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4 Clinicians Explain Issues in Vitiligo and Skin of Color

Experts explain the societal, systemic, and clinical challenges that come with managing skin disease in people of color.

In alignment with Black History Month, HCPLive highlighted issues, research, and expert perspectives in skin of color all throughout today, February 11, on its site.

Though the month-long commemoration to observing Black history and culture serves as an opportune time to reflect on the still greatly unmet needs of health inequity in the US, matters of dermatological disease in people color are often lifelong—and the role of dermatologists is to address it every month of every year.

Below is a collection of expert perspectives shared with HCPLive in the last 2 years on matters of skin of color, and specific conditions including vitiligo. From societal burdens to clinical needs, clinicians and researchers in dermatology work continuously to address challenges that particularly impact their patients of color.

Lifelong Impacts

Seemal Desai, MD, a board-certified dermatologist and board member with the American Academy of Dermatology (AAD), joined the inaugural episode of Derm Discussions in October 2020 to discuss his personal interest in and greater perspective on the state of skins of color and vitiligo:

“Treating patients of color and understanding disease in skin of color is part of what we do every day as board-certified dermatologists. So there really doesn’t need to be a whole separated, carved-out discussion. The reason we’re having these discussions is because this is an unmet need, and we need to continue to delve into this more. But…we are the true and only experts in hair, skin and nail.

Vitiligo is an extremely devastating and difficult condition to treat. It’s difficult because we still don’t know the exact etiologic cause. We’re making a lot of progress in the science and the molecular mechanisms of vitiligo, but we don’t have a cure and we have zero FDA-approved treatments.

Vitiligo is the reason I became a dermatologist specializing in pigmentation and skin of color, because of my own younger brother’s experience dealing with vitiligo. (It was) viewed as a social death sentence, if you will—ostracizing from many socioeconomic factors, culturally stigmatizing in many parts of the world, including my native India. There’s still such a lack of understanding that this is not a contagious skin disease, but it’s a medical skin condition.”

Breaking Down Stigmas Early

Arianna Yanes, MD, a PGY-3 Dermatology Resident, University of Pennsylvania and member of the Society for Pediatric Dermatology (SPD), joined DocTalk last November to highlight a new series of SPD-produced information handouts for school nurses and teachers providing background on pediatric conditions including vitiligo.

Yanes discuss the particularities in what children with skin disease may face among their peers and in their earliest introductions to society:

“Skin disease is unique in that others can see it and others can make assumptions and judgments and treat people differently as a result. So, for that reason, I think that it's very critical for the teachers and the peers to have an understanding of how to help these students and how to be kind to these students.

I think the overall goal is to be comfortable talking about these things, and to help break down some of the stigmas because the more we learn about it and the more we understand, the less we fear and the fewer assumptions we make.”

Introducing Skin of Color to Physicians

Raj Chovatiya, MD, PhD, Assistant Professor in the Department of Dermatology at Northwestern University Feinberg School of Medicine, discussed inherent issues in medical education around skin disease—specifically, being exposed to differing patients—in an end-of-year HCPLive feature article:

“Some of the differences that we see in (dermatological care) can be explained by genes, proteins, cells, pigment, and the immune system. But a lot of the differences that drive many of the social constructs underlying the concepts of race, ethnicity, education, housing, access to health care, income geography, a lot of this really underlies many of the differences that we see across dermatology and skin of color.

You've seen a lot of studies start to come out that are suggesting that with a lot of our educational materials, we're not really looking at photographs of dermatologic presentations across diverse skin types, we really don't have that much data on treatment outcomes across diverse skin types, (and) understanding of if there are differences in longitudinal course disease across different skin types as well.”

The Promise of Therapy Development

Finally, John E. Harris, MD, PhD, Professor and Chair, Department of Dermatology, Founding Director, Vitiligo Clinic and Research Center, discussed the exciting future of vitiligo—a field laden with historic setbacks and continued challenges in universal definition among dermatologists—in a September 2021 episode of Derm Discussions:

“The next 20-30 years is going to be a whole of fun in treating vitiligo patients. But, until that happens, we’re using the same treatments they were using in the Iron Age, 3400 years ago—we haven’t changed our treatment. We’re going to get there. Access to phototherapy is not simple. You have to have a dermatologist’s office nearby that offers it. Even if you have that, you have to find a way to get away from work or school and get it into your schedule. It requires 2-3 visits per week. That’s not easy…and home phototherapy is mostly an out-of-pocket cost, so patients who don’t have the means can’t participate.

The hope is that with new FDA-approved therapies, we’ll have much better options for patients that can be prescribed from anywhere. If we have a biologic therapy that only has to be administered a couple times a year, that would be fantastic so we don’t have worry about access becoming an issue. We just need to make sure insurance companies agree to pay for them and support these patients. A lot of times people try to get away with calling vitiligo and alopecia areata cosmetic diseases—even some of my colleagues in dermatology have said that. Remember that cosmetics are things that happen to everyone. Vitiligo is an autoimmune disease, and so is alopecia areata, that affects 1% of the population and causes psychological damage that’s equal or greater than diseases treat all the time. So they deserve treatment, and they deserve have treatments covered like everyone else.”