example of a newer treatment are the JAK inhibitors, Tofacitinib and Ruxolitinib. These can improve not only stability of the lesions, but also re-pigmentation too. Newer generation JAK inhibitors are also in clinical trial mode at the moment. There are also developments in the works for medications that stop vitiligo recurring and these, when available, will be a huge win for the several hundreds of patients we see each year.

The great thing is that we are at a pivotal point in vitiligo therapeutics. We will soon have biologic therapy to treat patients with that will revolutionise things for 2022 and beyond.

What do you do if a patient has really widespread vitiligo?
It is always important to spend time understanding the patients goals and motivations. For patients who have very extensive vitiligo and are keen to ‘just be one colour’ depigmenting agents in the form of a cream called Monobenzylether of hydroquinone can be used. To depigment someone is a very big process psychologically. This needs to be entered into with absolute caution and after a really comprehensive discussion with the patient and potentially their family members as well.

What are some other skin conditions that can also cause depigmentation?

Most other depigmenting conditions are actually congenital, meaning people are born with these from birth. Vitiligo is not something that is seen at birth. However, there are other conditions that can look just like vitiligo like depigmentation from certain chronic dermatoses.

What has been a breakthrough in vitiligo during your career?

In terms of breakthrough for vitiligo, it is definitely the advent of biologic therapy for vitiligo. There are JAK inhibitors for example and these treatments are currently in trial mode in different parts of the world, including Melbourne. In fact, the phase 3 clinical trials for one of these agents is likely to start later this year and I am really looking forward to being involved in this study.

The JAK inhibitors, I am sure will revolutionise the treatment of vitiligo and will open up the doors to many other new treatments in the biologics space.

The benefits of such treatment advances will be physical, psychological and social. And our patients are deserving of this.

Does vitiligo affect mental health and wellbeing?

A huge collection of research shows that pigmentary disorders have a significant impact on quality of life. Vitiligo in particular, can impact a patient’s ability to work and get involved in intimate relationships. It may cause anxiety, depression and social isolation.

I am really passionate about providing therapeutic options for vitiligo that enable patients to integrate back into the community, workforce and relationships. I hope the new therapeutic options will really help propel the vitiligo community forward.

Are there any other exciting developments in the area of vitiligo that you can share?
There is emerging evidence that the skin and gut microbiome may be different in those with vitiligo. This means that gut health may play a small role in vitiligo. We still don’t know what this means in terms of diet and lifestyle recommendations but I am very interested in holistic care of my vitiligo patients so can’t wait to watch and wait as the scientific evidence rolls in.

How can people find more about vitiligo and vitiligo treatments available at Chroma Dermatology?
Chroma dermatology is a dedicated centre for pigment and skin of colour and that is at the heart of all we do.

In addition to our medical consultations and medical therapy for vitiligo, we have a cosmetic camouflage service, phototherapy, surgical treatments and fully integrational depigmentation services. The best way to find out some more information is to like and follow our social media channels on Instagram and Facebook and read more on our website.

For more scientifically factual information on vitiligo, check out our prior blogs and website posts!

The information contained in this blog post is intended as a guide only and should not substitute seeking medical attention. Please see your healthcare provider for more information on suitability of products, treatments or procedures.