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Vitiligo is a chronic autoimmune condition resulting in depigmented lesions of skin that can appear on any part of the body. The condition, which has been diagnosed in approximately 1.5 million people in the United States1, occurs with similar frequency in all ethnic groups and can occur at any age, although initial symptoms often appear before the age of 302,3.
Given the visual nature of the disease, vitiligo is sometimes viewed as a cosmetic issue rather than as an autoimmune condition4. Because of this misconception, the severity and impact of vitiligo – both physical and emotional – can often be downplayed or overlooked. In addition, the limited treatment options currently available for vitiligo can lead people living with this condition to believe they have little to no choices4.
More than cosmetic: The role of the immune system in vitiligo
Research suggests vitiligo develops in genetically-susceptible individuals when environmental triggers – e.g., sun exposure, chemical exposure, physical skin trauma or psychological strain – induce stress responses in the skin5.This causes a localized autoimmune response in which melanocytes are targeted and destroyed by CD8+ T-cells5,6.
People living with vitiligo would benefit from additional options to consider with their health care team.
Vitiligo has a significant burden of disease
The social stigma around vitiligo, and the idea that it is a cosmetic issue rather than an autoimmune condition, can significantly impact people with vitiligo. Findings from the global Vitiligo And Life Impact Among INTernational Communities (VALIANT) study underscore the profound impact vitiligo has on people’s lives. This was an observational, cross-sectional evaluation of the burden of vitiligo from the perspective of patients aged 18 years and older with vitiligo and health care professionals who treat patients with vitiligo10.
Additionally, a patient-focused meeting held by the U.S. Food and Drug Administration (FDA) in March 2021 explored the health effects and daily impact of vitiligo as well as management goals4. Among the key findings was that vitiligo can lead to feelings of loss of identity, particularly among African Americans4. Some participants expressed that others are unable to see past their condition, making it hard to establish successful friendships or secure employment4.
As such, it is critical for health care providers to approach discussions about vitiligo with their patients as an autoimmune condition and to consider the full impact that vitiligo can have on a person’s daily life. By educating people with vitiligo about the science behind their condition and forming a doctor-patient relationship based on trust, an individualized management plan tailored to a patient’s specific needs and goals can be established.
Supporting patients and managing vitiligo
As a result of their disease, people with vitiligo may feel frustrated, misunderstood and unheard, and their health care teams may have a challenging time supporting their needs. It is essential that dermatologists and other health care providers who diagnose and manage vitiligo discuss the science behind the condition and the impact it may have with their patients. Approaches to engage in these conversations can include:
It is important that dermatologists take the time to understand how the condition impacts their patients’ quality of life and emotional well-being. Management of vitiligo is a process, and expectations need to be set based on each patients’ individualized management plan. We need to form open lines of communication with patients early on and provide easily understood information about the science behind the condition. We can thereby help people living with vitiligo see it as an autoimmune rather than cosmetic issue and support informed decisions about their health and the overall management of their disease.
For more information, visit vitiligodeeper.com.
Note: Dr. Batra has been compensated for her time.