George Woodbury MD 1/27/2023
Vitiligo is an autoimmune skin condition affecting upwards of 1.5 million Americans in which depigmented patches appear, particularly on the face, hands, feet, and body, often beginning in childhood or early adulthood. Vitiligo can have both effects on the skin but also on a person’s self-image, leading to increased risk of emotional distress and depression. From my perspective as a Memphis Dermatologist for the last over 30 years, let’s take a look at Vitiligo treatment options: Dermatology research has fortunately uncovered promising treatment options.
First, what is Vitiligo? Vitiligo happens when the immune system of the body starts attacking the pigment-producing cells, or melanocytes. We now know that sometimes it goes hand in hand with autoimmune attacks upon the thyroid gland, so sometimes we Dermatologists do screening bloodwork, checking for what are called Antithyroglobulin Antibodies, a possible marker for accompanying autoimmune attack upon the thyroid gland as well.
Initial treatment of Vitiligo can sometimes involve use of Ultra-potent steroid creams and ointments, such as Clobetasol or Halobetasol. Sometimes we consider steroid-free products, such as tacrolimus ointment or pimecrolimus cream. These therapies are generally done with supervision by the prescribing doctor, because steroids can be absorbed into the body, and they can cause risk of thinning of the skin, or what is called stretch marks and skin atrophy.
Some patients with Vitiligo respond well to what is called Ultraviolet phototherapy, whereby invisible UV light is shone several times a week to affected areas. Many patients respond reasonably well to this therapy, but once again results take months of treatment.
Studies from the Indian Dermatologic literature have shown some initial benefits for Vitiligo patients from taking an oral tablet – Gingko biloba –at a dose of 40 milligrams three times a day for twelve months. This option can be taken as well as 60 milligrams twice a day.
In August of 2022, the F.D.A. approved a new steroid-free cream - Opzelura® (Ruxolitinib) – for treatment of a special type of Vitiligo –Nonsegmental Vitiligo – for adults and teenagers 12 years old and older. Opzelura is what’s called a JAK inhibitor, meaning that it acts upon the JAK-stat immune pathway. Similar JAK-stat inhibiting medications have been used by Rheumatologists to control Rheumatoid Arthritis for upwards of eight years, with promising results. Being a new medication, Opzelura generally does require lab monitoring.
Initial research in Dermatologic studies of use of Opzelura has shown that approximately 30% of patients achieve about 75% repigmentation within the depigmented patches at six months of treatment, whereas that number rises to 50% of patients achieving 75% repigmentation at a year of treatment. About 1 patient in 6 Vitiligo patients achieves 90% repigmentation at a year of treatment, so Opzelura holds promise for many patients, but giving the therapy time to show effects is important.
So a best first move if you or a family member may have Vitiligo is a consultation with a Board-certified Dermatologist for a skin check-up. I have practiced as a Cordova Dermatologist since 1993, with Rheumatology and Dermatology (www.Rheumderm.com), Memphis, TN, near Germantown, Bartlett, and Arlington (8143 Walnut Grove Road, Cordova TN 38018 1-901-753-0168). Or you could find a Board-certified Dermatologist closer to you from the American Academy of Dermatology’s “Find a Dermatologist” site (AAD.org). Plug in your zip code, and you’ll get a list.
And if you have oily or combination skin and complexion issues, a company of which I am President – Big River Silk Skincare – manufactures and distributes a helpful deep organic skincare cleanser – AmberSoy Soap Gel – which can be used as a type of skin mask, for 3-5 minutes prior to washing off. (www.Bigriversilkskincare.com).
1 oz: $12.95; 2 oz: $18.95; 8 oz: $59.95.
Big River Silk Skincare also manufactures a gentle lubricating organic moisturizer: HypoShea Moisturizer Cream, free of dyes, oil, sulfates, and propylene glycol. 1 oz: $12.95; 2 oz: $18.95; 8 oz: $39.95. All of our products can be picked up at 8143 Walnut Grove Monday-Friday 7:30 AM to 4:30 PM. Otherwise, for orders under $40.00: $5.00 shipping and handling ($10 for Canadian orders), otherwise free shipping and handling: https://www.Bigriversilkskincare.com).