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.
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 The Society for Pediatric Dermatology explained.
In his first-ever interview 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.
However, during all this time the only 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 depigmentation of the skin rather than repigmentation.
“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.