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Illustrating the Presentation of Vitiligo


A panel of experts open a discussion surrounding vitiligo, including the definition and nature of the disease.

Jeffrey D. Dunn, PharmD, MBA: Hello, and welcome to this AJMC® Peer Exchange program titled, “Disease Burden and Management of Vitiligo.” My name is Dr Jeff Dunn. I’m the chief clinical officer at Cooperative Benefits Group in Salt Lake City, Utah. Joining me today for this discussion are my colleagues, Dr David Rosmarin, the vice chair of education and research at Tufts Medical Center [in Boston, Massachusetts]; Dr Brett King, an associate professor of dermatology at Yale School of Medicine [in New Haven, Connecticut]; and Dr David Epstein, an independent consultant. Our panel of experts will explore the clinical and economic burden of vitiligo, review treatment paradigms and standard-of-care therapies, and discuss unmet needs and future directions in the treatment of vitiligo. Thank you for joining us. Let’s begin. I’m going to start with Dr Rosmarin. What is vitiligo? How do you typically see it present in patients?

David Rosmarin, MD: Vitiligo is a disease in which the immune system is too active in the skin in such a way that it destroys the pigment cell, or melanocyte. After the melanocyte, or pigment cell, is destroyed, it leaves white spots. This usually presents as depigmented or white patches, often in exposed areas such as the face or hands, but any part of the body can be affected. Some people only have vitiligo on a small part of their body. Some have almost their whole body affected.

There are 2 main types of vitiligo: segmental and nonsegmental vitiligo. Most patients have the nonsegmental type. The segmental type tends to affect younger children. It’s expressed as somewhat rapid depigmentation in a somewhat contained area of the body, and then it’s usually stabilized for the rest of that patient’s life. The normal type of vitiligo can happen at any time, can be progressive or stable, and is often symmetric.

Jeffrey D. Dunn, PharmD, MBA: Thank you. I appreciate that. Dr King, this is important in understanding how the drugs work. What are the hypothesized causes of vitiligo?

Brett King, MD, PhD: Vitiligo is clearly an autoimmune disease. There’s nothing vague or uncertain about that. As David mentioned, the body’s immune cells—this set of cells is fairly well defined—attack the pigment cells, or the melanocytes, of the skin. That’s autoimmunity. There are other clinical clues of autoimmunity. We’ll get to more of this later. Vitiligo isn’t uncommonly associated with autoimmune thyroid disease. That gets to this other aspect of the cause, that there are probably underlying genetics in most people, maybe all people, with vitiligo. Genetics are predisposing people to autoimmunity, in which the body’s immune system attacks a certain population of cells, leading to the white spots that David described.

Transcript edited for clarity.

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