By John Harris, MD, as told to Haley Levine
I have been a vitiligo researcher for nearly 20 years. While it affects people of all races and ethnicities equally, it is more noticeable in people with darker skin. As a result, they may be more self-conscious about it or suffer more social stigma. But what I tell people is, there has never been a more exciting time when it comes to treating vitiligo. This past July, the FDA approved ruxolitinib (Opzelura) as the first-ever medication to restore pigment in people with vitiligo. More drugs are in the pipeline. I hope some of these will prove to be game-changers for people of color with vitiligo.
The challenges of finding a cure
Historically, dermatologists have dismissed vitiligo as merely a cosmetic problem. Many people have come to me in desperation after going through five or six other dermatologists who told them their condition was no big deal. But research shows that people of color have a more negative attitude towards vitiligo than fair-skinned people. This may be because there is a lot of social stigma surrounding vitiligo in certain cultures, such as some cultures in South Asia or Africa. There are misconceptions that the condition is contagious, a form of leprosy, or even a form of punishment from God. Since people with darker skin are more often affected by vitiligo than people with lighter skin, their quality of life may be further affected.
In addition, some of the early medications we used to treat vitiligo made the problem more noticeable in darker skin. Take monobenzone (Benoquin), which for years was the only FDA-approved treatment for vitiligo. This drug removes pigmentation from the skin, and it does it very quickly, after about 12 months of use. If you are a very light-skinned redhead, this is not a big deal. But if you are someone who
Color, there are a lot of social implications. Take Michael Jackson, for example, who went public with vitiligo and whose autopsy results revealed he used monobenzene. People accused him of wanting to be white and said he was ashamed of being black. But it wasn’t. He was just trying to cure his vitiligo.
Some of the other treatments we have, like UVB phototherapy, haven’t been much better. While UVB phototherapy works well, it can be very difficult to get right. You have to drive to the dermatologist’s office two to three times a week, and it’s very expensive. If someone doesn’t have access to transportation, can’t afford time off work, or find childcare, they won’t always be able to get treatment.
Excitement about new treatments
Ruxolitinib (Opzelura) may soon become the gold standard for the treatment of vitiligo. It is a type of medicine known as a JAK inhibitor. It inhibits JAK1 and JAK2, two enzymes that increase the inflammation that causes vitiligo. A study published last year in The New England Journal of Medicine It was found to restore pigment in about a third of patients who used it for 6 months. I am very hopeful that it will work well for many people of color with vitiligo. Although we didn’t have as much variety in clinical trials as we would have liked, we were happy to report that it seemed to work just as well for darker-skinned people as it did for lighter-skinned people.
I see ruxolitinib as just the beginning of a new wave of effective drug therapies. Ruxolitinib is applied as a cream and is limited to only 10% of a person’s body surface area. Currently, I am participating in two other clinical trials testing JAK inhibitors that patients can take orally. The hope is that it will be more effective than the topical version. I’m also developing auremolimab, a type of drug known as a monoclonal antibody, to help treat vitiligo. JAK inhibitors are very effective, but if you stop them, you will relapse. Hopefully, auremolimab will be a drug that people take for a month or two every year to maintain their new color.
While these advances help everyone with vitiligo, they really do benefit skin of color. People will no longer have to rely on depigmentation drugs or take time off work to travel for UV light treatments. If you can get infrequent treatments which only require 2 months treatment each year, it saves a lot of time.
To treat or not to treat?
Some people of color decide not to have their vitiligo treated. That’s totally fine! I just told them that if the vitiligo spreads, it will become more difficult to treat later. This is especially true of areas with bony bumps, such as the hands and feet. The only challenge I see among people with Vitiligo is finding good cosmetic coverage if they want to hide their condition. Many conventional cosmetics that you find in a drugstore or department store can’t cover vitiligo on dark skin very well. There are some companies that specialize in covering vitiligo, but I would advise people to do a color match personally. This may not be exactly what you need if you guessed it and order online.