Dr. Robert Brito: "Vitiligo has a great psychological and emotional impact on patients".
Before creating a treatment plan, a dermatologist thinks about what is best for each patient. To do this, your dermatologist considers your age, your general health and the effects the disease has on your life.
June 25 marks World Vitiligo Day, an autoimmune disease. This means that your immune system is attacking the healthy cells in your body that give your skin its color, due to the progressive destruction of pigment-producing cells known as melanocytes.
Vitiligo has a great psychological and emotional impact on patients, although many times its only manifestation is at the skin level, which could be interpreted only as an aesthetic problem; however, many studies have shown it to be something more complex. Such considerations correspond to Dr. Robert Brito, dermatologist, trichologist and hair surgeon of the Hospital Metropolitano de Santiago (HOMS), interviewed for Diario Libre about this condition.
What is your approach to patients with vitiligo?
We perform a clinical history, physical examination of the skin and skin appendages such as hair and nails. Wood’s lamp, dermatoscope and other alternatives such as skin biopsy are used for diagnosis. If the patient is diagnosed with vitiligo, blood tests are recommended for associated autoimmune diseases, such as thyroid disease, diabetes mellitus, alopecia areata, psoriasis, pernicious anemia, lupus, rheumatoid arthritis and others. After giving the diagnosis, we also ask if they want to treat their disease. Some people choose not to. Model Winnie Harlow, who has vitiligo, lets the world see her skin as it is.
What are the treatment objectives?
Restore lost skin color, prevent patches and blemishes from enlarging and prevent new blemishes from appearing. Before creating a treatment plan, a dermatologist thinks about what is best for each patient. To do this, your dermatologist considers your age, your general health and the effects the disease has on your life. The type of vitiligo, where it appears on the body and how it progresses also play an important role.
Instead of receiving medical treatment, some people prefer to cover light spots with make-up, self-tanner or skin dye. For patients who do want treatment, there are therapeutic alternatives that can restore lost skin color. Treatment cannot cure vitiligo.
What are the most effective and promising treatment advances available today?
The advent of new treatment options provides people with vitiligo the option of treating their disease. In 2022, Opzelura (ruxolitinib), for the treatment of non-segmental vitiligo, was approved by the Food and Drug Administration (FDA), USA. on July 18, 2022 and the European Medicines Agency (EMA) on April 19, 2023.
What is Opzelura?
Opzelura is a drug used in adults and adolescents aged 12 years and older with non-segmental vitiligo that also affects the face. Opzelura’s active ingredient, ruxolitinib, works by blocking enzymes called Janus kinase (JAK) 1 and 2, which are involved in the activity of a substance called interferon-gamma.
It may take more than 24 weeks to achieve satisfactory results. If you have not experienced significant repigmentation in this period, consult your physician. Do not use Opzelura in combination with therapeutic biologics, other JAK inhibitors or potent immunosuppressants such as azathioprine or cyclosporine.
Other treatments:
- Topical and systemic corticosteroids.
- Topical calcineurin inhibitors: tacrolimus and pimecrolimus.
- Melagenin.
- Phenylalanine and heliotherapy.
- Vitamin D analogues Calcipotrium.
- KUVAtherapy: kellin + UVA.
- PUVA photochemotherapy (8 methoxypsoralen).
- Antioxidants ginkgo biloba extract 40 mg, three times a day.
- 308 nm XeCl laser excimer 1 to 3 times per week.
- Helium-neon laser many sessions 1 or 2 times a week from 1 to 5 years.
- Surgery, melanocyte transplantation.
- Permanent depigmentation, preparations containing hydroquinone.
- Levamizole and Prostaglandin E, Polypodium leucotomos.
- Transplantation of cultured melanocytes.
- Fluoruracil: Little experience, there are reports of intradermal application in combination with UVBba.
- Micropigmentation.
Link of the medium:
Vitiligo: what are the advances in treatments – Diario Libre
Doctor: Dr. Robert Brito, dermatologist, trichologist and hair surgeon of the Metropolitan Hospital of Santiago.