Putting Progress Into Practice for Patients With Vitiligo: Part 3

Across a trio of Dermatology Times Case-Based Roundtable events held nationwide, 3 board-certified dermatologists joined peers in Texas and California to dissect the clinical challenges and treatment nuances of vitiligo. Through lively, in-depth conversations, participants tackled real-world patient scenarios, offering diagnostic insights, therapeutic strategies, and practical pearls from their own experiences.

The roundtables were moderated by Seemal Desai, MD, FAAD; Ted Lain, MD, MBA, FAAD; and Pearl Grimes, MD, FAAD. Desai, founder of Innovative Dermatology in Plano, Texas, and a clinical assistant professor at The University of Texas Southwestern, led the Dallas-based session. Lain, chief medical officer at Sanova Dermatology in Austin, facilitated the Austin event, while Grimes, founder and director of the Vitiligo & Pigmentation Institute of Southern California, hosted the discussion in Los Angeles.

Each clinician guided peers through 3 complex patient cases, highlighting differences in disease severity, comorbidities, psychosocial impact, and treatment history.

Read part 1 here

Read part 2 here

Case 3: Navigating Psychosocial Impact and Treatment in Pediatric Patients

The final case focused on the challenges of managing vitiligo in adolescents, a population in which visible lesions often intersect with high psychosocial vulnerability. Clinicians examined the need for family-centered care, appropriate treatment selection, and clear expectation setting to support young patients navigating both physical symptoms and emotional hurdles.

In Dallas, Desai described the case of a 15-year-old girl with vitiligo on her face and hands, both highly visible areas that often carry a heavier psychosocial burden. She had previously used triamcinolone and tacrolimus without success, discontinuing both due to either inefficacy or stinging.

“It’s a younger patient, so you have to manage family anxiety, patient anxiety, and self-esteem issues—really talking about the need for that durable repigmentation, the fact that repigmenting vitiligo takes a long time, and [the] need to use both topicals, and, in some cases, use other therapies, as well,” Desai said.

The patient was ultimately prescribed ruxolitinib cream 1.5%, and attendees explored how to improve adherence by fostering open communication, establishing realistic expectations, and addressing the emotional toll on both patient and family. Short-term progress markers and structured follow-up were recommended to maintain motivation during what is often a prolonged treatment course.

In Los Angeles, Grimes presented a similar case of a 13-year-old girl with 1 year of facial and hand involvement. The patient had discontinued topical treatments for reasons similar to Desai’s case and was increasingly frustrated by the lack of results.

Grimes emphasized that while children may be more responsive to treatment than adults, they also experience intensified emotional strain due to bullying, stigma, and evolving self-image during adolescence.

“Children and adolescents often respond better to treatment,” she noted, “but they also carry a deeper psychosocial burden.”

To that end, Grimes highlighted the importance of supportive resources like Camp Victory, hosted by the Global Vitiligo Foundation, where children with vitiligo and their families can build community and resilience.⁴

“Camp Victory was a phenomenal experience for me,” she shared. “This year, we had 40 kids, 40 parents, and 11 therapists from around the world. We had kids from Mexico, the UK, Canada, plus our contingency of kids from the US.”

Treatment decisions, she stressed, should center on the patient’s willingness and emotional readiness. “If the child is motivated and the lesions are visible, treat. But pushing treatment on a reluctant teen may do more harm than good,” Grimes said.

Ruxolitinib cream again emerged as a favorable option, supported by post hoc TRuE-V1 data and long-term studies showing continued repigmentation beyond 52 weeks, with some patients achieving peak results after 104 weeks.⁵

In Austin, Lain also emphasized the psychosocial dimension of pediatric vitiligo.

“This was a really unfortunate presentation,” he said. “Again, the psychosocial aspect of it came through, and perhaps the need to refer for child psychology to help with coping mechanisms.”

Lain walked attendees through a conversation on balancing disease control with minimizing treatment burden in this age group. Systemic agents and pulse corticosteroids were discussed cautiously, with a strong preference for shared decision-
making and gentle topical options.

“It’s a shared model of determining what’s the right path forward,” Lain said. “We present the data, we present our options, and let the patient and her parents really work through those themselves.”

Given the sensitive location of lesions and tolerability concerns, ruxolitinib stood out as a leading candidate.

“Topical calcineurin inhibitors often sting and burn, and especially younger patients seem to be more susceptible to that,” Lain noted. “So the topical JAK inhibitor ruxolitinib came into play here.”

Across all 3 events, the pediatric case reinforced the need for empathy, education, and individualized care plans that address the emotional and clinical realities of growing up with vitiligo.

Clinician Response and Therapeutic Momentum

Across all 3 roundtable events, clinicians expressed strong enthusiasm for evolving vitiligo treatment strategies, particularly in light of new therapeutic options and emerging long-term data. From topical innovations like ruxolitinib to practical guidance on phototherapy and systemic agents, discussions reflected a dynamic exchange of real-world experience and evidence-based insight.

“There was a lot of excitement about ruxolitinib,” Desai said. “There was a lot of discussion on how to incorporate phototherapy and when to use systemic steroids. I think everyone got a lot out of it.”

Participants weighed the nuances of treatment sequencing, safety in pediatric and adult populations, and the logistical hurdles of access and insurance approval for newer therapies. These layered conversations emphasized the importance of shared decision-making, patient education, and advocacy in ensuring equitable care.

Lain noted the attendees fostered a collaborative atmosphere that supported the willingness of attendees—many early-career dermatologists—to share perspectives and practical insights.

“I was really impressed with the level of engagement we had.… They felt very comfortable giving their ideas in front of their peers and having a conversation,” he said.

That openness created space for rich clinical discussion and peer learning.

“Sharing that in an open forum like this—where no one is right or wrong, and there’s no judgment—was a way for us to hear different viewpoints and options for treatment,” Lain added. “And I think we all took those home and will apply those to our practice.”

Together, the roundtables illustrated not only the complexity of vitiligo management but also the energy and commitment driving innovation in care. As research advances and therapeutic options expand, forums like these continue to play a vital role in translating data into action and improving outcomes for patients navigating this challenging disease.

View the full supplement here

References

4. Camp Victory. Global Vitiligo Foundation. Accessed July 23, 2025. https://globalvitiligofoundation.org/camp-victory/

5. Wolkerstorfer A, Gooderham M, Sebastian M, et al. Efficacy of prolonged ruxolitinib cream treatment for vitiligo among patients with limited or no initial response at 6 months. Presented at: 32nd European Academy of Dermatology and Venereology Congress; October 11-14, 2023. Berlin, Germany.