Classifying Vitiligo Severity Beyond Body Surface Area

In "Classifying Vitiligo Severity Beyond Body Surface Area," Dr. Desai joins the panel to refine how clinicians classify vitiligo severity beyond body surface area alone.

Dr. Desai agrees that body surface area matters, citing a recent JAMA Dermatology paper his team published establishing cutoffs of three percent, three to ten percent, and above ten percent to correlate with mild, moderate, and severe disease. But he stresses that surface area alone cannot capture severity: anatomic site, disease instability, and psychological or comorbid factors can all elevate a case's true severity regardless of extent. He describes patients with vitiligo limited to the fingertips and hands, among the hardest areas to fully repigment, who carry a disproportionate psychological burden because those areas stay constantly visible during everyday activities like typing or shaking hands. Genital involvement, though invisible to others, can be equally devastating to self-confidence and relationships. He argues that relying solely on the FDA label's BSA-based framework is short-sighted, which is why his research aims to quantify severity more holistically.

Dr. Lal extends the psychosocial discussion, noting that his practice sees a disproportionate share of patients with skin of color, including many Mexican families in which parents often feel guilty, believing they are somehow responsible for their child's disease. He recommends family therapy for both children and parents given the anxiety and depression documented in the literature. He describes one white patient who quit her daytime job to drive for a rideshare service at night rather than let people see her face. Beyond therapy access and out-of-pocket costs, he details the financial burden of phototherapy: patients often drive twenty to thirty miles each way, multiple times weekly, for dozens of sessions, on top of gas, copays, and medication costs that push some patients to give up on treatment entirely.

In "The Current Vitiligo Treatment Landscape, From Topicals to Orals," Dr. Rosmarin will walk through the full treatment landscape, from topical steroids to emerging JAK inhibitors.