There has been notable interest in using a combination of sodium-glucose co-transporter 2 inhibitor (SGLT2i) and glucagon-like peptide-1 receptor agonist (GLP-1 RA) to reduce the risk of cardiovascular and kidney outcomes in individuals with 

, Jennifer Green, MD, Duke University School of Medicine, provided insight into her presentation on the summary of data on each drug class given to patients with T2D. 

Green noted that the combination of SGLT2 and GLP-1 RA leads to greater lowering in glucose and potentially weight loss compared to each, which she considers a good starting place.

However, she noted there is dedicated analyses and cardiovascular outcome trials where investigators look at GLP-1 RA in combination with or without SGLT2i benefited equally from the GLP-1 RA. 

"The data that we have so far suggests that if you're already on an SGLT2i which should provide its own risk reduction, and you were further treated with a GLP-1 RA, that you benefit just as much as someone who's not on an SGLT2i, so it requires a, shall we say, a leap of faith, or you need to understand that they're already on a beneficial drug," Green said. "And then if you add the next, it does appear to provide a further benefit."

Due to available, powerful agents to lower CV risk and T2D, Green noted that randomized trials may have a difficult time determining a difference in outcomes with confidence. 

"At the present time, there there are trials like that under discussion and and attempts to perform those trials embedded into usual clinical care," Green said. "But I'm not sure that they've gotten terribly far yet, we certainly don't have any results." 

Moreover, Green pointed out that although combination therapy is worthwhile to think about, clinicians need to prioritize high risk patients with one medicine class to reduce CV risk. 

"We need to make sure that the highest risk patients are being are being treated appropriately and that's really the most effective way to alter population health," Green said. "So let's start there and then we can think about combination therapy after that." 

Videos

Dr. Green discusses the potential of combination therapy to reduce cardiovascular and kidney outcomes in people with type 2 diabetes.

Jennifer Green, MD: Outcomes, Impact of SGLT2i, GLP-1 RA Combination Therapy 

A recent presentation focused on the clinical cornerstones of treatment of cardiovascular disease (CVD) risk factors and diabetes and the long-term outcomes stemming from cardiometabolic disease.

The presentation was given at the 6th Annual Heart in Diabetes Meeting in Philadelphia, Pennsylvania. 

In an interview with HCPLive, the presenter, Joshua J. Joseph, MD, The Ohio State University Wexner Medical Center, focused on an American Heart Association scientific statement on the comprehensive risk management of these diseases.

"The number one priority that really sits in the center of everything else that we do in diabetes, management of cardiovascular risk factors, is lifestyle management," Joseph said. 

He described studies within the lifestyle management space and provided guidance on providers on how to improve lifestyle behaviors. Joseph went on to discuss medications known to reduce the risk of CVD and differences and similarities across trials. 

He additionally described the importance of equity and the importance of team-based care as an innovation in CVD management in diabetes. 

"Importantly, thinking that we need to all work on this together," Joseph said. We really need team based care to do that, whether that is cardiologists working with endocrinologists nephrologists, hepatologists, or whether that is health care systems working with communities to address social determinants of health, and social needs, like food insecurity, and housing insecurity, two factors that are critical in diabetes treatment and care."

Moreover, Joseph discussed pharmacological options in obesity management as a risk factor for diabetes patients.

"We really need to greatly increase the amount of individuals who are utilizing therapies that can improve not only their diabetes, but also hypertension, and cholesterol and all these other cardiovascular risk factors, and improve overall life expectancy," he said. 

Joseph concluded by discussing policy and the environmental level factors which may improve an individual's ability to live in a healthy envirionment, have access to medications, and receive a living wage, ultimately reducing rates. 

"I think the opportunity to do to do that is to engage with people where they are performing education and community engagement in order to address this really important issue," Joseph said. 

Dr. Joseph discusses modalities to address cardiometabolic disease in individuals around the country, from lifestyle management to policy-level changes. 

Joshua J. Joseph, MD: Managing CV Risk Factors in Patients with Type 2 Diabetes

Antirituximab antibodies (ARAs) were detected in the serum of patients who were treated with rituximab (RTX) for moderate to severe pemphigus, according to data from new cohort study.

Despite the frequency in which the ARAs were detected, investigators noted that they were not associated with any noticeable patient outcomes. However, a select number of patients who were affected by a combination of ARAs, low RTX concentration, incomplete B-cell depletion, and persistent serum anti-DSG3 appeared to be at high risk of relapse.

Though RTX had been approved as the first-line treatment for moderate to severe pemphigus vulgaris, instances of ARAs have been rarely studied in patients who do not achieve complete remission (CR) during treatment.

As such, an investigative team led by Alexandre Lemieux, MD, of Normandie University in Rouen, France, evaluated the prevalence of ARAs in patients with pemphigus who were treated with RTX and he association between achievement of sustained CR and occurrence of relapse.

The team enrolled patients from the Ritux3 trial, which collected serum samples at months 12, 18, and 36. Those who were enrolled in the study were treated in accordance to the regimen established in the trial, which included 1000 mg of intravenous RTX on the first and fifteenth day followed by 2 maintenance infusions of 500 mg at months 12 and 18.

These infusions were combined with a short course of prednisone which was tapered over 3-6 months, and the team followed patients for up to 36 months.

A total of 42 patients from the RTX arm of the Ritux3 trial were included in the present study, which also featured 5 additional patients from an ancillary study to broaden the groups of patients who had relapsed. The mean age of patients included in the study was 55 years and 56 years for patients with and without ARAs, respectively, and 59.5% of all patients were women.

During the first year of the study, investigators detected ARAs in 13 (31%) patients, and 9 patients who experienced relapse before month 12 were excluded due to additional infusions.

Of the 33 patients who remained in the study, 2 (6.1%) experienced relapse prior to month 12, and 31 (95.9%) maintained a sustained CR until 36 months. No differences were observed in the rate of CR between patients who had ARAs (85%) and those who did not (P=.15), and both groups were reported to have similar CD19+ B-cell depletion and RTX levels, though patients with ARAs had higher DSG3 Ab levels compared with those without (P=.03).

“Few patients with the combination of ARAs, an undetectable RTX serum level, an incomplete B-cell depletion, and a persistence of high levels of anti-DSG3 Abs seem at high risk of relapse,” the authors wrote.”However, because the number of patients included was relatively small, prospective studies encompassing more patients are needed to properly address this question.”

"Evaluation of Clinical Relevance and Biological Effects of Antirituximab Antibodies in Patients With Pemphigus,"

Articles

Despite the frequency in which the ARAs were detected, investigators noted that they were not associated with any noticeable patient outcomes.

Antirituximab Antibodies Detected in Patients with Pemphigus 

A systematic review into the validity of several patient-reported outcome measures (PROM) concluded with the recommendation of 2 specific tools- Acne-Q and CompAQ- for patients affected by acne vulgaris.

For years, PROMs have been utilized by dermatologists to assess health-related quality of life (HRQoL) of affected patients and bolster clinical assessments.The dermatology field is replete with different PROMs, yet little is known regarding the content validity and various other measurement properties of many of them.

“As the breadth of available acne-specific, dermatology-specific, and generic HRQoL PROMs continues to grow, heterogeneity in outcome reporting in clinical research may result,” wrote study author Zachary H. Hopkins, of Broward Health Dermatology, Fort Lauderdale. “This heterogeneity can stifle efforts to synthesize research across studies by limiting the ability to conduct systematic reviews and meta-analyses.”

For this systematic review, and investigative team led by Hopkins set out to determine which HRQoL PROMs were most appropriate for acne research and clinical practice.

The team examined any full-text articles that had investigated development, pilot studies, or evaluation of 1 or more measurement properties related to PROM assessing HRQoL in patients with acne.Studies that only featured the PROM as an outcome measurement or where PROMs were included to validate a new or other PROM were excluded.

Based on the investigators’ interpretations, general HRQoL instruments were defined as those that were developed for use in patients with various medical conditions, while dermatology-specific HRQoL instruments were developed specifically for patients with dermatologic conditions. Acne-specific instruments were defined as those developed for use only among patients with acne and measuring acne-mediated HRQoL status.

In total, 21 patient-reported outcome measures were featured in the review.

Among these instruments, only 2- the Acne-Q and the CompAQ- featured sufficient evidence for content validity and internal structure, and received an “A” recommendation by Hopkins and colleagues.

The Acne-Q featured 63 items, all of which were divided into different scales for facial acne (15), chest and back acne (10 items), facial skin (12 items), appearance-related distress (10 items), symptoms (6 items), and scars (10 items).

Meanwhile, the CompAQ featured 5 domains and a total of 20 items, including psychological/emotional (4 items), social-judgement (4 items), social-interactions (4 items), treatment concerns (4 items), and symptoms (4 items).

A short form version of the CompAQ was also available for use in busier clinical settings, though the content and measurement properties were not assessed in the review.

Notably, no short-form HRQoL instruments for acne met the criteria established by the investigators, who deemed this “an important shortcoming”. However, the team believed that the available short forms for the CompAQ could possibly improve feasibility of use in a clinical practice environment.

“Further research is needed to better define content validity, other measurement properties such as responsiveness, and interpretability of PROMs used to assess HRQoL in patients with acne,” the team wrote.

"Patient-Reported Outcome Measures for Health-Related Quality of Life in Patients With Acne Vulgaris,"

The Acne-Q and the CompAQ instruments received an “A” recommendation by investigators, though evidence on content validity and other measurement properties were lacking.

Investigators Recommend 2 PROMs for Use in Acne Vulgaris

This morning the Supreme Court's anticipated decision to overturn Roe v. Wade became official, inhibiting access to 

 in some states, or entirely banning care in others. In May, a draft of this decision became public which reignited an ongoing debate surrounding abortion care. 

In hopes of emphasizing the voices of experts and medical professionals who can speak to the necessity of abortion care from their education, training, and experience, 

 interviewed Michael M. Aziz, MD, MPH, to explain the implications of denying abortion care to those who seek it. 

Aziz is a maternal-fetal medicine (MFM) specialist and a member of the State Liaison Network for the Society for 

Abortion from a Purely Scientific Perspective

"Of all the developed nations in the world, the United States has the 

," Aziz said. "That's only gone up with the current COVID-19 pandemic."

 is about 35 per 100,000 births, he explained, depending on the patient's ethnic and racial background, with the rate increasing. 

"The day that you have a baby is the most dangerous day of your life," Aziz explained.

Many patients that Aziz treats have life-limiting illnesses that complicate and endager patients who become pregnant. Additionally, these patients may not have good access to birth control or aren't good candidates for birth control based on their health problems. 

"Even without chronic health issues, pregnancy is inherently more dangerous than not being pregnant," he said. 

Abortion is much safer than having a term delivery and actually reduces the patient's chance of death by nearly 100 fold–from a purely scientific perspective, which Aziz said, is the perspective all physicians should hold when they approach difficult situations. 

"The risk of death from an abortion is the same as your risk of death from tooth extraction," he said, "and it's a shame that abortion has become so highly politicized, that the facts aren't just left to speak for themselves." 

According to Aziz, it's important to always keep that in mind because an abortion could be considered medically indicated as it reduces a patient's risk of death.

Restricting Access to Care Doesn't Stop Abortions

The "overwhelming majority" of patients that Aziz sees never imagined themselves in a situation where they would choose to have an abortion. Aside from the politicization of abortion care, the decision is already difficult even if it's the healthiest option for the patient, and each patient has to reconcile that decision in their own way, he explained. 

"Because of the politicization of the issue," Aziz said, "it's become so charged that even though the patient knows the right decision, they then are forced to be in a strange situation where they're hoping to have a miscarriage, or hoping that no one finds out, or hoping that that they'll just deliver and then that decision will be taken out of their hands for them and they won't have to make this terrible, painful decision to have an abortion."

Unfortunately, before Roe V. Wade came into affect and abortion was illegal, 20% of all maternal deaths were a result of illegal and unsanitary abortions, according to Aziz. 

"There are people who will get pregnant, who will not want to take the risks of having a baby–whether those are emotional risks, whether there are financial risks, whether they are health risks of having a baby–and they will choose not to have a baby," Aziz said.

"Does a person who doesn't want to have a baby deserve to die or not?" he ashed. "I think it really boils down to that question. And even if you, as the physician, are not willing to perform the abortion for them, that's perfectly fine. You can refer them to someone who will. And that's your obligation."

"My name is Michael Aziz. I'm a maternal-fetal medicine physician. I'm a member of the State Liaison network for the Society for maternal fetal medicine. My opinions are my own."

Abortion is much safer than having a term delivery and actually reduces the patient's chance of death–from a purely scientific perspective, which Aziz said, is the perspective all physicians should hold when they approach difficult situations. 

Michael Aziz, MD: Abortion Reduces Risk of Death

Noah Rindos, MD, practices minimally invasive gynecology at 

®, he explained that the majority of women will develop fibroids in their lifetime but that many cases are asymptomatic. 

For those that do get diagnosed with a fibroid, it's most likely because they have experienced symptoms like heavy menstrual bleeding and pain. There are different treatment options and Rindos said he approaches fibroid treatment similarly to anything else.

"We always have the option of expectant management, right?" he said. "So, sitting down and having a conversation about what your symptoms are, how much they're impacting your life, what your goals are around the subject, and, you know, are you overall living a pretty high quality life?"

Oftentimes, if a patient has made it into his office it's because their symptoms have been impacting their quality of life and they want to be proactive, Rindos said. Before considering a laproscopic procedure, or a myomectomy, to remove the fibroid there are other options, such as birth control pills or an intrauterine device (IUD), that can mitigate painful symptoms and bleeding.

"For some women, we can have some improvement with the use of an IUD," Rindos explained, "or for other women, they'll choose to have a more interventional option such as uterine fibroid embolization, where an interventional radiologist can actually do a very minimally invasive procedure where small access is gained through either the arm or the leg using one of the big blood vessels."

In uterine fibroid embolization (UFE), or uterine artery embolization (UAE), small beads are sent through the artery to inhibit bloody supply to the fibroid causing it to shrink. It's a great service, according to Rindos, and it's offered at AHN.

Dr. Rindos discusses the intricacies of diagnosing and treating uterine fibroids, which develop in the majority of women. 

Noah Rindos, MD: Management of Uterine Fibroids

New data shows a drop in the prevalence of 

 (HBV) infections and deaths among the youngest populations.

A team of investigators called the GBD 2019 Hepatitis B Collaborators estimated the global, regional, and national prevalence of HBV along with the mortality and disability-adjusted life-years (DALYs) because of HBV.

In recent years the World Health Organization (WHO) put forth goals to eliminate hepatitis B targets as part of the Global Health Sector Strategy on Viral Hepatitis (WHO-GHSS) and Interim Guidance for Country Validation of Viral Hepatitis Elimination (WHO Interim Guidance).

The new study was part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, which includes an estimated 194 WHO member states.

In the study, the investigators used population-based serosurveys, claims and hospital discharges, cancer registries, vital registration systems, and published case series. The investigators estimated chronic HBV infection and the burden of HBV-related disease, which was defined as an aggregate of cirrhosis because of hepatitis B, liver cancer because of hepatitis B, and acute hepatitis B.

To estimate the prevalence of chronic HBV infections, cirrhosis, and etiological proportions of cirrhosis, the investigators used a Bayesian mixed-effects meta-regression tool and used mortality-to-incidence ratios modelled with spatiotemporal Gaussian process regression to estimate the incidence of liver cancer.

Finally, they used the Cause of Death Ensemble modelling (CODEm) to estimate mortality because of cirrhosis, liver cancer, and acute hepatitis B.

In 2019, the last year of the study, the investigators estimated the global, all-age prevalence of chronic HBV infections was 4.1% (95% UI, 3.7-4.5). This equates to 316 million (284-351 million) infected individuals.

They also found a 31.3% (29-33.9%) decline in the all-age prevalence between 1990-2019. There was a more marked decline of 76.8% (76.2-77.5%) in the prevalence of children younger than 5 years.

In total, there were 555,000 (487,000-630,000) global deaths due to HBV-related diseases in 2019, while the number of HBV-related deaths increased between 1990-2019 by 5.9% (-5.6 to 19.2%).

Between 2015-2019 the number of HBV-related deaths increased by 2.9% (-5.9 to 11.3%). However, all-age and age-standardized death rates because of HBV-related diseases decreased during these periods.

The investigators also compared estimates for 2019 in the 194 WHO locations to the WHO-GHSS 2020 targets and found 4 countries achieved a 10% reduction in deaths, 15 countries saw a 30% decrease in new cases, and 147 countries had a 1% prevalence in cases for children younger than 5 years.

Looking at the even longer term goals, 68 countries have already achieved the 2030 target proposed in WHO Interim Guidance of an all-age HBV-related death rate of 4 per 100,000 as of 2019.

“The prevalence of chronic HBV infection declined over time, particularly in children younger than 5 years, since the introduction of hepatitis B vaccination,” the authors wrote. “HBV-related death rates also decreased, but HBV-related death counts increased as a result of population growth, ageing, and cohort effects.”

Global, regional, and national burden of hepatitis B, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Between 2015-2019 the number of HBV-related deaths increased by 2.9%.

Chronic Hepatitis B Infections Decreasing in Recent Years

Camouflage plus psychotherapy may be a significantly beneficial and comprehensively modulating treatment for patients undergoing 

In new research from investigators in China, the practice of pigmentation camouflage—a common cosmetic strategy for patients with vitiligo in regions including China—in combination with psychotherapy provided perceptible improvements to the network psychiatric, neurological, endocrine, immunologic and dermatologic outcomes associated with managing the chronic skin pigmentation condition.

Led by Yuqian Chang, of the department of dermatology in Xijing Hospital in Xi’an, investigators sought to investigate the joint efficacy and multi-system interactions of camouflage plus psychotherapy in patients with vitiligo. The team cited a recently innovative trial demonstrating association between stress and the release of norepinephrine from sympathetic nerves—which then leads to melanocyte stems cells to convert to pigment production and eventually induce the graying of hair.”

“These findings prompt us to investigate the importance of maintaining a positive psychological state in the selection of management modalities,” they wrote. “Camouflage treatment has always been considered a dispensable cosmetic option for many patients in China based on our clinical observations because of lack of corresponding psychological construct and clear mechanism statement when patients are recommended to apply masking agents.”

Chang and colleagues conducted a prospective, non-randomized, concurrent trial involving 238 patients with non-segmental vitiligo recruited from Xijing Hospital. Patients were 18-60 years old, with vilitiginous patches visible on their exposed skin.

Key exclusion criteria included certain topical inhibitor therapy or immunosuppressant treatment regimens, experience with camouflage products, psychiatric or mental health illnesses, concomitant autoimmune skin disorders, etc.

Patients were selected into either an intervention arm including conventional medical treatment plus camouflage and a trial outcome-specific psychotherapy program, or a control arm of lone conventional treatment. Investigators sought blood serum-based outcomes for neuropeptide and cytosine change via immunosorbent assay, and quality of life was evaluated via Vitiligo Life Quality Index - China (VLQI-C).

The final evaluation included 149 patients in the trial. The team observed significant total and subcategory quality-of-life score improvements among the intervention group versus control group after 4 weeks of treatment. Neuropeptide and melanin-concentrating hormone serum less significantly decreased, and adrenocorticotropic hormone (ACTH) increased in the intervention arm.

Patients in the treatment arm additionally reported improved mean serum levels for interferon-γ , CXC chemokine ligand 10, and interleukin-1β.

“In our previous study, we have demonstrated increased serum IL-1β levels in patients with vitiligo and correlated it with disease activity and severity, as well as a decrease after routine care,” investigators noted. “These findings will help us understand the potential psycho-neuro-endocrine-immuno-skin system mechanism in management of vitiligo.”

The team concluded that camouflage plus psychotherapy, when added on to standard care, improves both quality of life outcomes and complements systemic interactions associated with vitiligo management.

“Dermatologists should be aware of the importance of easing psychosocial burdens using cover products and psychological support during treatment of vitiligo,” they wrote.

The Efficacy and Psychoneuroimmunology Mechanism of Camouflage Combined With Psychotherapy in Vitiligo Treatment

New data suggest a combination of cosmetic and psychiatric care for patients with the chronic pigmentation condition may provide multi-systemic benefit.

Camouflage, Psychotherapy with Vitiligo Management Improves Patient Care

Among the myriad of complications related to the management of vitiligo, treatment adherence appears to be one the most prevalent. For years, patients have yearned for rapid and effective therapies, but even the most effective topicals and light therapies require months of commitment before any repigmentation of the skin can be observed.

In an interview with HCPLive, Brittany Craiglow, MD, of Yale School of Medicine, spoke of how dermatologists can set expectations with their patients regarding the effectiveness and timeliness of current therapies, and what the proposed approval of ruxolitinib cream could mean for patients with limited surface area vitiligo.

“This is a long game, and so a lot of patients will come in and you'll offer something, and they'll say, ‘oh, I already tried that,’ but actually, they only use it for a month, and a month is not long enough,” Craiglow said. “I think people tire up these things pretty quickly, which you understand -especially if you're not seeing results. But I think just really saying like, ‘okay, if you want to do this, we have to really commit to it, and we're going to reevaluate not in a month, but in three or four months’, and even then, we will not be all the way there.”

Typically, dermatologists can determine whether topic therapies will effective for patients based on pigmented hair on their body, as hair tends to be the last area of the skin in which the melanocytes will disappear. If a patient has pigmented hairs within a patch of vitiligo, they often have a better chance of repigmentation.

Craiglow has utilized phototherapy for patients with more severe cases of vitiligo, though she noted the time-intensive nature of this particular strategy. Not every patient is able to carve out the time in their schedule to get to and from the dermatologist to receive phototherapy, which is why she has advocated for home units for patients whose insurance will cover it.

When asked about the upcoming ruxolitinib approval, Craiglow noted that patients with limited surface area would benefit greatly from the topical, which would likely only require twice daily application.

Regardless of what therapeutic strategies are being utilized (often in conjunction with one another), Craiglow has been determined in offering patients the best, most appropriate care possible.

“Combining therapies, being creative, reinforcing that it's going to take time, those are all important,” Craiglow said. “It's really fun to help (patients with vitiligo), and they're very grateful, and I think we should not be shy when thinking about being more aggressive with treatment.”

Dr. Craiglow speaks on how dermatologists can set expectations with their patients regarding the effectiveness and timeliness of current vitiligo therapies,

Brittany Craiglow, MD: Managing Expectations for Vitiligo Therapies 

Treating vitiligo can be a challenging but rewarding experience for many dermatologists, as Karan Lal, DO, MS, FAAD, of the Schweiger Dermatology Group and member of 

 with HCPLive back in February, Lal mentioned that he had previously studied under John E. Harris, MD, PhD, of UMass Chan Medical School, a prominent figure in the dermatology field whose name is synonymous with vitiligo research.

Lal himself would go on to treat vitiligo patients from across the globe with a myriad of different treatments including off-label topicals, light therapy, and more.

approved treatment for vitiligo by the US Food and Drug Administration (FDA) has been monobenyzyl ether of hydroquinone (MBEH). Crucially, this drug is only used for the 

“That's the FDA approved indication for treatment of vitiligo, which is bizarre; who wants to go from-like me - to having brown skin and having a few white spots to looking like I'm white all over?” Lal questioned. “It's just not feasible, and it's not reasonable for all patients. For patients that are extremely fair, or extremely discouraged by treatment, it's a great option because it allows them to have one skin color. And I think that's beautiful. But most people do not want that.”

Lal is keenly aware of the demand for a more effective therapy for vitiligo, especially considering some of the trials his patients have faced.

In one instance, a patient of Lal’s who originated from Africa and struggled with progressive vitiligo had to seek asylum in another country due to the scorn and violence associated with their condition.

“It's very serious, and people don't know about these things; in India, there are populations and villages of people with vitiligo that are essentially called ‘untouchables’, because no one wants to interact with them, because they think that they have leprosy and they have a communicable disease. So it's very, very difficult to have these conversations. The medical therapy, believe it or not, is a very easy part to have a conversation about, but the social implications of the disease is very difficult.”

The anticipated approval of ruxolitinib cream by the FDA might signal a path forward for these patients, however. Lal noted that the data regarding this topical therapy were very strong, and he anticipated no less than 100 calls from patients and fellow dermatologists regarding prescription write ups if and when the approval is announced.

Despite being limited to specific body surface areas like the face or genital region and the Blackbox warning for ruxolitinib for atopic dermatitis, Lal still anticipates great success with the therapy in the coming months.

“I think that this is a true medical breakthrough, I'm very excited that this medication, ruxolitinib cream, is going to be approved for vitiligo, (and) it's going to be our first topical agent that is approved for treatment of vitiligo that actually helps with repigmenting the skin,” Lal said. “I think it's going to open up a great conversation, and it's going to give people options. People don't like being pigeon holed. People want options, and I think we're going to be we're going to be in this position where we're going to have a medication that is safe to use.”

To hear more about Dr. Lal’s experience with treating various forms of vitiligo, and the current treatment armamentarium against the condition, please watch the full video interview above.

Dr. Karan Lal speaks on treating vitiligo in patients from across the world, and how he expects a wave of prescription requests for ruxolitinib cream following the potential FDA approval.

Karan Lal, DO, MS, FAAD: Ruxolitinib Cream a "True Medical Breakthrough" for Vitiligo 

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