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Diagnosis and Pathophysiology of Vitiligo


A panel of experts discuss the diagnosis and pathophysiology of vitiligo.

Heather Woolery-Lloyd, MD: Hello and welcome to this Dermatology Times program, “Payer Perspectives and Vitiligo: Optimizing Patient Outcomes With Novel Therapeutic Approaches.” I’m Dr Heather Woolery-Lloyd, director of the Skin of Color Division at the Dr Phillip Frost Department of Dermatology and Cutaneous Surgery at the University of Miami Miller School of Medicine [in Florida]. Joining me today in this virtual discussion are Dr Chesahna Kindred, founder of the Kindred Hair and Skin Center in Columbia, Maryland; Dr Gary Owens, president of Gary Owens Associates in Ocean View, Delaware; and Renata Block, certified physician assistant with Advanced Dermatology and Aesthetic Medicine in Chicago, Illinois. Today, we are going to be talking about several topics, including an overview of vitiligo, an evaluation of therapy options for vitiligo, and payer perspectives for the management of vitiligo. With that, let’s get started.

Chesahna Kindred, MD, MBA, FAAD: The diagnosis of vitiligo, thankfully, is one of the more straightforward diseases. Usually, [it] does appear with white spots, but I always do a white Wood’s lamp, and that helps me to notice the accentuation or a bright glowing to the skin. One of the reasons is because sometimes you can’t see the vitiligo, and I want to appreciate all the lesions of vitiligo to make sure I have a good assessment of how advanced the disease may or may not be.

Heather Woolery-Lloyd, MD: Yes, I definitely think Wood’s lamp is very helpful, especially in patients with lighter skin, where it may not be as obvious.

Chesahna Kindred, MD, MBA, FAAD:Yeah.

Heather Woolery-Lloyd, MD: I want to talk a little bit more about the pathophysiology of vitiligo. Renata, we know that vitiligo is an autoimmune disease. Can you tell us a little bit more about the pathophysiology of vitiligo?

Renata Block, PA-C: We can all agree that it’s an autoimmune disease. The question is whether the immune system is attacking the melanocytes or [whether] it an intrinsic deficit within the melanocytes. We know that genetic component, genetic history, or genetics can play a big role [with regard] to vitiligo as well as areas of trauma. Or maybe people are using depigmentation agents. That can definitely throw them into the vitiligo, depigmentation on the skin. Other factors can be maybe thyroid disease, like a hypo- or hyperthyroid, or endocrine disorders like diabetes and even adrenal insufficiency such as Addison disease.

Heather Woolery-Lloyd, MD: Yeah. It’s interesting. I agree that we know it’s autoimmune, and I try to explain to my patients that this is an autoimmune condition. The simplest way to explain it is that the immune system is attacking the melanocytes, and that’s such an easy way for patients to understand. But it is so multifactorial when we think about vitiligo. There are so many other factors that play a role.

Renata Block, PA-C: Absolutely. What you said [with regard] to explaining that to the patient, it’s kind of like an aha moment. But when they hear the word “autoimmune,” they are taken aback and it’s our job then to clarify what exactly that means. It means that the immune system is [homing] in on those melanocytes. But again, is it [an] intrinsic deficit within the melanocytes? That’s what I would like to know.

Heather Woolery-Lloyd, MD: Right. It’s very interesting. I like that idea of saying “[homing] in” because I think for patients that is a little more palatable than saying “autoimmune.” I think that can sometimes be a scary word.

Transcript edited for clarity.

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