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Updates in Vitiligo Management


Seemal Desai, MD, shares highlights from his session at Winter Clinical Hawaii.

At the 2023 Winter Clinical Hawaii Dermatology Conference, Seemal Desai, MD, clinical assistant professor of dermatology at the University of Texas Southwest Medical Center in Dallas, Texas, and advisory board member of the Fall and Winter Clinical dermatology conferences, shares key highlights from his session, “Managing Vitiligo and Other Pigmentary Disorders.”


I'm Seemal Desai. I'm a board-certified dermatologist in private and academic practice in Dallas, Texas. And it's a pleasure to be able to recap some pearls from my lecture here today at Winter Clinical 2023 in beautiful Kona, covering vitiligo and other pigmentary disorders. We actually talked about the fact that now is probably our most exciting time for managing vitiligo that we've ever had in our understanding of this disease. The recent FDA approval of topical ruxolitinib cream, now with new potential IL-15, antibody-based products that are going to hopefully be a game changer in helping stabilize and having a remittive effect for vitiligo. Just like we have biologics for psoriasis and atopic dermatitis, having a biologic for vitiligo would be so exciting, and I think it's on the horizon.

We also focused on melasma. Remember, melasma does not just affect women, men can get melasma, and melasma also can happen on areas other than the face. The most common sight of having melasma other than the face is on the bilateral dorsal forearms. We also talked about oral tranexamic acid, FDA off-label for the treatment of melasma but works really well oftentimes in doses of 325 milligrams once to twice daily. These are medications that require screening and counseling for patients, especially those who are on contraceptives, hormonal-based therapies, history of blood clots, renal and liver disease, nursing pregnant; you want to avoid it for those patients. But in patients who are healthy and otherwise not on any major systemic medications, no history of clotting, these can be an option for recalcitrant disease in the oral form. And finally, we talked about lichen planus pigmentosus, erythema dyschromicum perstans, and that sort of alphabet soup of these reticulated pigmentary anomalies where you can actually use low-dose oral isotretinoin off-label for patients with lichen planus pigmentosus and it tends to work really well. This is a condition that we're seeing lots of cases of now in my practice and probably in yours as well. And remember, LPP classically are those smaller coalescing lesions on the head, neck, forehead. axilla, whereas erythema dyschromicum perstans is more commonly on the truncal area. Sunscreens, antioxidants like oral polypodium leucotomos and low-dose oral isotretinoin, 20 milligrams a day, off-label for six to eight months tends to work quite well.

So there is lots to cover and lots of excitement in the world of pigmentation, and I hope you enjoy the rest of this meeting and look forward to seeing you all in person very soon.

Transcript edited for clarity

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